BACKGROUND:The surgical step-up approach often requires multiple debridements and might not be suitable for infected pancreatic necrosis(IPN)patients with various abscesses or no safe route for percutaneous catheter d...BACKGROUND:The surgical step-up approach often requires multiple debridements and might not be suitable for infected pancreatic necrosis(IPN)patients with various abscesses or no safe route for percutaneous catheter drainage(PCD).This case-control study aimed to investigate the safety and effectiveness of one-step laparoscopic pancreatic necrosectomy(LPN)in treating IPN.METHODS:This case-control study included IPN patients undergoing one-step LPN or surgical step-up in our center from January 2015 to December 2020.The short-term and long-term complications after surgery,length of hospital stay,and postoperative ICU stays in both groups were analyzed.Univariate and multivariate logistic regression analyses were performed to explore the risk factors of major complications or death.RESULTS:A total of 53 IPN patients underwent one-step LPN and 37 IPN patients underwent surgical step-up approach in this study.There was no significant difference in the incidence of death,major complications,new-onset diabetes,or new-onset pancreatic exocrine insufficiency between the two groups.However,the length of hospital stay in the one-step LPN group was significantly shorter than that in the surgical step-up group.Univariate regression analysis showed that the surgical approach(one-step/step-up)was not the risk factor for major complications or death.Multivariate logistic regression analysis indicated that computed tomography(CT)severity index,American Society of Anesthesiologists(ASA)class IV,and white blood cell(WBC)were the significant risk factors for major complications or death.CONCLUSION:One-step LPN is as safe and effective as the surgical step-up approach for treating IPN patients,and reduces total hospital stay.展开更多
AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy wer...AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy were compared. Operative mortality, overall mortality, morbidity and overall length of stay were determined. METHODS After institutional ethics committee clearance and waiver of consent, records of patients of pancreatitis were reviewed. After excluding patients as per criteria, epidemiologic and clinical data of patients of NP was noted. Treatment protocol was reviewed. Data of patients in whom stepup approach was used was compared to those in whom it was not used. RESULTS A total of 41 interventions were required in 39% patients. About 60% interventions targeted the pancreatic necrosis while the rest were required to deal with the complications of the necrosis. Image guided percutaneous catheter drainage was done in 9 patients for infected necrosis all of whom required further necrosectomy and in 3 patients with sterile necrosis. Direct retroperitoneal or anterior necrosectomy was performed in 15 patients. The average time to first intervention was 19.6 d in the non step-up group(range 11-36) vs 18.22 d in the Step-up group(range 13-25). The average hospital stay in non step-up group was 33.3 d vs 38 d in step up group. The mortality in the step-up group was 0%(0/9) vs 13%(2/15) in the non step up group. Overall mortality was 10.3% while post-operative mortality was 8.3%. Average hospital stay was 22.25 d.CONCLUSION Early conservative management plays an important role in management of NP. In patients who require intervention, the approach used and the timing of intervention should be based upon the clinical condition and local expertise available. Delaying intervention and use of minimal invasive means when intervention is necessary is desirable. The step-up approach should be used whenever possible. Even when the classical retroperitoneal catheter drainage is not feasible, there should be an attempt to follow principles of step-up technique to buy time. The outcome of patients in the step-up group compared to the non stepup group is comparable in our series. Interventions for bowel diversion, bypass and hemorrhage control should be done at the appropriate times.展开更多
BACKGROUND Emphysematous hepatitis(EH)is a rare,rapidly progressive fulminant gasforming infection of the liver parenchyma.It is often fatal and mostly affects diabetes patients.CASE SUMMARY We report a case of EH suc...BACKGROUND Emphysematous hepatitis(EH)is a rare,rapidly progressive fulminant gasforming infection of the liver parenchyma.It is often fatal and mostly affects diabetes patients.CASE SUMMARY We report a case of EH successfully managed by a step-up approach consisting of aggressive hemodynamic support,intravenous antibiotics,and percutaneous drainage,ultimately followed by laparoscopic deroofing.Of 11 documented cases worldwide,only 1 of the patients survived,treated by urgent laparotomy and surgical debridement.CONCLUSION EH is a life-threatening infection.Its high mortality rate makes timely diagnosis essential,in order to navigate treatment accordingly.展开更多
To the Editor:We sincerely applaud the work done by Gupta et al.,in which they analyzed a single-center experience regarding gallbladder per-foration(GBP)management[1].Currently,there is a lack of cohort studies to ad...To the Editor:We sincerely applaud the work done by Gupta et al.,in which they analyzed a single-center experience regarding gallbladder per-foration(GBP)management[1].Currently,there is a lack of cohort studies to adequately describe the approach strategies and man-agement for this pathology,with international guidelines making ambiguous recommendations[2,3].Their study stratified GBP types and provided details regarding clinical presentation,comorbidities,preoperative diagnosis,etiology,imaging techniques,and surgical approach.The study reported a high conversion rate when a la-paroscopic approach was attempted for cholecystectomy.展开更多
BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidec...BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches(TAA)are the two most commonly used remote approaches.No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.AIM To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.METHODS We searched PubMed MEDLINE,Google Scholar,and Cochrane Library from the date of the first published article up to August 2025.The term used were transoral thyroidectomy vestibular approach,trans areolar thyroidectomy,scarless thyroidectomy,remote thyroidectomy,infections,postoperative,inflammation,dysphagia,and swallowing difficulties.We identified 130 studies,of them,30 full texts were screened and only six studies were included in the final meta-analysis.RESULTS Postoperative infections were not different between the two approaches,odd ratio=1.33,95%confidence interval:0.50-3.53,theχ2 was 1.92 and the P-value for overall effect of 0.57.Similarly,transient swallowing difficulty was not different between the two forms of surgery,with odd ratio=0.91,95%confidence interval:0.35-2.40;theχ2 was 1.32,and the P-value for overall effect of 0.85.CONCLUSION No significant statistical differences were evident between trans-oral endoscopic Mirghani H.Infections and swallowing difficulty in scarless thyroidectomy WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties.Further longer randomized trials are needed.展开更多
The ideal treatment strategy for Crohn’s disease (CD) remains uncertain, as does the optimal endpoint of therapy. Top-down versus step-up describes two different approaches: early use of immunomodulators and biologic...The ideal treatment strategy for Crohn’s disease (CD) remains uncertain, as does the optimal endpoint of therapy. Top-down versus step-up describes two different approaches: early use of immunomodulators and biological agents in the former versus initial treatment with steroids in the latter, with escalation to immunomodulators or biological drugs in patients proven to be steroid refractory or steroid dependent. Top-down therapy has been associated with higher rates of mucosal healing. If mucosal healing proves to be associated with better long-term outcomes, such as a decreased need for hospitalization and surgery, top-down therapy may be the better approach for many patients. The main concern with the top-down approach is the toxicity of the immunomodulators and biological agents, which have been linked with infectious complications as well as an increased risk of lymphoma. It is unlikely that one strategy will be best for all patients given the underlying heterogeneity of CD presentation and severity. Ultimately, we must weigh the safety and efficacy of the therapies with the risks of the disease itself. Unfortunately our ability to risk stratify patients at diagnosis remains rudimentary. The purpose of this paper is to review the data that supports or refutes the differing treatment paradigms in CD, and to provide a rationale for an approach, termed the "accelerated step-up" approach, which attempts to balance the risks and benefits of our currently available therapies with the risk of disease related complications as we understand them in 2008.展开更多
