Genotypic variations in the adaptive response to low-phosphorus （P） stress and P-uptake efficiency have been widely reported in many crops. We conducted a pot experiment to evaluate the P-acquisition ability of two ...Genotypic variations in the adaptive response to low-phosphorus （P） stress and P-uptake efficiency have been widely reported in many crops. We conducted a pot experiment to evaluate the P-acquisition ability of two rapeseed （Brassica napus） geno- types supplied with two sparingly soluble sources of P, A1-P and Fe-P. Then, the root morphology, proton concentrations, and carboxylate content were investigated in a solution experiment to examine the genotypic difference in P-acquisition efficiency. Both genotypes produced greater biomass and accumulated more P when supplied with A1-P than when supplied with Fe-P. The P-efficient genotype 102 showed a significantly greater ability to deplete sparingly soluble P from the rhizosphere soil be- cause of its greater biomass and higher P uptake compared with those of the P-inefficient genotype 105. In the solution exper- iment, the P-efficient genotype under low-P conditions developed dominant root morphological traits, and it showed more in- tensive rhizosphere acidification because of greater H＋ effiux, higher H＋-ATPase activity, and greater exudation of carbox- ylates than the P-inefficient genotype. Thus, a combination of morphological and physiological mechanisms contributed to the genotypic variation in the utilization of different sparingly soluble P sources in B. napus.展开更多
Lithium-sulfur(Li-S)batteries hold great promise to be the next-generation candidate for high-energy-density secondary batteries but in the prerequisite of using low electrolyte-to-sulfur(E/S)ratios.Highly solvating e...Lithium-sulfur(Li-S)batteries hold great promise to be the next-generation candidate for high-energy-density secondary batteries but in the prerequisite of using low electrolyte-to-sulfur(E/S)ratios.Highly solvating electrolytes(HSEs)and sparingly solvating electrolytes(SSEs),with opposite nature towards the dissolution of polysulfides,have recently emerged as two effective solutions to decrease the E/S ratio and increase the overall practical energy density of Li-S batteries.HSEs featuring with high polysulfide solvation ability have the potential to reduce the E/S ratio by dissolving more polysulfides with less electrolyte,while SSEs alter the sulfur reaction pathway from a dissolution-precipitation mechanism to a quasi-solid mechanism,thereby independent on the use of electrolyte amount.Both HSEs and SSEs show respective effectiveness in lean-electrolyte Li-S batteries,but encounter different challenges to bring Li-S batteries into practical application.This review aims to present a comparative discussion on their unique features and basic electrochemical reaction mechanisms in practical lean-electrolyte Li-S batteries.Emphasis is focused on the current technical challenges and possible solutions for their future development.展开更多
Tumor recurrence, the Gordian knot of liver transplantation for malignancies, may be attributed to many parameters. The technique of the “classical” recipient hepatectomy is believed to be one of the potential reaso...Tumor recurrence, the Gordian knot of liver transplantation for malignancies, may be attributed to many parameters. The technique of the “classical” recipient hepatectomy is believed to be one of the potential reasons to cause tumor evasion because of the possible increase of circulating tumor cells, thus leading to an increased recurrent rate. On this background, the no-touch oncological recipient hepatectomy technique has been developed. A comprehensive review of the development and the key surgical steps of the no-touch recipient hepatectomy is presented. This technique might improve clinical outcomes, especially for those recipients who are at a high risk for tumor recurrence. Multicenter prospective studies should be set up to further validate the prognostic role of this technique in patients with liver cancer treated with liver transplantation.展开更多
The prelimbic cortex(PL)plays a critical role in processing both the sensory and affective components of pain.However,the underlying molecular mechanisms remain poorly understood.In this study,we observed a reduction ...The prelimbic cortex(PL)plays a critical role in processing both the sensory and affective components of pain.However,the underlying molecular mechanisms remain poorly understood.In this study,we observed a reduction in hyperpolarization-activated cation current(Ih)in layer V pyramidal neurons of the contralateral PL in a mouse model of spared nerve injury(SNI).The expression of hyperpolarization-activated cyclic nucleotide-gated 2(HCN2)channels was also decreased in the contralateral PL.Conversely,microinjection of fisetin,a partial agonist of HCN2,produced both analgesic and anxiolytic effects.Additionally,we found that cyclin-dependent kinase 5(CDK5)was activated in the contralateral PL,where it formed a complex with HCN2 and phosphorylated its C-terminus.Knockdown of CDK5 restored HCN2 expression and alleviated both pain hypersensitivity and anxiety-like behaviors.Collectively,these results indicate that CDK5-mediated dysfunction of HCN2 in the PL underlies nerve injury-induced mechanical hypersensitivity and anxiety.展开更多
