Fenestrating Versus Reconstituting Subtotal Cholecystectomy: Systematic Review and Meta-Analysis on Bile Leak, Bile Duct Injury, and Outcomes.

Symptoms of gallstone disease are the most common reason for cholecystectomy. Fenestration reduces the likelihood of severe inflammation or scarring after normal treatments are used, and it also enhances control over bile outflow. The goal of reconstituted cholecystectomy is to lessen symptoms like pain and jaundice without undergoing the high-risk procedures associated with more invasive procedures. The reconstituted and fenestrated procedures were assessed by a meta-analysis and systematic review. Of the five studies, 189 (34.2%) had a reconstituted subtotal cholecystectomy, and 363 (65.8%) had a fenestrated subtotal cholecystectomy, which had populations from the United States of America, the United Kingdom, Japan, and Turkey. Two individuals from three trials had bile duct injury, according to three studies. Whereas the fenestrated group reported no bile injury from 236 individuals (0%), the reconstituted group reported two bile duct injuries from 100 patients (2%). The incidence was found to be lower in the fenestrated group (OR 10.81; CI 95% 1.03-113.65; p = 0.39; I2 = 0%) than in the reconstituted group. Four studies revealed 92 cases of bile leaks: 19 out of 155 cases (12.3%) were reconstituted, and 73 out of 351 cases (20.8%) were fenestrated. Between the two groups, there was a significant difference in bile leakage (OR 0.72; CI 95% 0.23-2.32; p = 0.03; I2 = 66%). Two studies reported the establishment of fistulas following surgery in 58 patients in the reconstituted group (5.2%) and 120 patients in the fenestrated group (2.5%) (p = 0.56, I2 = 0%, and OR 0.65; CI 95% 0.12-3.38); however, there was no statistically significant difference between the groups. Following a fenestrated partial cholecystectomy, postoperative bile leakage, fistula development, wound infection, and retained stones are more prevalent. Additionally, we saw that the fenestrated method was being used more frequently for post-operative endoscopic retrograde cholangiopancreatography (ERCP). The subtotal cholecystectomy technique used should be chosen according to the surgeon's comfort level and experience with the various techniques and intraoperative findings, even if the reconstituted procedure could be preferred when feasible. To completely understand the role of each method in the general surgeon's toolkit for treating complex gallbladder (GB) patients, longer-term follow-up studies are still necessary.

Evaluation of the Educational Quality of Endonasal Endoscopic Dacryocystorhinostomy Videos on YouTube with IVORY and LAP-VEGaS Guidelines.

Objective: The aim of this study was to evaluate the educational quality of endonasal endoscopic dacryocystorhinostomy (EE-DCR) videos on YouTube with Instructional Videos in Otorhinolaryngology by YO-IFOS (IVORY) and LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) guidelines and to evaluate the correlation of the 2 guidelines. Methods: EE-DCR videos were queried using search terms on YouTube. Views, likes, likes/dislikes ratio, age, and length of videos were noted. Videos were evaluated using the IVORY and LAP-VEGaS guidelines. Two IVORY scores were created: total (IVORY-1) and organ-specific (IVORY-2). The correlation analysis between video features and guideline scores was performed. Results: A total of 61 EE-DCR videos were evaluated. The mean score of LAP-VEGaS was 10.3 (±SD 2.7), the mean IVORY-1 score was 22.5 (±SD 5.5), and the mean IVORY-2 score was 10.6 (±SD 1.94). Correlation analysis revealed a statistically significant correlation between the IVORY-1 total score and the number of likes, the duration of the video, the age of the video, and the LAP-VEGaS score. Linear regression analysis showed that higher IVORY-1 scores predicted longer video duration, newer video age, and higher LAP-VEGaS scores. There was a significant association between LAP-VEGaS categories and the IVORY-1 total score (P < .001). Conclusion: The quality of EE-DCR videos is generally low to moderate. The IVORY and LAP-VEGaS guidelines were found to be correlated with each other. Both guidelines can be used to evaluate EE-DCR videos and otolaryngology surgical education videos in general. We believe that scales such as IVORY and LAP-VEGaS may be improved according to specific surgical procedures.

LC3-associated phagocytosis and human diseases: Insights from mechanisms to therapeutic potential.

LC3-associated phagocytosis (LAP) is a distinct type of autophagy that involves the sequestration of extracellular material by phagocytes. Beyond the removal of dead cells and cellular debris from eukaryotic cells, LAP is also involved in the removal of a variety of pathogens, including bacteria, fungi, and viruses. These events are integral to multiple physiological and pathological processes, such as host defense, inflammation, and tissue homeostasis. Dysregulation of LAP has been associated with the pathogenesis of several human diseases, including infectious diseases, autoimmune diseases, and neurodegenerative diseases. Thus, understanding the molecular mechanisms underlying LAP and its involvement in human diseases may provide new insights into the development of novel therapeutic strategies for these conditions. In this review, we summarize and highlight the current consensus on the role of LAP and its biological functions in disease progression to propose new therapeutic strategies. Further studies are needed to illustrate the precise role of LAP in human disease and to determine new therapeutic targets for LAP-associated pathologies.