BACKGROUND Although the“Step-up”strategy is the primary surgical treatment for infected pancreatic necrosis,it is not suitable for all such patients.The“One-step”strategy represents a novel treatment,but the safet...BACKGROUND Although the“Step-up”strategy is the primary surgical treatment for infected pancreatic necrosis,it is not suitable for all such patients.The“One-step”strategy represents a novel treatment,but the safety,efficacy,and long-term follow-up have not yet been compared between these two approaches.AIM To compare the safety,efficacy,and long-term follow-up of two surgical approaches to provide a reference for infected pancreatic necrosis treatment.METHODS This was a retrospective analysis of infectious pancreatic necrosis patients who underwent“One-step”or“Step-up”necrosectomy at Xuan Wu Hospital,Capital Medical University,from May 2014 to December 2020.The primary outcome was the composite endpoint of severe complications or death.Patients were followed up every 6 mo after discharge until death or June 30,2021.Statistical analysis was performed using SPSS 21.0 and GraphPad Prism 8.0,and statistical significance was set at P<0.05.RESULTS One-hundred-and-fifty-eight patients were enrolled,of whom 61 patients underwent“One-step”necrosectomy and 97 patients underwent“Step-up”necrosectomy.During the long-term follow-up period,40 patients in the“Onestep”group and 63 patients in the“Step-up”group survived.The time from disease onset to hospital admission(53.69±38.14 vs 32.20±20.75,P<0.001)and to initial surgical treatment was longer in the“Step-up”than in the“One-step”group(54.38±10.46 vs 76.58±17.03,P<0.001).Patients who underwent“Step up”necrosectomy had a longer hospitalization duration(65.41±28.14 vs 52.76±24.71,P=0.02),and more interventions(4.26±1.71 vs 3.18±1.39,P<0.001).Postoperative inflammatory indicator levels were significantly lower than preoperative levels in each group.Although the incisional hernia incidence was higher in the“One-step”group,no significant difference was found in the composite outcomes of severe complications or death,new-onset organ failure,postoperative complications,inflammatory indicators,long-term complications,quality of life,and medical costs between the groups(P>0.05).CONCLUSION Compared with the“Step-up”approach,the“One-step”approach is a safe and effective treatment method with better long-term quality of life and prognosis.It also provides an alternative surgical treatment strategy for patients with infected pancreatic necrosis.展开更多
Cardiovascular diseases(CVDs)remain the leading cause of morbidity and mortality worldwide,necessitating innovative diagnostic and prognostic strategies.Traditional biomarkers like C-reactive protein,uric acid,troponi...Cardiovascular diseases(CVDs)remain the leading cause of morbidity and mortality worldwide,necessitating innovative diagnostic and prognostic strategies.Traditional biomarkers like C-reactive protein,uric acid,troponin,and natriuretic peptides play crucial roles in CVD management,yet they are often limited by sensitivity and specificity constraints.This narrative review critically examines the emerging landscape of cardiac biomarkers and advocates for a multiple-marker approach to enhance early detection,prognosis,and risk stratification of CVD.In recent years,several novel biomarkers have shown promise in revolutionizing CVD diagnostics.Gamma-glutamyltransferase,microRNAs,endothelial microparticles,placental growth factor,trimethylamine N-oxide,retinol-binding protein 4,copeptin,heart-type fatty acid-binding protein,galectin-3,growth differentiation factor-15,soluble suppression of tumorigenicity 2,fibroblast growth factor 23,and adrenomedullin have emerged as significant indicators of CV health.These biomarkers provide insights into various pathophysiological processes,such as oxidative stress,endothelial dysfunction,inflammation,metabolic disturbances,and myocardial injury.The integration of these novel biomarkers with traditional ones offers a more comprehensive understanding of CVD mechanisms.This multiple-marker approach can improve diagnostic accuracy,allowing for better risk stratification and more personalized treatment strategies.This review underscores the need for continued research to validate the clinical utility of these biomarkers and their potential incorporation into routine clinical practice.By leveraging the strengths of both traditional and novel biomarkers,precise therapeutic plans can be developed,thereby improving the management and prognosis of patients with CVDs.The ongoing exploration and validation of these biomarkers are crucial for advancing CV care and addressing the limitations of current diagnostic tools.展开更多
The progressive loss of dopaminergic neurons in affected patient brains is one of the pathological features of Parkinson's disease,the second most common human neurodegenerative disease.Although the detailed patho...The progressive loss of dopaminergic neurons in affected patient brains is one of the pathological features of Parkinson's disease,the second most common human neurodegenerative disease.Although the detailed pathogenesis accounting for dopaminergic neuron degeneration in Parkinson's disease is still unclear,the advancement of stem cell approaches has shown promise for Parkinson's disease research and therapy.The induced pluripotent stem cells have been commonly used to generate dopaminergic neurons,which has provided valuable insights to improve our understanding of Parkinson's disease pathogenesis and contributed to anti-Parkinson's disease therapies.The current review discusses the practical approaches and potential applications of induced pluripotent stem cell techniques for generating and differentiating dopaminergic neurons from induced pluripotent stem cells.The benefits of induced pluripotent stem cell-based research are highlighted.Various dopaminergic neuron differentiation protocols from induced pluripotent stem cells are compared.The emerging three-dimension-based brain organoid models compared with conventional two-dimensional cell culture are evaluated.Finally,limitations,challenges,and future directions of induced pluripotent stem cell–based approaches are analyzed and proposed,which will be significant to the future application of induced pluripotent stem cell-related techniques for Parkinson's disease.展开更多
Deep learning algorithms have been rapidly incorporated into many different applications due to the increase in computational power and the availability of massive amounts of data.Recently,both deep learning and ensem...Deep learning algorithms have been rapidly incorporated into many different applications due to the increase in computational power and the availability of massive amounts of data.Recently,both deep learning and ensemble learning have been used to recognize underlying structures and patterns from high-level features to make predictions/decisions.With the growth in popularity of deep learning and ensemble learning algorithms,they have received significant attention from both scientists and the industrial community due to their superior ability to learn features from big data.Ensemble deep learning has exhibited significant performance in enhancing learning generalization through the use of multiple deep learning algorithms.Although ensemble deep learning has large quantities of training parameters,which results in time and space overheads,it performs much better than traditional ensemble learning.Ensemble deep learning has been successfully used in several areas,such as bioinformatics,finance,and health care.In this paper,we review and investigate recent ensemble deep learning algorithms and techniques in health care domains,medical imaging,health care data analytics,genomics,diagnosis,disease prevention,and drug discovery.We cover several widely used deep learning algorithms along with their architectures,including deep neural networks(DNNs),convolutional neural networks(CNNs),recurrent neural networks(RNNs),and generative adversarial networks(GANs).Common healthcare tasks,such as medical imaging,electronic health records,and genomics,are also demonstrated.Furthermore,in this review,the challenges inherent in reducing the burden on the healthcare system are discussed and explored.Finally,future directions and opportunities for enhancing healthcare model performance are discussed.展开更多