BACKGROUND Laparoscopic nephrectomy is a preferred surgical approach due to its minimally invasive nature and faster recovery times.However,effective management of postoperative pain remains a significant challenge.Se...BACKGROUND Laparoscopic nephrectomy is a preferred surgical approach due to its minimally invasive nature and faster recovery times.However,effective management of postoperative pain remains a significant challenge.Several traditional methods,including opioid-based analgesia,are commonly used but are associated with side effects such as nausea,vomiting,sedation,and delayed recovery.In recent years,the erector spinae plane block(ESPB)has gained attention as an ultrasoundguided regional anesthesia technique offering promising results in various surgical procedures by reducing opioid requirements and enhancing patient comfort.AIM To evaluate the efficacy and safety of ESPB in comparison to conventional pain management strategies in patients undergoing laparoscopic nephrectomy.METHODS Following PRISMA guidelines,we searched PubMed,EMBASE,Web of Science,and the Cochrane Register for randomized controlled trials(RCTs)comparing ESPB with control for laparoscopic nephrectomy.The Cochrane Risk of Bias tool was employed for quality assessment.The primary outcome was total patient-controlled analgesia(PCA)consumption.Secondary outcomes included hospital discharge time and the incidence of postoperative nausea and vomiting.A random-effects meta-analysis was conducted to calculate pooled mean differences(MD)and odds ratios(OR)with 95%CIs.RESULTS Nine RCTs involving a total of 643 patients(ESPB group=320;control group=323)were included in the analysis.ESPB significantly reduced PCA opioid consumption compared to controls(MD:-14.24,95%CI:-20.66 to-7.83,P<0.0001).Subgroup analysis showed reduced PCA use with ESPB vs morphine(MD:-8.78,95%CI:-15.34 to-2.22,P=0.009),and a non-significant effect compared to other analgesics(MD:-48.26,95%CI:-143.60 to 47.09).No statistically significant differences were observed in discharge time or the incidence of nausea and vomiting.CONCLUSION ESPB demonstrates the potential of reducing PCA in laparoscopic nephrectomy patients;however,its impact on secondary outcomes remains inconclusive.Large-scale RCTs are needed to confirm ESPB's benefits and explore long-term effects.展开更多
BACKGROUND The volar approach with plate fixation is the gold standard for treating distal radius fractures,often requiring incision of the pronator quadratus(PQ)muscle.Preserving the PQ during surgery may facilitate ...BACKGROUND The volar approach with plate fixation is the gold standard for treating distal radius fractures,often requiring incision of the pronator quadratus(PQ)muscle.Preserving the PQ during surgery may facilitate early postoperative recovery.However,conventional minimally invasive plate osteosynthesis(MIPO)techniques frequently necessitate multiple(3-4)intraoperative fluoroscopic adjustments to achieve optimal plate positioning,which can inadvertently damage the PQ muscle.Based on our clinical observations,we developed a novel 3-point positioning technique to minimize PQ injury while ensuring accurate plate placement.Preliminary results demonstrate promising early clinical outcomes.AIM To retrospectively analyze distal radius fractures treated using the 3-point positioning-assisted MIPO technique with preservation of the PQ.METHODS The 3-point positioning technique was applied:The Kirschner wire was inserted after fluoroscopy and was correctly adjusted the position of the plate above the PQ.With the aid of Kirschner wires positioning the PQ stripping was performed only once,and the plate then placed in a correct and satisfactory position.Operation time,incision length,wrist pain score,upper extremity function disabilities of the arm,shoulder and hand(DASH)score,wrist Gartland-Werley score,wrist grip strength,and range of motion were among the quantitative variables recorded.Qualitative variables including AO fracture classification,intraoperative and postoperative complications were evaluated.RESULTS At a mean follow-up of 6.9±0.8 months,the mean scar length was 25.4±1.5 mm,the pain score was 0.7±0.6,the DASH score for the upper limb was 4.7±1.3,and the Gartland-Werley score for wrist function was 4.1±1.1 at the last follow-up.Mean flexion was 97.3%,extension was 97.0%,pronation was 98.9%,supination was 98.9%,and grip strength was 86.6%compared to contralateral values.No unfavorable intraoperative or postoperative complications occurred.CONCLUSION The 3-point positioning technique may reduce the damage to the PQ muscle and is a safe and effective method for MIPO for distal radius fractures.展开更多
On July 17,2024,Chinese electric vehicle manufacturer GAC International opened a smart factory in Rayong Province,Thailand.The next day,then Prime Minister of Thailand Saita Thawaixin met with a delegation led by Zeng...On July 17,2024,Chinese electric vehicle manufacturer GAC International opened a smart factory in Rayong Province,Thailand.The next day,then Prime Minister of Thailand Saita Thawaixin met with a delegation led by Zeng Qinghong,chairman of GAC Group.He encouraged GAC to purchase various spare parts in Thailand to enhance Thailand’s position in the global electric vehicle industry supply chain.“Thailand has a favorable business environment,”Zeng responded.“As the location of GAC’s first wholly-owned overseas facility,it was our premier choice.”展开更多
Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,a...Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].展开更多
Objective: To study the feasibility of radionuclide colloid 32P used for the treatment of stage II lung cancer by video enhanced minimal access muscle sparing thoracotomy (VEMAST). Methods: Video assisted thoracosc...Objective: To study the feasibility of radionuclide colloid 32P used for the treatment of stage II lung cancer by video enhanced minimal access muscle sparing thoracotomy (VEMAST). Methods: Video assisted thoracoscopic surgery (VATS) was carried out under general anesthesia. A double lumen endobronchial tube was intubated into trachea. One lung ventilation of the healthy side was done during operation. An incision of 8–10 cm long was made along the 4th or 5th intercostals. The lobectomy could be performed under VATS. Radionuclide colloid 32P was injected locally into the area where surgical cleaning of lymph node around was considered to be unsatisfactory or desection of the tumor was not completed. Results: The operation with VEMAST was successful in 29 patients. A conventional lobectomy by thoracotomy had to be done due to unusual bleeding from the pulmonary artery involved during VEMAST in one case and the procedure was interrupted because the pulmonary artery cloud not be separated from the tumor in another patient. There was no dead case or the patient who had any severe complication or adverse response to the radiant. Conclusion: Radionuclide therapy was performed to the treatment of stage II lung cancer with VEMAST in case that surgical resection was considered not to be satisfactory. Minithoractomy assisted with VATS lobectomy and radionuclide colloid 32P therapy is a safe and e?ective technique for some selected stage II lung cancer.展开更多