Damping excessive viral-induced IFN-γ rescues the impaired anti-Aspergillus host immune response in influenza-associated pulmonary aspergillosis.

BACKGROUND: Influenza-associated pulmonary aspergillosis (IAPA) is a severe fungal superinfection in critically ill influenza patients that is of incompletely understood pathogenesis. Despite the use of contemporary therapies with antifungal and antivirals, mortality rates remain unacceptably high. We aimed to unravel the IAPA immunopathogenesis as a means to develop adjunctive immunomodulatory therapies. METHODS: We used a murine model of IAPA to investigate how influenza predisposes to the development of invasive pulmonary aspergillosis. Immunocompetent mice were challenged with an intranasal instillation of influenza on day 0 followed by an orotracheal inoculation with Aspergillus 4 days later. Mice were monitored daily for overall health status, lung pathology with micro-computed tomography (µCT) and fungal burden with bioluminescence imaging (BLI). At endpoint, high parameter immunophenotyping, spatial transcriptomics, histopathology, dynamic phagosome biogenesis assays with live imaging, immunofluorescence staining, specialized functional phagocytosis and killing assays were performed. FINDINGS: We uncovered an early exuberant influenza-induced interferon-gamma (IFN-γ) production as the major driver of immunopathology in IAPA and delineated the molecular mechanisms. Specifically, excessive IFN-γ production resulted in a defective Th17-immune response, depletion of macrophages, and impaired killing of Aspergillus conidia by macrophages due to the inhibition of NADPH oxidase-dependent activation of LC3-associated phagocytosis (LAP). Markedly, mice with partial or complete genetic ablation of IFN-γ had a restored Th17-immune response, LAP-dependent mechanism of killing and were fully protected from invasive fungal infection. INTERPRETATION: Together, these results identify exuberant viral induced IFN-γ production as a major driver of immune dysfunction in IAPA, paving the way to explore the use of excessive viral-induced IFN-γ as a biomarker and new immunotherapeutic target in IAPA. FUNDING: This research was funded by the Research Foundation Flanders (FWO), project funding under Grant G053121N to JW, SHB and GVV; G057721N, G0G4820N to GVV; 1506114 N to KL and GVV; KU Leuven internal funds (C24/17/061) to GVV, clinical research funding to JW, Research Foundation Flanders (FWO) aspirant mandate under Grant 1186121N/1186123 N to LS, 11B5520N to FS, 1SF2222N to EV and 11M6922N/11M6924N to SF, travel grants V428023N, K103723N, K217722N to LS. FLvdV was supported by a Vidi grant of the Netherlands Association for Scientific Research. FLvdV, JW, AC and GC were supported by the Europeans Union's Horizon 2020 research and innovation program under grant agreement no 847507 HDM-FUN. AC was also supported by the Fundação para a Ciência e a Tecnologia (FCT), with the references UIDB/50026/2020, UIDP/50026/2020, PTDC/MED-OUT/1112/2021 (https://doi.org/10.54499/PTDC/MED-OUT/1112/2021), and 2022.06674.PTDC (http://doi.org/10.54499/2022.06674.PTDC); and the "la Caixa" Foundation under the agreement LCF/PR/HR22/52420003 (MICROFUN).

Association of diabetic retinopathy with plasma atherosclerotic index, visceral obesity index, and lipid accumulation products: NHANES 2005-2008.

BACKGROUND: Abdominal obesity, a significant risk factor for the progression of diabetic retinopathy (DR), may lead to improved visual outcomes through early assessment. This study aims to evaluate any potential associations between DR and novel lipid metabolism markers, including the Atherogenic Index of Plasma (AIP), Visceral Adiposity Index (VAI), and Lipid Accumulation Product (LAP). METHODS: This study aimed to elucidate the association between various lipid markers and DR by screening the National Health and Nutrition Examination Survey (NHANES) database in the United States from 2005 to 2008. To examine the correlation, multifactor logistic regression analysis, subgroup analysis, threshold effect analysis, interaction test, and smooth curve fitting were used. RESULTS: Among the 2591 participants included, the incidence of DR was 13.6% and the mean age was 59.55 ± 12.26 years. After adjusting for important confounding covariates, logistic regression studies suggested a possible positive association between LAP, VAI, AIP, and DR occurrence (odds ratio [OR] = 1.004; 95% confidence interval [CI]: 1.002, 1.006; P < 0.0001; [OR] = 1.090; 95% [CI]: 1.037, 1.146; P = 0.0007; [OR] = 1.802; 95% [CI]: 1.240, 2.618; P = 0.0020). The nonlinear association between LAP and DR was further illustrated using an S-shaped curve by smoothing curve fitting, with the inflection point of the curve located at 63.4. Subgroup analyses and interaction tests were performed with full variable adjustment (P > 0.05 for all interactions). CONCLUSION: Studies have shown that elevated levels of LAP, VAI, and AIP increase the likelihood of DR, suggesting that they have the potential to be predictive markers of DR, emphasizing their potential utility in risk assessment and prevention strategies, and advocating for early intervention to mitigate the likelihood of DR.