This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal disease...This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal diseases.The study sheds light on how illness perception,anxiety,and depression significantly influence recovery outcomes.Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery.The article explores the critical role of pre-operative psychological assessment,highlighting the need for mental health support and personalized recovery plans in enhancing POR quality.A multidisciplinary approach,integrating mental health professionals with surgeons,anesthesiologists,and other specialists,is emphasized to ensure comprehensive care for patients.The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.展开更多
As the core facility of offshore wind power systems,the structural safety of offshore booster stations directly impacts the stable operation of entire wind farms.With the global energy transition toward green and lowc...As the core facility of offshore wind power systems,the structural safety of offshore booster stations directly impacts the stable operation of entire wind farms.With the global energy transition toward green and lowcarbon goals,offshore wind power has emerged as a key renewable energy source,yet its booster stations face harsh marine environments,including persistent wave impacts,salt spray corrosion,and equipment-induced vibrations.Traditional monitoring methods relying on manual inspections and single-dimensional sensors suffer from critical limitations:low efficiency,poor real-time performance,and inability to capture millinewton-level stress fluctuations that signal early structural fatigue.To address these challenges,this study proposes a biomechanics-driven structural safety monitoring system integrated with deep learning.Inspired by biological stress-sensing mechanisms,the system deploys a distributedmulti-dimensional force sensor network to capture real-time stress distributions in key structural components.A hybrid convolutional neural network-radial basis function(CNN-RBF)model is developed:the CNN branch extracts spatiotemporal features from multi-source sensing data,while the RBF branch reconstructs the nonlinear stress field for accurate anomaly diagnosis.The three-tier architectural design—data layer(distributed sensor array),function layer(CNN-RBF modeling),and application layer(edge computing terminal)—enables a closedloop process from high-resolution data collection to real-time early warning,with data processing delay controlled within 200 ms.Experimental validation against traditional SOM-based systems demonstrates significant performance improvements:monitoring accuracy increased by 19.8%,efficiency by 23.4%,recall rate by 20.5%,and F1 score by 21.6%.Under extreme weather(e.g.,typhoons and winter storms),the system’s stability is 40% higher,with user satisfaction improving by 17.2%.The biomechanics-inspired sensor design enhances survival rates in salt fog(85.7%improvement)and dynamic loads,highlighting its robust engineering applicability for intelligent offshore wind farm maintenance.展开更多
This paper focuses on the research of the main transformer selection and layout scheme for new energy step-up substations.From the perspective of engineering design,it analyzes the principles of main transformer selec...This paper focuses on the research of the main transformer selection and layout scheme for new energy step-up substations.From the perspective of engineering design,it analyzes the principles of main transformer selection,key parameters,and their matching with the characteristics of new energy.It also explores the layout methods and optimization strategies.Combined with typical case studies,optimization suggestions are proposed for the design of main transformers in new energy step-up substations.The research shows that rational main transformer selection and scientific layout schemes can better adapt to the characteristics of new energy projects while effectively improving land use efficiency and economic viability.This study can provide technical experience support for the design of new energy projects.展开更多
Objective: To explore the effect of Health Action Process Approach (HAPA) theory in patients with type D personality psoriasis. Methods: A total of 66 patients with type D personality psoriasis admitted to the dermato...Objective: To explore the effect of Health Action Process Approach (HAPA) theory in patients with type D personality psoriasis. Methods: A total of 66 patients with type D personality psoriasis admitted to the dermatology department of a top-three hospital in Jingzhou City from November 2022 to July 2023 were selected and divided into control group and test group with 33 cases in each group by random number table method. The control group received routine health education, and the experimental group received health education based on the HAPA theory. Chronic disease self-efficacy scale, hospital anxiety and depression scale and skin disease quality of life scale were used to evaluate the effect of intervention. Results: After 3 months of intervention, the scores of self-efficacy in experimental group were higher than those in control group (P P Conclusion: Health education based on the theory of HAPA can enhance the self-efficacy of patients with type D personality psoriasis, relieve negative emotions and improve their quality of life.展开更多
BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of ...BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.展开更多
BACKGROUND Laparoscopic hepatectomy has been widely accepted for the treatment of liver tumors.Compared with open surgery,it provides a reduced hospital stay,less intraoperative blood loss,less trauma,and fewer incisi...BACKGROUND Laparoscopic hepatectomy has been widely accepted for the treatment of liver tumors.Compared with open surgery,it provides a reduced hospital stay,less intraoperative blood loss,less trauma,and fewer incisional infections,without affecting tumor outcomes.However,lesions in the right lobe of the liver are deep and obstructed by the ribs,making exposure difficult and increasing the degree of surgical difficulty;thus,liver tumors in the deep right lobe pose technical challenges in standard laparoscopic surgery.AIM To investigate the safety and efficacy of laparoscopic retroperitoneal partial hepatectomy for liver tumors.METHODS The clinical data of 72 patients who underwent laparoscopic retroperitoneal partial hepatectomy for liver tumors between January 2018 and December 2024 at the First People’s Hospital of Yunnan Province were analyzed.Of the 72 patients included,34 were male and 38 were female,with ages ranging from 34 years to 72 years(median age,45 years).The tumors were all located in the right lobe of the liver,with 30 cases in segment S6,27 cases in segment S7,and 15 cases in segment S8;the mean tumor diameter was 7.5±3.4 cm.The postoperative tumor indices,liver function,and postoperative complications were analyzed to evaluate the clinical efficacy of laparoscopic partial hepatectomy via the retroperitoneal approach.RESULTS The surgeries were successfully completed in all patients,and conversion to open surgery was required in 10 patients.The mean operative time,blood loss,drain retention time,and length of postoperative hospital stay were 140±30 minutes,150±46 mL,3.8±1.2 days,and 8.3±5.3 days,respectively.Liver function tests returned to normal in all patients within two weeks of surgery.Fifteen patients developed atelectasis and pleural effusion and were managed with incision and drainage and antibiotics.Two patients developed uncomplicated minimal ascites,and the remaining patients had no perioperative complications,such as abdominal hemorrhage,infection,liver failure,bile leakage,and other adverse events.All patients were successfully treated.CONCLUSION Laparoscopic retroperitoneal partial hepatectomy is a safe and effective approach for right hepatic space-occupying lesions,particularly in segments S6,S7,and S8,with fewer postoperative complications,less trauma,and faster recovery times.This procedure provides a new surgical access for resection of deep tumors in the right lobe of the liver and has clear clinical implications.展开更多