Rational planning of spares configuration project is an effective approach to improve equipment availability as well as reduce life cycle cost （LCC）. With an analysis of various impacts on support system, the spares...Rational planning of spares configuration project is an effective approach to improve equipment availability as well as reduce life cycle cost （LCC）. With an analysis of various impacts on support system, the spares demand rate forecast model is constructed. According to systemic analysis method, spares support effectiveness evaluation indicators system is built, and then, initial spares configuration and optimization method is researched. To the issue of discarding and con-sumption for incomplete repairable items, its expected backorders function is approximated by Laplace demand distribution. Combining the （s-1, s） and （R, Q） inventory policy, the spares resup-ply model is established under the batch ordering policy based on inventory state, and the optimi-zation analysis flow for spares configuration is proposed. Through application on shipborne equipment spares configuration, the given scenarios are analyzed under two constraint targets：one is the support effectiveness, and the other is the spares cost. Analysis reveals that the result is consistent with practical regulation;therefore, the model＇s correctness, method＇s validity as well as optimization project＇s rationality are proved to a certain extent.展开更多
Emerging evidence indicates that CXCL12/ CXCR4 signaling is involved in chronic pain. However, few studies have systemically assessed its role in direct nerve injury-induced neuropathic pain and the underlying mech- a...Emerging evidence indicates that CXCL12/ CXCR4 signaling is involved in chronic pain. However, few studies have systemically assessed its role in direct nerve injury-induced neuropathic pain and the underlying mech- anism. Here, we determined that spared nerve injury （SNI） increased the expression of CXCL12 and its cognate receptor CXCR4 in lumbar 5 dorsal root ganglia （DRG） neurons and satellite glial cells. SNI also induced long- lasting upregulation of CXCL12 and CXCR4 in the ipsi- lateral L4-5 spinal cord dorsal horn, characterized by CXCL12 expression in neurons and microglia, and CXCR4 expression in neurons and astrocytes. Moreover, SNI- induced a sustained increase in TNF-α expression in the DRG and spinal cord. Intraperitoneal injection （i.p.） of the TNF-α synthesis inhibitor thalidomide reduced the SNI-in- duced mechanical hypersensitivity and inhibited the expression of CXCL12 in the DRG and spinal cord. Intrathecal injection （i.t.） of the CXCR4 antagonist AMD3100, both 30 rain before and 7 days after SNI, reduced the behavioral signs of allodynia. Rats given an i.t. or i.p. bolus of AMD3100 on day 8 of SNI exhibited attenuated abnormal pain behaviors. The neuropathic pain established following SNI was also impaired by i.t. admin- istration of a CXCL12-neutralizing antibody. Moreover, repetitive i.t. AMD3100 administration prevented the acti- vation of ERK in the spinal cord. The mechanical hyper- sensitivity induced in nai＇ve rats by i.t. CXCL12 was alleviated by pretreatment with the MEK inhibitor PD98059. Collectively, our results revealed that TNF-α might mediate the upregulation of CXCL12 in the DRG and spinal cord following SNI, and that CXCL 12/CXCR4 sig- naling via ERK activation contributes to the development and maintenance of neuropathic pain.展开更多
Level of repair analysis（LORA） is an important method of maintenance decision for establishing systems of operation and maintenance in the equipment development period. Currently, the research on equipment of repair...Level of repair analysis（LORA） is an important method of maintenance decision for establishing systems of operation and maintenance in the equipment development period. Currently, the research on equipment of repair level focuses on economic analysis models which are used to optimize costs and rarely considers the maintenance time required by the implementation of the maintenance program. In fact, as to the system requiring high mission complete success, the maintenance time is an important factor which has a great influence on the availability of equipment systems. Considering the relationship between the maintenance time and the spares stocks level, it is obvious that there are contradictions between the maintenance time and the cost. In order to balance these two factors, it is necessary to build an optimization LORA model. To this end, the maintenance time representing performance characteristic is introduced, and on the basis of spares stocks which is traditionally regarded as a decision variable, a decision variable of repair level is added, and a multi-echelon multiindenture（MEMI） optimization LORA model is built which takes the best cost-effectiveness ratio as the criterion, the expected number of backorder（EBO） as the objective function and the cost as the constraint. Besides, the paper designs a convex programming algorithm of multi-variable for the optimization model, provides solutions to the non-convex objective function and methods for improving the efficiency of the algorithm. The method provided in this paper is proved to be credible and effective according to the numerical example and the simulation result.展开更多