The effects of environments and adhesive layer thickness on the failure modes of composite material bonded joints.

In this study, a structural adhesive was used to bond unidirectional prepreg and fiber fabric in a single lap joint. The mechanical properties of the structural adhesive were investigated under room temperature dry state (RTD) and elevated temperature wet state (ETW, 71 â„ƒ/85% RH), and different adhesive layer thicknesses (0.5 mm, 1.0 mm, 1.5 mm, and 2.0 mm). The fracture surfaces of the bonded joints were examined using scanning electron microscopy (SEM), and finite element simulations were conducted to observe the failure modes and failure paths. Additionally, the specimens were immersed in water and hydraulic oil, and their tensile shear strength was tested to evaluate their liquid sensitivity. The experimental results indicated that with increasing adhesive layer thickness, the strength of the specimens decreased by 21% in the RTD and by 52% in the ETW. The strength differences between different environments were minimal for adhesive layer thicknesses of 1 mm and 1.5 mm. The shear strength of the specimens decreased after immersion in water and hydraulic oil, with reductions of 43.78% and 39.21%, compared to the room temperature dry respectively. SEM observations of the bonded joint sections revealed that the primary failure modes were adherend failure and adhesive layer failure. Finite element simulations indicated that fiber tearing and crack initiation occurred in stress concentration areas during loading, leading to structural failure.

Evaluation of lap belt-pelvis load transfer in frontal impact simulations using finite element occupant models.

OBJECTIVE: The goal of this study was to examine the relationship between lap belt tension and force measured at the iliac wing and the effects of model type and torso posture on this relationship. From this analysis, preliminary transfer functions were developed to predict loads applied to the iliac wing as a function of lap belt tension at magnitudes typically measured in sled and vehicle crash tests. METHODS: A DOE study was conducted to provide a robust assessment of the lap belt-pelvis load relationship under various conditions. The GHBMC, THUMS, and THOR FE models were positioned in upright and reclined postures with several other intrinsic and extrinsic parameters varied for a total of 360 simulations. For the HBMs, instrumentation was developed to measure ASIS load at each iliac wing. Simulations that resulted in submarining were identified and removed from the subsequent development of lap belt-ASIS force transfer functions. RESULTS: The GHBMC exhibited submarining more frequently than the THUMS and THOR models. In addition to submarining, there were several cases in which the lap belt remained below the ASIS instrumentation or roped during the model's forward excursion. These phenomena, particularly prevalent in the THUMS model, also influenced how the lap belt engaged the ASIS instrumentation and were thus eliminated from the transfer function development. Transfer functions relating peak lap belt tension and corresponding ASIS force magnitudes were developed for the GHBMC and THOR models in upright and reclined postures. In the upright posture, the THOR showed a higher level of ASIS load measured for a given level of lap belt tension than the GHBMC; however, in recline the lap belt-pelvis load relationship was similar between the two models. CONCLUSIONS: The lap belt-pelvis load relationship was found to be affected by model type, posture, the area in which the ASIS instrumentation was defined, and occupant kinematics. This study showed it was possible to minimize the ASIS force by having the lap belt engage low on the pelvis and upper thighs, though further study is needed to determine if this loading mechanism is truly protective from an injury standpoint or an artifact of bypassing the ASIS instrumentation. The transfer function that showed the highest ASIS force measured for a given level of lap belt tension is recommended for future use.

Double-Sided Pressure-Sensitive Adhesive Materials under Human-Centric Extreme Environments.