In response to the common problems in college English writing teaching,such as the separation of learning and application,students’low interest in writing,and difficulties in expression,this paper,based on the theore...In response to the common problems in college English writing teaching,such as the separation of learning and application,students’low interest in writing,and difficulties in expression,this paper,based on the theoretical framework of the production-oriented approach(POA)proposed by Professor Wen Qiufang,designed and implemented a set of IELTS writing teaching plan.This plan takes“motivating,enabling,and assessing”as the core teaching process,and selects typical IELTS argumentative essay topics(such as food diversity)to create real communication scenarios.In the motivating stage,diverse inputs are used to stimulate students’interest and expose their language weaknesses;in the enabling stage,language knowledge,viewpoint generation,and text structure are focused on for targeted input and training;in the assessing stage,a combination of teacher-student cooperation and peer evaluation is adopted to guide students to identify and correct deficiencies in language use.The research results show that the POA model can effectively enhance students’writing interest,active learning awareness,and writing ability,particularly in overcoming vocabulary poverty and material shortages,as well as improving language accuracy and expression richness.This provides an operational theoretical basis and practical path for improving the teaching effect of IELTS writing.展开更多
Background:Dorsal approach is the potentially effective strategy for minimally invasive liver resection.This study aimed to compare the outcomes between robot-assisted and laparoscopic hemihepatectomy through dorsal a...Background:Dorsal approach is the potentially effective strategy for minimally invasive liver resection.This study aimed to compare the outcomes between robot-assisted and laparoscopic hemihepatectomy through dorsal approach.Methods:We compared the patients who underwent robot-assisted hemihepatectomy(Rob-HH)and who had laparoscopic hemihepatectomy(Lap-HH)through dorsal approach between January 2020 and December 2022.A 1:1 propensity score-matching(PSM)analysis was performed to minimize bias and confounding factors.Results:Ninety-six patients were included,41 with Rob-HH and 55 with Lap-HH.Among them,58 underwent left hemihepatectomy(LHH)and 38 underwent right hemihepatectomy(RHH).Compared with LapHH group,patients with Rob-HH had less estimated blood loss(median:100.0 vs.300.0 m L,P=0.016),lower blood transfusion rates(4.9%vs.29.1%,P=0.003)and postoperative complication rates(26.8%vs.54.5%,P=0.016).These significant differences consistently existed after PSM and in the LHH subgroups.Furthermore,robot-assisted LHH was associated with decreased Pringle duration(45 vs.60 min,P=0.047).RHH subgroup analysis showed that compared with Lap-RHH,Rob-RHH was associated with less estimated blood loss(200.0 vs.400.0 m L,P=0.013).No significant differences were found in other perioperative outcomes among pre-and post-PSM cohorts,such as Pringle duration,operative time,and hospital stay.Conclusions:The dorsal approach was a safe and feasible strategy for hemi-hepatectomy with favorable outcomes under robot-assisted system in reducing intraoperative blood loss,transfusion,and postoperative complications.展开更多
Metabolomics utilizes advanced analytical profiling techniques to comprehensively measure small molecules in cells,tissues,and biological fluids.Nutritional metabolomics studies in pigs have reported changes in hundre...Metabolomics utilizes advanced analytical profiling techniques to comprehensively measure small molecules in cells,tissues,and biological fluids.Nutritional metabolomics studies in pigs have reported changes in hundreds of metabolites across various sample types,including plasma,serum,urine,digesta,and feces,following dietary interventions.These findings can help identify biomarkers of gastrointestinal functionality and beyond,as well as investigate mechanistic interactions between diet,host,microbiome,and metabolites.This review aims to summarize the current literature on nutritional metabolomics in pigs and its use to investigate how different dietary approaches impact the gut health of pigs.Here,we critically assessed and categorized the impact of the main macronutrients-carbohydrates,proteins,and fats—along with feed additives such as amino acids,bile acids,and probiotics,as well as feeding strategies like creep feeding,milk replacer introduction,and time-restricted feeding,on the pig metabolome.Additionally,we discuss the potential modes of action of the key affected metabolites on pig gut health.展开更多
Enhancing the mechanical properties is crucial for polyimide films,but the mechanical properties(Young's modulus,tensile strength,and elongation at break)mutually constrain each other,complicating simultaneous enh...Enhancing the mechanical properties is crucial for polyimide films,but the mechanical properties(Young's modulus,tensile strength,and elongation at break)mutually constrain each other,complicating simultaneous enhancement via traditional trial-and-error methods.In this work,we proposed a materials genome approach to design and screen phenylethynyl-terminated polyimides for films with enhanced mechani-cal properties.We first established machine learning models to predict Young's modulus,tensile strength,and elongation at break to explore the chemical space containing thousands of candidate structures.The accuracies of the machine learning models were verified by molecular dynamics simulations on screened polyimides and experimental testing on three representative polyimide films.The performance advantages of the best-selected polyimides were analyzed by comparing well-known polyimides based on molecular dynamics simulations,and the structural rationale was revealed by"gene"analysis and feature importance evaluation.This work provides a cost-effective strategy for designing polyimide films withenhancedmechanical properties.展开更多
基金This work was supported by the Clinical Research Physician Program of Tongji Medical College,Huazhong University of Science and Technology。
文摘BACKGROUND:The surgical step-up approach often requires multiple debridements and might not be suitable for infected pancreatic necrosis(IPN)patients with various abscesses or no safe route for percutaneous catheter drainage(PCD).This case-control study aimed to investigate the safety and effectiveness of one-step laparoscopic pancreatic necrosectomy(LPN)in treating IPN.METHODS:This case-control study included IPN patients undergoing one-step LPN or surgical step-up in our center from January 2015 to December 2020.The short-term and long-term complications after surgery,length of hospital stay,and postoperative ICU stays in both groups were analyzed.Univariate and multivariate logistic regression analyses were performed to explore the risk factors of major complications or death.RESULTS:A total of 53 IPN patients underwent one-step LPN and 37 IPN patients underwent surgical step-up approach in this study.There was no significant difference in the incidence of death,major complications,new-onset diabetes,or new-onset pancreatic exocrine insufficiency between the two groups.However,the length of hospital stay in the one-step LPN group was significantly shorter than that in the surgical step-up group.Univariate regression analysis showed that the surgical approach(one-step/step-up)was not the risk factor for major complications or death.Multivariate logistic regression analysis indicated that computed tomography(CT)severity index,American Society of Anesthesiologists(ASA)class IV,and white blood cell(WBC)were the significant risk factors for major complications or death.CONCLUSION:One-step LPN is as safe and effective as the surgical step-up approach for treating IPN patients,and reduces total hospital stay.