The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and ...The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.展开更多
In order to optimize the spares configuration project at different stages during the life cycle, the factor of time is considered to relax the assumption of the spares steady demand in multi-echelon technique for reco...In order to optimize the spares configuration project at different stages during the life cycle, the factor of time is considered to relax the assumption of the spares steady demand in multi-echelon technique for recoverable item control (METRIC) theory. According to the method of systems analysis, the dynamic palm theorem is introduced to establish the prediction model of the spares demand rate, and its main influence factors are analyzed, based on which, the spares support effectiveness evaluation index system is studied, and the system optimization-oriented spares dynamic configuration method for multi-echelon multi-indenture system is proposed. Through the analysis of the optimization algorithm, the layered marginal algorithm is designed to improve the model calculation efficiency. In a given example, the multi-stage spares configuration project during its life cycle is gotten, the research result conforms to the actual status, and it can provide a new way for the spares dynamic optimization.展开更多
Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of conti...Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of continence.Treatment options continue to evolve-as a result,it is important to review old and new options on a regular basis to ensure that our patients are provided with up to date information and options.This paper will briefly cover some of the traditional approaches that have been used as well as some newer promising procedures.展开更多
Ulcerative colitis and Crohn’s disease are the major phenotypes of the idiopathic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms, i...Ulcerative colitis and Crohn’s disease are the major phenotypes of the idiopathic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms, impairing function and quality of life. Current medications are aimed at reducing the symptoms or suppressing exacerbations. However, patients require life-long medications, and this can lead to drug dependency, loss of response together with adverse side effects. Indeed, drug side effects become additional morbidity factor in many patients on long-term medications. Nonetheless, the efficacy of anti-tumour necrosis factors (TNF)-α biologics has validated the role of inflammatory cytokines notably TNF-α in the exacerbation of IBD. However, inflammatory cytokines are released by patients’ own cellular elements including myeloid lineage leucocytes, which in patients with IBD are elevated with activation behaviour and prolonged survival. Accordingly, these leucocytes appear logical targets of therapy and can be depleted by adsorptive granulocyte/monocyte apheresis (GMA) with an Adacolumn. Based on this background, recently GMA has been applied to treat patients with IBD in Japan and in the European Union countries. Efficacy rates have been impressive as well as disappointing. In fact the clinical response to GMA seems to define the patients’ disease course, response to medications, duration of active disease, and severity at entry. The best responders have been first episode cases (up to 100%) followed by steroid naïve and patients with a short duration of active disease prior to GMA. Patients with deep ulcers together with extensive loss of the mucosal tissue and cases with a long duration of IBD refractory to existing medications are not likely to benefit from GMA. It is clinically interesting that patients who respond to GMA have a good long-term disease course by avoiding drugs including corticosteroids in the early stage of their IBD. Additionally, GMA is very much favoured by patients for its good safety profile. GMA in 21<sup>st</sup> century reminds us of phlebotomy as a major medical practice at the time of Hippocrates. However, in patients with IBD, there is a scope for removing from the body the sources of pro-inflammatory cytokines and achieve disease remission. The bottom line is that by introducing GMA at an early stage following the onset of IBD or before patients develop extensive mucosal damage and become refractory to medications, many patients should respond to GMA and avoid pharmacologics. This should fulfill the desire to treat without drugs.展开更多
基金supported by the National Basic Research Program of China (Grant No. 2011CB100301)
文摘Genotypic variations in the adaptive response to low-phosphorus （P） stress and P-uptake efficiency have been widely reported in many crops. We conducted a pot experiment to evaluate the P-acquisition ability of two rapeseed （Brassica napus） geno- types supplied with two sparingly soluble sources of P, A1-P and Fe-P. Then, the root morphology, proton concentrations, and carboxylate content were investigated in a solution experiment to examine the genotypic difference in P-acquisition efficiency. Both genotypes produced greater biomass and accumulated more P when supplied with A1-P than when supplied with Fe-P. The P-efficient genotype 102 showed a significantly greater ability to deplete sparingly soluble P from the rhizosphere soil be- cause of its greater biomass and higher P uptake compared with those of the P-inefficient genotype 105. In the solution exper- iment, the P-efficient genotype under low-P conditions developed dominant root morphological traits, and it showed more in- tensive rhizosphere acidification because of greater H＋ effiux, higher H＋-ATPase activity, and greater exudation of carbox- ylates than the P-inefficient genotype. Thus, a combination of morphological and physiological mechanisms contributed to the genotypic variation in the utilization of different sparingly soluble P sources in B. napus.
基金The authors acknowledge the support from the National Natural Science Foundation of China(Nos.U2002213 and 51972219)the Science and Technology Development Fund Macao SAR(No.0077/2021/A2),the Collaborative Innovation Center of Suzhou Nano Science and Technology,the 111 Project,and the Joint International Research Laboratory of Carbon-based Functional Materials and Devices.
文摘Lithium-sulfur(Li-S)batteries hold great promise to be the next-generation candidate for high-energy-density secondary batteries but in the prerequisite of using low electrolyte-to-sulfur(E/S)ratios.Highly solvating electrolytes(HSEs)and sparingly solvating electrolytes(SSEs),with opposite nature towards the dissolution of polysulfides,have recently emerged as two effective solutions to decrease the E/S ratio and increase the overall practical energy density of Li-S batteries.HSEs featuring with high polysulfide solvation ability have the potential to reduce the E/S ratio by dissolving more polysulfides with less electrolyte,while SSEs alter the sulfur reaction pathway from a dissolution-precipitation mechanism to a quasi-solid mechanism,thereby independent on the use of electrolyte amount.Both HSEs and SSEs show respective effectiveness in lean-electrolyte Li-S batteries,but encounter different challenges to bring Li-S batteries into practical application.This review aims to present a comparative discussion on their unique features and basic electrochemical reaction mechanisms in practical lean-electrolyte Li-S batteries.Emphasis is focused on the current technical challenges and possible solutions for their future development.
基金supported in part by grants from National Nat-ural Science Foundation of China (82200726 and U23A20451)Key Program of the National Natural Science Foundation of China (81930016)National Key Research and Development Program of China (2021YFA1100500)。
文摘Tumor recurrence, the Gordian knot of liver transplantation for malignancies, may be attributed to many parameters. The technique of the “classical” recipient hepatectomy is believed to be one of the potential reasons to cause tumor evasion because of the possible increase of circulating tumor cells, thus leading to an increased recurrent rate. On this background, the no-touch oncological recipient hepatectomy technique has been developed. A comprehensive review of the development and the key surgical steps of the no-touch recipient hepatectomy is presented. This technique might improve clinical outcomes, especially for those recipients who are at a high risk for tumor recurrence. Multicenter prospective studies should be set up to further validate the prognostic role of this technique in patients with liver cancer treated with liver transplantation.
基金supported by the National Natural Science Foundation of China(32030052,W2411014 to Yun Wang,32271190 and 31972905 to Ying Zhang)the STI 2030 Major Project of the Ministry of Science and Technology of China(2021ZD0203204)the Beijing Natural Science Foundation(QY23067).
文摘The prelimbic cortex(PL)plays a critical role in processing both the sensory and affective components of pain.However,the underlying molecular mechanisms remain poorly understood.In this study,we observed a reduction in hyperpolarization-activated cation current(Ih)in layer V pyramidal neurons of the contralateral PL in a mouse model of spared nerve injury(SNI).The expression of hyperpolarization-activated cyclic nucleotide-gated 2(HCN2)channels was also decreased in the contralateral PL.Conversely,microinjection of fisetin,a partial agonist of HCN2,produced both analgesic and anxiolytic effects.Additionally,we found that cyclin-dependent kinase 5(CDK5)was activated in the contralateral PL,where it formed a complex with HCN2 and phosphorylated its C-terminus.Knockdown of CDK5 restored HCN2 expression and alleviated both pain hypersensitivity and anxiety-like behaviors.Collectively,these results indicate that CDK5-mediated dysfunction of HCN2 in the PL underlies nerve injury-induced mechanical hypersensitivity and anxiety.