文摘AIM To determine percentage of patients of necrotizing pancreatitis(NP) requiring intervention and the types of interventions performed. Outcomes of patients of step up necrosectomy to those of direct necrosectomy were compared. Operative mortality, overall mortality, morbidity and overall length of stay were determined. METHODS After institutional ethics committee clearance and waiver of consent, records of patients of pancreatitis were reviewed. After excluding patients as per criteria, epidemiologic and clinical data of patients of NP was noted. Treatment protocol was reviewed. Data of patients in whom stepup approach was used was compared to those in whom it was not used. RESULTS A total of 41 interventions were required in 39% patients. About 60% interventions targeted the pancreatic necrosis while the rest were required to deal with the complications of the necrosis. Image guided percutaneous catheter drainage was done in 9 patients for infected necrosis all of whom required further necrosectomy and in 3 patients with sterile necrosis. Direct retroperitoneal or anterior necrosectomy was performed in 15 patients. The average time to first intervention was 19.6 d in the non step-up group(range 11-36) vs 18.22 d in the Step-up group(range 13-25). The average hospital stay in non step-up group was 33.3 d vs 38 d in step up group. The mortality in the step-up group was 0%(0/9) vs 13%(2/15) in the non step up group. Overall mortality was 10.3% while post-operative mortality was 8.3%. Average hospital stay was 22.25 d.CONCLUSION Early conservative management plays an important role in management of NP. In patients who require intervention, the approach used and the timing of intervention should be based upon the clinical condition and local expertise available. Delaying intervention and use of minimal invasive means when intervention is necessary is desirable. The step-up approach should be used whenever possible. Even when the classical retroperitoneal catheter drainage is not feasible, there should be an attempt to follow principles of step-up technique to buy time. The outcome of patients in the step-up group compared to the non stepup group is comparable in our series. Interventions for bowel diversion, bypass and hemorrhage control should be done at the appropriate times.
文摘BACKGROUND Emphysematous hepatitis(EH)is a rare,rapidly progressive fulminant gasforming infection of the liver parenchyma.It is often fatal and mostly affects diabetes patients.CASE SUMMARY We report a case of EH successfully managed by a step-up approach consisting of aggressive hemodynamic support,intravenous antibiotics,and percutaneous drainage,ultimately followed by laparoscopic deroofing.Of 11 documented cases worldwide,only 1 of the patients survived,treated by urgent laparotomy and surgical debridement.CONCLUSION EH is a life-threatening infection.Its high mortality rate makes timely diagnosis essential,in order to navigate treatment accordingly.
文摘To the Editor:We sincerely applaud the work done by Gupta et al.,in which they analyzed a single-center experience regarding gallbladder per-foration(GBP)management[1].Currently,there is a lack of cohort studies to adequately describe the approach strategies and man-agement for this pathology,with international guidelines making ambiguous recommendations[2,3].Their study stratified GBP types and provided details regarding clinical presentation,comorbidities,preoperative diagnosis,etiology,imaging techniques,and surgical approach.The study reported a high conversion rate when a la-paroscopic approach was attempted for cholecystectomy.
文摘BACKGROUND Due to the increasing rate of thyroid nodules diagnosis,and the desire to avoid the unsightly cervical scar,remote thyroidectomies were invented and are increasingly performed.Transoral endoscopic thyroidectomy vestibular approach and trans-areolar approaches(TAA)are the two most commonly used remote approaches.No previous meta-analysis has compared postoperative infections and swallowing difficulties among the two procedures.AIM To compared the same among patients undergoing lobectomy for unilateral thyroid carcinoma/benign thyroid nodule.METHODS We searched PubMed MEDLINE,Google Scholar,and Cochrane Library from the date of the first published article up to August 2025.The term used were transoral thyroidectomy vestibular approach,trans areolar thyroidectomy,scarless thyroidectomy,remote thyroidectomy,infections,postoperative,inflammation,dysphagia,and swallowing difficulties.We identified 130 studies,of them,30 full texts were screened and only six studies were included in the final meta-analysis.RESULTS Postoperative infections were not different between the two approaches,odd ratio=1.33,95%confidence interval:0.50-3.53,theχ2 was 1.92 and the P-value for overall effect of 0.57.Similarly,transient swallowing difficulty was not different between the two forms of surgery,with odd ratio=0.91,95%confidence interval:0.35-2.40;theχ2 was 1.32,and the P-value for overall effect of 0.85.CONCLUSION No significant statistical differences were evident between trans-oral endoscopic Mirghani H.Infections and swallowing difficulty in scarless thyroidectomy WJCC https://www.wjgnet.com 2 January 6,2026 Volume 14 Issue 1 thyroidectomy vestibular approach and trans-areolar approach regarding postoperative infection and transient swallowing difficulties.Further longer randomized trials are needed.
文摘The ideal treatment strategy for Crohn’s disease (CD) remains uncertain, as does the optimal endpoint of therapy. Top-down versus step-up describes two different approaches: early use of immunomodulators and biological agents in the former versus initial treatment with steroids in the latter, with escalation to immunomodulators or biological drugs in patients proven to be steroid refractory or steroid dependent. Top-down therapy has been associated with higher rates of mucosal healing. If mucosal healing proves to be associated with better long-term outcomes, such as a decreased need for hospitalization and surgery, top-down therapy may be the better approach for many patients. The main concern with the top-down approach is the toxicity of the immunomodulators and biological agents, which have been linked with infectious complications as well as an increased risk of lymphoma. It is unlikely that one strategy will be best for all patients given the underlying heterogeneity of CD presentation and severity. Ultimately, we must weigh the safety and efficacy of the therapies with the risks of the disease itself. Unfortunately our ability to risk stratify patients at diagnosis remains rudimentary. The purpose of this paper is to review the data that supports or refutes the differing treatment paradigms in CD, and to provide a rationale for an approach, termed the "accelerated step-up" approach, which attempts to balance the risks and benefits of our currently available therapies with the risk of disease related complications as we understand them in 2008.