文摘BACKGROUND Laparoscopic nephrectomy is a preferred surgical approach due to its minimally invasive nature and faster recovery times.However,effective management of postoperative pain remains a significant challenge.Several traditional methods,including opioid-based analgesia,are commonly used but are associated with side effects such as nausea,vomiting,sedation,and delayed recovery.In recent years,the erector spinae plane block(ESPB)has gained attention as an ultrasoundguided regional anesthesia technique offering promising results in various surgical procedures by reducing opioid requirements and enhancing patient comfort.AIM To evaluate the efficacy and safety of ESPB in comparison to conventional pain management strategies in patients undergoing laparoscopic nephrectomy.METHODS Following PRISMA guidelines,we searched PubMed,EMBASE,Web of Science,and the Cochrane Register for randomized controlled trials(RCTs)comparing ESPB with control for laparoscopic nephrectomy.The Cochrane Risk of Bias tool was employed for quality assessment.The primary outcome was total patient-controlled analgesia(PCA)consumption.Secondary outcomes included hospital discharge time and the incidence of postoperative nausea and vomiting.A random-effects meta-analysis was conducted to calculate pooled mean differences(MD)and odds ratios(OR)with 95%CIs.RESULTS Nine RCTs involving a total of 643 patients(ESPB group=320;control group=323)were included in the analysis.ESPB significantly reduced PCA opioid consumption compared to controls(MD:-14.24,95%CI:-20.66 to-7.83,P<0.0001).Subgroup analysis showed reduced PCA use with ESPB vs morphine(MD:-8.78,95%CI:-15.34 to-2.22,P=0.009),and a non-significant effect compared to other analgesics(MD:-48.26,95%CI:-143.60 to 47.09).No statistically significant differences were observed in discharge time or the incidence of nausea and vomiting.CONCLUSION ESPB demonstrates the potential of reducing PCA in laparoscopic nephrectomy patients;however,its impact on secondary outcomes remains inconclusive.Large-scale RCTs are needed to confirm ESPB's benefits and explore long-term effects.
基金Supported by Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma,No.2020Y2014Fuzhou Health Technology Innovation Platform Construction Project,No.2019-S-wp2.
文摘BACKGROUND The volar approach with plate fixation is the gold standard for treating distal radius fractures,often requiring incision of the pronator quadratus(PQ)muscle.Preserving the PQ during surgery may facilitate early postoperative recovery.However,conventional minimally invasive plate osteosynthesis(MIPO)techniques frequently necessitate multiple(3-4)intraoperative fluoroscopic adjustments to achieve optimal plate positioning,which can inadvertently damage the PQ muscle.Based on our clinical observations,we developed a novel 3-point positioning technique to minimize PQ injury while ensuring accurate plate placement.Preliminary results demonstrate promising early clinical outcomes.AIM To retrospectively analyze distal radius fractures treated using the 3-point positioning-assisted MIPO technique with preservation of the PQ.METHODS The 3-point positioning technique was applied:The Kirschner wire was inserted after fluoroscopy and was correctly adjusted the position of the plate above the PQ.With the aid of Kirschner wires positioning the PQ stripping was performed only once,and the plate then placed in a correct and satisfactory position.Operation time,incision length,wrist pain score,upper extremity function disabilities of the arm,shoulder and hand(DASH)score,wrist Gartland-Werley score,wrist grip strength,and range of motion were among the quantitative variables recorded.Qualitative variables including AO fracture classification,intraoperative and postoperative complications were evaluated.RESULTS At a mean follow-up of 6.9±0.8 months,the mean scar length was 25.4±1.5 mm,the pain score was 0.7±0.6,the DASH score for the upper limb was 4.7±1.3,and the Gartland-Werley score for wrist function was 4.1±1.1 at the last follow-up.Mean flexion was 97.3%,extension was 97.0%,pronation was 98.9%,supination was 98.9%,and grip strength was 86.6%compared to contralateral values.No unfavorable intraoperative or postoperative complications occurred.CONCLUSION The 3-point positioning technique may reduce the damage to the PQ muscle and is a safe and effective method for MIPO for distal radius fractures.
文摘On July 17,2024,Chinese electric vehicle manufacturer GAC International opened a smart factory in Rayong Province,Thailand.The next day,then Prime Minister of Thailand Saita Thawaixin met with a delegation led by Zeng Qinghong,chairman of GAC Group.He encouraged GAC to purchase various spare parts in Thailand to enhance Thailand’s position in the global electric vehicle industry supply chain.“Thailand has a favorable business environment,”Zeng responded.“As the location of GAC’s first wholly-owned overseas facility,it was our premier choice.”
文摘Dear Editor,Primary bladder neck obstruction(PBNO)affects approximately 28%–54%of men[1].Its etiology remains unclear.Symptoms of PBNO present as voiding(e.g.,decreased force of stream,hesitancy,intermittent stream,and incomplete emptying),storage(e.g.,frequency,urgency,urge incontinence,and nocturia),or a combination of both[2].Untreated PBNO can lead to bladder dysfunction,bladder diverticula,hydronephrosis,and impaired renal function[3].
文摘Objective: To study the feasibility of radionuclide colloid 32P used for the treatment of stage II lung cancer by video enhanced minimal access muscle sparing thoracotomy (VEMAST). Methods: Video assisted thoracoscopic surgery (VATS) was carried out under general anesthesia. A double lumen endobronchial tube was intubated into trachea. One lung ventilation of the healthy side was done during operation. An incision of 8–10 cm long was made along the 4th or 5th intercostals. The lobectomy could be performed under VATS. Radionuclide colloid 32P was injected locally into the area where surgical cleaning of lymph node around was considered to be unsatisfactory or desection of the tumor was not completed. Results: The operation with VEMAST was successful in 29 patients. A conventional lobectomy by thoracotomy had to be done due to unusual bleeding from the pulmonary artery involved during VEMAST in one case and the procedure was interrupted because the pulmonary artery cloud not be separated from the tumor in another patient. There was no dead case or the patient who had any severe complication or adverse response to the radiant. Conclusion: Radionuclide therapy was performed to the treatment of stage II lung cancer with VEMAST in case that surgical resection was considered not to be satisfactory. Minithoractomy assisted with VATS lobectomy and radionuclide colloid 32P therapy is a safe and e?ective technique for some selected stage II lung cancer.
基金co-supported by the General Armament Department Pre-research Foundation of China (Nos. 51304010206, 51327 020105)
文摘Rational planning of spares configuration project is an effective approach to improve equipment availability as well as reduce life cycle cost （LCC）. With an analysis of various impacts on support system, the spares demand rate forecast model is constructed. According to systemic analysis method, spares support effectiveness evaluation indicators system is built, and then, initial spares configuration and optimization method is researched. To the issue of discarding and con-sumption for incomplete repairable items, its expected backorders function is approximated by Laplace demand distribution. Combining the （s-1, s） and （R, Q） inventory policy, the spares resup-ply model is established under the batch ordering policy based on inventory state, and the optimi-zation analysis flow for spares configuration is proposed. Through application on shipborne equipment spares configuration, the given scenarios are analyzed under two constraint targets：one is the support effectiveness, and the other is the spares cost. Analysis reveals that the result is consistent with practical regulation;therefore, the model＇s correctness, method＇s validity as well as optimization project＇s rationality are proved to a certain extent.
基金supported by grants from the National Natural Science Foundation of China(31171070,81171060,81501070and 81571079)
文摘Emerging evidence indicates that CXCL12/ CXCR4 signaling is involved in chronic pain. However, few studies have systemically assessed its role in direct nerve injury-induced neuropathic pain and the underlying mech- anism. Here, we determined that spared nerve injury （SNI） increased the expression of CXCL12 and its cognate receptor CXCR4 in lumbar 5 dorsal root ganglia （DRG） neurons and satellite glial cells. SNI also induced long- lasting upregulation of CXCL12 and CXCR4 in the ipsi- lateral L4-5 spinal cord dorsal horn, characterized by CXCL12 expression in neurons and microglia, and CXCR4 expression in neurons and astrocytes. Moreover, SNI- induced a sustained increase in TNF-α expression in the DRG and spinal cord. Intraperitoneal injection （i.p.） of the TNF-α synthesis inhibitor thalidomide reduced the SNI-in- duced mechanical hypersensitivity and inhibited the expression of CXCL12 in the DRG and spinal cord. Intrathecal injection （i.t.） of the CXCR4 antagonist AMD3100, both 30 rain before and 7 days after SNI, reduced the behavioral signs of allodynia. Rats given an i.t. or i.p. bolus of AMD3100 on day 8 of SNI exhibited attenuated abnormal pain behaviors. The neuropathic pain established following SNI was also impaired by i.t. admin- istration of a CXCL12-neutralizing antibody. Moreover, repetitive i.t. AMD3100 administration prevented the acti- vation of ERK in the spinal cord. The mechanical hyper- sensitivity induced in nai＇ve rats by i.t. CXCL12 was alleviated by pretreatment with the MEK inhibitor PD98059. Collectively, our results revealed that TNF-α might mediate the upregulation of CXCL12 in the DRG and spinal cord following SNI, and that CXCL 12/CXCR4 sig- naling via ERK activation contributes to the development and maintenance of neuropathic pain.