基金Beijing Municipal Science and Technology Commission,Capital Research and Demonstration Application of Clinical Diagnosis and Treatment Technology,No.Z191100006619038 and No.Z171100001017077Capital Health Research and Development of Special,No.2020-1-2012.
文摘BACKGROUND Although the“Step-up”strategy is the primary surgical treatment for infected pancreatic necrosis,it is not suitable for all such patients.The“One-step”strategy represents a novel treatment,but the safety,efficacy,and long-term follow-up have not yet been compared between these two approaches.AIM To compare the safety,efficacy,and long-term follow-up of two surgical approaches to provide a reference for infected pancreatic necrosis treatment.METHODS This was a retrospective analysis of infectious pancreatic necrosis patients who underwent“One-step”or“Step-up”necrosectomy at Xuan Wu Hospital,Capital Medical University,from May 2014 to December 2020.The primary outcome was the composite endpoint of severe complications or death.Patients were followed up every 6 mo after discharge until death or June 30,2021.Statistical analysis was performed using SPSS 21.0 and GraphPad Prism 8.0,and statistical significance was set at P<0.05.RESULTS One-hundred-and-fifty-eight patients were enrolled,of whom 61 patients underwent“One-step”necrosectomy and 97 patients underwent“Step-up”necrosectomy.During the long-term follow-up period,40 patients in the“Onestep”group and 63 patients in the“Step-up”group survived.The time from disease onset to hospital admission(53.69±38.14 vs 32.20±20.75,P<0.001)and to initial surgical treatment was longer in the“Step-up”than in the“One-step”group(54.38±10.46 vs 76.58±17.03,P<0.001).Patients who underwent“Step up”necrosectomy had a longer hospitalization duration(65.41±28.14 vs 52.76±24.71,P=0.02),and more interventions(4.26±1.71 vs 3.18±1.39,P<0.001).Postoperative inflammatory indicator levels were significantly lower than preoperative levels in each group.Although the incisional hernia incidence was higher in the“One-step”group,no significant difference was found in the composite outcomes of severe complications or death,new-onset organ failure,postoperative complications,inflammatory indicators,long-term complications,quality of life,and medical costs between the groups(P>0.05).CONCLUSION Compared with the“Step-up”approach,the“One-step”approach is a safe and effective treatment method with better long-term quality of life and prognosis.It also provides an alternative surgical treatment strategy for patients with infected pancreatic necrosis.
文摘Cardiovascular diseases(CVDs)remain the leading cause of morbidity and mortality worldwide,necessitating innovative diagnostic and prognostic strategies.Traditional biomarkers like C-reactive protein,uric acid,troponin,and natriuretic peptides play crucial roles in CVD management,yet they are often limited by sensitivity and specificity constraints.This narrative review critically examines the emerging landscape of cardiac biomarkers and advocates for a multiple-marker approach to enhance early detection,prognosis,and risk stratification of CVD.In recent years,several novel biomarkers have shown promise in revolutionizing CVD diagnostics.Gamma-glutamyltransferase,microRNAs,endothelial microparticles,placental growth factor,trimethylamine N-oxide,retinol-binding protein 4,copeptin,heart-type fatty acid-binding protein,galectin-3,growth differentiation factor-15,soluble suppression of tumorigenicity 2,fibroblast growth factor 23,and adrenomedullin have emerged as significant indicators of CV health.These biomarkers provide insights into various pathophysiological processes,such as oxidative stress,endothelial dysfunction,inflammation,metabolic disturbances,and myocardial injury.The integration of these novel biomarkers with traditional ones offers a more comprehensive understanding of CVD mechanisms.This multiple-marker approach can improve diagnostic accuracy,allowing for better risk stratification and more personalized treatment strategies.This review underscores the need for continued research to validate the clinical utility of these biomarkers and their potential incorporation into routine clinical practice.By leveraging the strengths of both traditional and novel biomarkers,precise therapeutic plans can be developed,thereby improving the management and prognosis of patients with CVDs.The ongoing exploration and validation of these biomarkers are crucial for advancing CV care and addressing the limitations of current diagnostic tools.
基金supported by Singapore National Medical Research Council(NMRC)grants,including CS-IRG,HLCA2022(to ZDZ),STaR,OF LCG 000207(to EKT)a Clinical Translational Research Programme in Parkinson's DiseaseDuke-Duke-NUS collaboration pilot grant(to ZDZ)。
文摘The progressive loss of dopaminergic neurons in affected patient brains is one of the pathological features of Parkinson's disease,the second most common human neurodegenerative disease.Although the detailed pathogenesis accounting for dopaminergic neuron degeneration in Parkinson's disease is still unclear,the advancement of stem cell approaches has shown promise for Parkinson's disease research and therapy.The induced pluripotent stem cells have been commonly used to generate dopaminergic neurons,which has provided valuable insights to improve our understanding of Parkinson's disease pathogenesis and contributed to anti-Parkinson's disease therapies.The current review discusses the practical approaches and potential applications of induced pluripotent stem cell techniques for generating and differentiating dopaminergic neurons from induced pluripotent stem cells.The benefits of induced pluripotent stem cell-based research are highlighted.Various dopaminergic neuron differentiation protocols from induced pluripotent stem cells are compared.The emerging three-dimension-based brain organoid models compared with conventional two-dimensional cell culture are evaluated.Finally,limitations,challenges,and future directions of induced pluripotent stem cell–based approaches are analyzed and proposed,which will be significant to the future application of induced pluripotent stem cell-related techniques for Parkinson's disease.
基金funded by Taif University,Saudi Arabia,project No.(TU-DSPP-2024-263).
文摘Deep learning algorithms have been rapidly incorporated into many different applications due to the increase in computational power and the availability of massive amounts of data.Recently,both deep learning and ensemble learning have been used to recognize underlying structures and patterns from high-level features to make predictions/decisions.With the growth in popularity of deep learning and ensemble learning algorithms,they have received significant attention from both scientists and the industrial community due to their superior ability to learn features from big data.Ensemble deep learning has exhibited significant performance in enhancing learning generalization through the use of multiple deep learning algorithms.Although ensemble deep learning has large quantities of training parameters,which results in time and space overheads,it performs much better than traditional ensemble learning.Ensemble deep learning has been successfully used in several areas,such as bioinformatics,finance,and health care.In this paper,we review and investigate recent ensemble deep learning algorithms and techniques in health care domains,medical imaging,health care data analytics,genomics,diagnosis,disease prevention,and drug discovery.We cover several widely used deep learning algorithms along with their architectures,including deep neural networks(DNNs),convolutional neural networks(CNNs),recurrent neural networks(RNNs),and generative adversarial networks(GANs).Common healthcare tasks,such as medical imaging,electronic health records,and genomics,are also demonstrated.Furthermore,in this review,the challenges inherent in reducing the burden on the healthcare system are discussed and explored.Finally,future directions and opportunities for enhancing healthcare model performance are discussed.