基金supported by the National Natural Science Foundation of China(6110413261304148)
文摘Level of repair analysis（LORA） is an important method of maintenance decision for establishing systems of operation and maintenance in the equipment development period. Currently, the research on equipment of repair level focuses on economic analysis models which are used to optimize costs and rarely considers the maintenance time required by the implementation of the maintenance program. In fact, as to the system requiring high mission complete success, the maintenance time is an important factor which has a great influence on the availability of equipment systems. Considering the relationship between the maintenance time and the spares stocks level, it is obvious that there are contradictions between the maintenance time and the cost. In order to balance these two factors, it is necessary to build an optimization LORA model. To this end, the maintenance time representing performance characteristic is introduced, and on the basis of spares stocks which is traditionally regarded as a decision variable, a decision variable of repair level is added, and a multi-echelon multiindenture（MEMI） optimization LORA model is built which takes the best cost-effectiveness ratio as the criterion, the expected number of backorder（EBO） as the objective function and the cost as the constraint. Besides, the paper designs a convex programming algorithm of multi-variable for the optimization model, provides solutions to the non-convex objective function and methods for improving the efficiency of the algorithm. The method provided in this paper is proved to be credible and effective according to the numerical example and the simulation result.
文摘The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision(TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life(QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision(TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending.As evidence for safety and feasibility accumulates,structured training programs to standardize teaching,training, and safe expansion will aid the safe spread of the TaTME.
基金supported by the National Defense Pre-research Project in 13th Five-Year(41404050502)the National Defense Science and Technology Fund of the Central Military Commission(2101140)
文摘In order to optimize the spares configuration project at different stages during the life cycle, the factor of time is considered to relax the assumption of the spares steady demand in multi-echelon technique for recoverable item control (METRIC) theory. According to the method of systems analysis, the dynamic palm theorem is introduced to establish the prediction model of the spares demand rate, and its main influence factors are analyzed, based on which, the spares support effectiveness evaluation index system is studied, and the system optimization-oriented spares dynamic configuration method for multi-echelon multi-indenture system is proposed. Through the analysis of the optimization algorithm, the layered marginal algorithm is designed to improve the model calculation efficiency. In a given example, the multi-stage spares configuration project during its life cycle is gotten, the research result conforms to the actual status, and it can provide a new way for the spares dynamic optimization.
文摘Fistula-in-ano is a difficult problem that physicians have struggled with for centuries.Appropriate treatment is based on 3 central tenets: (1) control of sepsis;(2) closure of the fistula;and (3) maintenance of continence.Treatment options continue to evolve-as a result,it is important to review old and new options on a regular basis to ensure that our patients are provided with up to date information and options.This paper will briefly cover some of the traditional approaches that have been used as well as some newer promising procedures.
文摘Ulcerative colitis and Crohn’s disease are the major phenotypes of the idiopathic inflammatory bowel disease (IBD), which afflicts millions of individuals throughout the world with debilitating symptoms, impairing function and quality of life. Current medications are aimed at reducing the symptoms or suppressing exacerbations. However, patients require life-long medications, and this can lead to drug dependency, loss of response together with adverse side effects. Indeed, drug side effects become additional morbidity factor in many patients on long-term medications. Nonetheless, the efficacy of anti-tumour necrosis factors (TNF)-α biologics has validated the role of inflammatory cytokines notably TNF-α in the exacerbation of IBD. However, inflammatory cytokines are released by patients’ own cellular elements including myeloid lineage leucocytes, which in patients with IBD are elevated with activation behaviour and prolonged survival. Accordingly, these leucocytes appear logical targets of therapy and can be depleted by adsorptive granulocyte/monocyte apheresis (GMA) with an Adacolumn. Based on this background, recently GMA has been applied to treat patients with IBD in Japan and in the European Union countries. Efficacy rates have been impressive as well as disappointing. In fact the clinical response to GMA seems to define the patients’ disease course, response to medications, duration of active disease, and severity at entry. The best responders have been first episode cases (up to 100%) followed by steroid naïve and patients with a short duration of active disease prior to GMA. Patients with deep ulcers together with extensive loss of the mucosal tissue and cases with a long duration of IBD refractory to existing medications are not likely to benefit from GMA. It is clinically interesting that patients who respond to GMA have a good long-term disease course by avoiding drugs including corticosteroids in the early stage of their IBD. Additionally, GMA is very much favoured by patients for its good safety profile. GMA in 21<sup>st</sup> century reminds us of phlebotomy as a major medical practice at the time of Hippocrates. However, in patients with IBD, there is a scope for removing from the body the sources of pro-inflammatory cytokines and achieve disease remission. The bottom line is that by introducing GMA at an early stage following the onset of IBD or before patients develop extensive mucosal damage and become refractory to medications, many patients should respond to GMA and avoid pharmacologics. This should fulfill the desire to treat without drugs.