基金Supported by National Research Foundation of Korea,No.NRF-2021S1A5A8062526.
文摘This article provides a comprehensive analysis of the study by Hou et al,focusing on the complex interplay between psychological and physical factors in the postoperative recovery(POR)of patients with perianal diseases.The study sheds light on how illness perception,anxiety,and depression significantly influence recovery outcomes.Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery.The article explores the critical role of pre-operative psychological assessment,highlighting the need for mental health support and personalized recovery plans in enhancing POR quality.A multidisciplinary approach,integrating mental health professionals with surgeons,anesthesiologists,and other specialists,is emphasized to ensure comprehensive care for patients.The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.
基金supported by the Science and Technology Project of China Huaneng Group Co.,Ltd.Research on Key Technologies for Monitoring and Protection of Offshore Wind Power Underwater Equipment(HNKJ21-H40).
文摘As the core facility of offshore wind power systems,the structural safety of offshore booster stations directly impacts the stable operation of entire wind farms.With the global energy transition toward green and lowcarbon goals,offshore wind power has emerged as a key renewable energy source,yet its booster stations face harsh marine environments,including persistent wave impacts,salt spray corrosion,and equipment-induced vibrations.Traditional monitoring methods relying on manual inspections and single-dimensional sensors suffer from critical limitations:low efficiency,poor real-time performance,and inability to capture millinewton-level stress fluctuations that signal early structural fatigue.To address these challenges,this study proposes a biomechanics-driven structural safety monitoring system integrated with deep learning.Inspired by biological stress-sensing mechanisms,the system deploys a distributedmulti-dimensional force sensor network to capture real-time stress distributions in key structural components.A hybrid convolutional neural network-radial basis function(CNN-RBF)model is developed:the CNN branch extracts spatiotemporal features from multi-source sensing data,while the RBF branch reconstructs the nonlinear stress field for accurate anomaly diagnosis.The three-tier architectural design—data layer(distributed sensor array),function layer(CNN-RBF modeling),and application layer(edge computing terminal)—enables a closedloop process from high-resolution data collection to real-time early warning,with data processing delay controlled within 200 ms.Experimental validation against traditional SOM-based systems demonstrates significant performance improvements:monitoring accuracy increased by 19.8%,efficiency by 23.4%,recall rate by 20.5%,and F1 score by 21.6%.Under extreme weather(e.g.,typhoons and winter storms),the system’s stability is 40% higher,with user satisfaction improving by 17.2%.The biomechanics-inspired sensor design enhances survival rates in salt fog(85.7%improvement)and dynamic loads,highlighting its robust engineering applicability for intelligent offshore wind farm maintenance.
文摘This paper focuses on the research of the main transformer selection and layout scheme for new energy step-up substations.From the perspective of engineering design,it analyzes the principles of main transformer selection,key parameters,and their matching with the characteristics of new energy.It also explores the layout methods and optimization strategies.Combined with typical case studies,optimization suggestions are proposed for the design of main transformers in new energy step-up substations.The research shows that rational main transformer selection and scientific layout schemes can better adapt to the characteristics of new energy projects while effectively improving land use efficiency and economic viability.This study can provide technical experience support for the design of new energy projects.
文摘Objective: To explore the effect of Health Action Process Approach (HAPA) theory in patients with type D personality psoriasis. Methods: A total of 66 patients with type D personality psoriasis admitted to the dermatology department of a top-three hospital in Jingzhou City from November 2022 to July 2023 were selected and divided into control group and test group with 33 cases in each group by random number table method. The control group received routine health education, and the experimental group received health education based on the HAPA theory. Chronic disease self-efficacy scale, hospital anxiety and depression scale and skin disease quality of life scale were used to evaluate the effect of intervention. Results: After 3 months of intervention, the scores of self-efficacy in experimental group were higher than those in control group (P P Conclusion: Health education based on the theory of HAPA can enhance the self-efficacy of patients with type D personality psoriasis, relieve negative emotions and improve their quality of life.
文摘BACKGROUND The root of mesentery dissection is one of the critical maneuvers,especially in borderline resectable pancreatic head cancer.Intra-abdominal chyle leak(CL)including chylous ascites may ensue in up to 10%of patients after pancreatic resections.Globally recognized superior mesenteric artery(SMA)first approaches are invariably performed.The mesenteric dissection through the inferior infracolic approach has been discussed in this study emphasizing its post-operative impact on CL which is the cornerstone of this study.AIM To assess incidence,risk factors,clinical impact of CL following root of mesentery dissection,and the different treatment modalities.METHODS This is a retrospective study incorporating the patients who underwent dissection of the root of mesentery with inferior infracolic SMA first approach pancreat-oduodenectomy for the ventral body and uncinate mass of pancreas in the Department of Gastrointestinal and General Surgery of Kathmandu Medical College and Teaching Hospital from January 1,2021 to February 28,2024.Intraop-erative findings and postoperative outcomes were analyzed.RESULTS In three years,ten patients underwent root of mesentery dissection with inferior infracolic SMA first approach pancreatoduodenectomy.The mean age was 67.6 years with a male-to-female ratio of 4:5.CL was seen in four patients.With virtue of CL,Clavien-Dindo grade Ⅱ or higher morbidity was observed in four patients.Two patients had a hospital stay of more than 20 days with the former having a delayed gastric emptying and the latter with long-term total parenteral nutrition requirement.The mean operative time was 330 minutes.Curative resection was achieved in 100%of the patients.The mean duration of the intensive care unit and hospital stay were 2.55±1.45 days and 15.7±5.32 days,respectively.CONCLUSION Root of mesentery dissection with lymphadenectomy and vascular resection correlated with occurrence of CL.After complete curative resection,these were managed with total parenteral nutrition without adversely impacting outcome.
基金Supported by Yunnan Provincial Clinical Medicine Center for Digestive System Diseases,No.2024YNLCYXZX0132.
文摘BACKGROUND Laparoscopic hepatectomy has been widely accepted for the treatment of liver tumors.Compared with open surgery,it provides a reduced hospital stay,less intraoperative blood loss,less trauma,and fewer incisional infections,without affecting tumor outcomes.However,lesions in the right lobe of the liver are deep and obstructed by the ribs,making exposure difficult and increasing the degree of surgical difficulty;thus,liver tumors in the deep right lobe pose technical challenges in standard laparoscopic surgery.AIM To investigate the safety and efficacy of laparoscopic retroperitoneal partial hepatectomy for liver tumors.METHODS The clinical data of 72 patients who underwent laparoscopic retroperitoneal partial hepatectomy for liver tumors between January 2018 and December 2024 at the First People’s Hospital of Yunnan Province were analyzed.Of the 72 patients included,34 were male and 38 were female,with ages ranging from 34 years to 72 years(median age,45 years).The tumors were all located in the right lobe of the liver,with 30 cases in segment S6,27 cases in segment S7,and 15 cases in segment S8;the mean tumor diameter was 7.5±3.4 cm.The postoperative tumor indices,liver function,and postoperative complications were analyzed to evaluate the clinical efficacy of laparoscopic partial hepatectomy via the retroperitoneal approach.RESULTS The surgeries were successfully completed in all patients,and conversion to open surgery was required in 10 patients.The mean operative time,blood loss,drain retention time,and length of postoperative hospital stay were 140±30 minutes,150±46 mL,3.8±1.2 days,and 8.3±5.3 days,respectively.Liver function tests returned to normal in all patients within two weeks of surgery.Fifteen patients developed atelectasis and pleural effusion and were managed with incision and drainage and antibiotics.Two patients developed uncomplicated minimal ascites,and the remaining patients had no perioperative complications,such as abdominal hemorrhage,infection,liver failure,bile leakage,and other adverse events.All patients were successfully treated.CONCLUSION Laparoscopic retroperitoneal partial hepatectomy is a safe and effective approach for right hepatic space-occupying lesions,particularly in segments S6,S7,and S8,with fewer postoperative complications,less trauma,and faster recovery times.This procedure provides a new surgical access for resection of deep tumors in the right lobe of the liver and has clear clinical implications.
文摘In response to the common problems in college English writing teaching,such as the separation of learning and application,students’low interest in writing,and difficulties in expression,this paper,based on the theoretical framework of the production-oriented approach(POA)proposed by Professor Wen Qiufang,designed and implemented a set of IELTS writing teaching plan.This plan takes“motivating,enabling,and assessing”as the core teaching process,and selects typical IELTS argumentative essay topics(such as food diversity)to create real communication scenarios.In the motivating stage,diverse inputs are used to stimulate students’interest and expose their language weaknesses;in the enabling stage,language knowledge,viewpoint generation,and text structure are focused on for targeted input and training;in the assessing stage,a combination of teacher-student cooperation and peer evaluation is adopted to guide students to identify and correct deficiencies in language use.The research results show that the POA model can effectively enhance students’writing interest,active learning awareness,and writing ability,particularly in overcoming vocabulary poverty and material shortages,as well as improving language accuracy and expression richness.This provides an operational theoretical basis and practical path for improving the teaching effect of IELTS writing.
基金supported by grants from the National Nat-ural Science Foundation of China(82173129)the Innova-tive and Entrepreneurial Talent Doctor of Jiangsu Province,China(JSSCBS20221872)。
文摘Background:Dorsal approach is the potentially effective strategy for minimally invasive liver resection.This study aimed to compare the outcomes between robot-assisted and laparoscopic hemihepatectomy through dorsal approach.Methods:We compared the patients who underwent robot-assisted hemihepatectomy(Rob-HH)and who had laparoscopic hemihepatectomy(Lap-HH)through dorsal approach between January 2020 and December 2022.A 1:1 propensity score-matching(PSM)analysis was performed to minimize bias and confounding factors.Results:Ninety-six patients were included,41 with Rob-HH and 55 with Lap-HH.Among them,58 underwent left hemihepatectomy(LHH)and 38 underwent right hemihepatectomy(RHH).Compared with LapHH group,patients with Rob-HH had less estimated blood loss(median:100.0 vs.300.0 m L,P=0.016),lower blood transfusion rates(4.9%vs.29.1%,P=0.003)and postoperative complication rates(26.8%vs.54.5%,P=0.016).These significant differences consistently existed after PSM and in the LHH subgroups.Furthermore,robot-assisted LHH was associated with decreased Pringle duration(45 vs.60 min,P=0.047).RHH subgroup analysis showed that compared with Lap-RHH,Rob-RHH was associated with less estimated blood loss(200.0 vs.400.0 m L,P=0.013).No significant differences were found in other perioperative outcomes among pre-and post-PSM cohorts,such as Pringle duration,operative time,and hospital stay.Conclusions:The dorsal approach was a safe and feasible strategy for hemi-hepatectomy with favorable outcomes under robot-assisted system in reducing intraoperative blood loss,transfusion,and postoperative complications.
基金the PIG-PARADIGM project,funded by the Novo Nordisk Foundation(Grant No.NNFSA210073688).
文摘Metabolomics utilizes advanced analytical profiling techniques to comprehensively measure small molecules in cells,tissues,and biological fluids.Nutritional metabolomics studies in pigs have reported changes in hundreds of metabolites across various sample types,including plasma,serum,urine,digesta,and feces,following dietary interventions.These findings can help identify biomarkers of gastrointestinal functionality and beyond,as well as investigate mechanistic interactions between diet,host,microbiome,and metabolites.This review aims to summarize the current literature on nutritional metabolomics in pigs and its use to investigate how different dietary approaches impact the gut health of pigs.Here,we critically assessed and categorized the impact of the main macronutrients-carbohydrates,proteins,and fats—along with feed additives such as amino acids,bile acids,and probiotics,as well as feeding strategies like creep feeding,milk replacer introduction,and time-restricted feeding,on the pig metabolome.Additionally,we discuss the potential modes of action of the key affected metabolites on pig gut health.
基金supported by the National Key R&D Program of China(No.2022YFB3707302)the National Natural Science Foundation of China(Nos.52394271 , 52394270).
文摘Enhancing the mechanical properties is crucial for polyimide films,but the mechanical properties(Young's modulus,tensile strength,and elongation at break)mutually constrain each other,complicating simultaneous enhancement via traditional trial-and-error methods.In this work,we proposed a materials genome approach to design and screen phenylethynyl-terminated polyimides for films with enhanced mechani-cal properties.We first established machine learning models to predict Young's modulus,tensile strength,and elongation at break to explore the chemical space containing thousands of candidate structures.The accuracies of the machine learning models were verified by molecular dynamics simulations on screened polyimides and experimental testing on three representative polyimide films.The performance advantages of the best-selected polyimides were analyzed by comparing well-known polyimides based on molecular dynamics simulations,and the structural rationale was revealed by"gene"analysis and feature importance evaluation.This work provides a cost-effective strategy for designing polyimide films withenhancedmechanical properties.