Maintaining the adhesion strength of flexible pressure-sensitive adhesives (PSAs) is crucial for advanced applications, such as health monitoring. Sustainable mounting is critical for wearable sensor devices, especially under challenging surroundings such as low and high temperatures (e.g., polar regions or deserts), underwater and sweat environments (physical activity), and cyclical shear complex stresses. In this article, we consider the adhesive, mechanical, and optical properties of medical-grade double-sided PSAs by simulating extreme human-centric environments. Diverse temperature conditions, water and humidity exposures, and cyclical loads were selected and tested over long intervals, up to 28 days. We observed that high temperatures increased the shear adhesion strength due to the pore closing and expanding contact area between the adhesive layer and substrate. Conversely, low temperatures caused the adhesive layers to harden and reduce the adhesive strength. Immersion in salty and weakly acidic water and excessive humidity reduced adhesion as water interfered with the interfacial interactions. PSA films showed either adhesive or cohesive failure under extreme mechanical stresses and cyclical loading, which is also affected by the presence of various polar solvents. We demonstrated that the variable adhesive performance, mechanical properties, and optical transparency of pressure-sensitive materials can be directly related to changes in their morphologies, surface roughness, swelling state, and alternation of the mechanical contact area, helping to establish the broader rules of design for wearable human health monitoring sensors for the long-term application of wearable devices, sensors, and electrodes.

Study on Single Nucleotide Polymorphism of LAP3 Gene and Its Correlation with Dairy Quality Traits of Gannan Yak.

This study explored the polymorphism of the leucine aminopeptidase (LAP3) gene and its relationship with milk quality characteristics in Gannan yak. A cohort of 162 Gannan yak was genotyped utilizing the Illumina Yak cGPS 7K BeadChip, and the identified single nucleotide polymorphisms (SNPs) were evaluated for their association with milk protein, casein, lactose, and fat concentrations. The results showed that four SNPs (g.4494G > A, g.5919A > G, g.8033G > C, and g.15,615A > G) in the LAP3 gene exhibited polymorphism with information content values of 0.267, 0.267, 0.293, and 0.114, respectively. All four SNPs were in Hardy-Weinberg equilibrium (p > 0.05). The g.4494G > A and g.5919A > G SNPs were significantly associated with protein content (p < 0.05), with homozygous genotypes showing significantly higher protein content than heterozygous genotypes (p < 0.05). The g.8033G > C SNP was significantly associated with casein content, protein content, non-fat solids, and acidity (p < 0.05), with the CC genotype having significantly higher casein, protein, and non-fat solids content than the GG and GC genotypes (p < 0.05). The g.15,615A > G SNP was significantly associated with average fat globule diameter (p < 0.05). In general, the mutations within the LAP3 gene demonstrated a positive impact on milk quality traits in Gannan yak, with mutated genotypes correlating with enhanced milk quality. These results indicate that the LAP3 gene could be a significant or candidate gene affecting milk quality traits in Gannan yak and offer potential genetic markers for molecular breeding programs in this species.

Quality and Educational Value of YouTube Surgical Videos of Transurethral Resection of the Prostate: A Descriptive Cross-Sectional Study.

Introduction The aim of the study is to evaluate the quality and educational value of surgical videos on YouTube (Alphabet Inc., Mountain View, CA) demonstrating transurethral resection of the prostate (TURP). Methods A thorough YouTube search for "TURP" or "transurethral resection of the prostate" was performed. Each video's uploader, content, duration, date of upload, time since upload, views, comments, likes, and dislikes, and Video Power Index (VPI) scores were recorded and evaluated. Video analysis and rating followed the LAParoscopic Surgery Video Educational Guidelines (LAP-VEGaS) recommendations, which constitute nine items with values from 0 (absence) to 2 (complete presence). The guidelines' overall score can be 0 to 18. A higher score is indicative of a better level of educational value. Results There were a total of 43 videos included, 10 (23.3%) of which were academic publications. The average LAP-VEGaS score was 6.58, with 22 (51.2%), 18 (41.8%), and three (7%) videos classified as having low, medium, and high educational quality, respectively. None of the videos satisfied all the requirements outlined in the checklist. There was no statistically significant positive correlation observed between the educational score and the number of views. Conclusion A significant proportion of transurethral resection of the prostate (TURP) videos available on the YouTube platform exhibit limited educational value. Videos frequently lack comprehensive and in-depth descriptions of surgical operations. Those seeking information on TURP should carefully choose which videos to view. It is recommended that academic institutions establish comprehensive criteria aimed at enhancing the educational value of surgical videos on the YouTube platform.

Multi-Flap Microsurgical Autologous Breast Reconstruction.

Microsurgical autologous breast reconstruction (MABR) remains the gold standard technique of breast reconstruction, providing a durable, natural, and aesthetically pleasing result. However, some patients may not be candidates for a traditional deep inferior epigastric perforator (DIEP) flap, either due to abdominal tissue paucity, the need for higher-volume reconstruction, or prior surgical procedures. In these patients, alternative flaps must be considered to achieve the optimal result. Such configurations include the conjoined (or double pedicle) DIEP flap, and alternative flaps such as the lumbar artery perforator (LAP) and profunda artery perforator (PAP) flaps, which can be combined in a stacked fashion. By combining multiple flaps in a conjoined or stacked fashion, breast reconstruction can be optimized to fulfill the three critical components of breast reconstruction in restoring the skin envelope, breast footprint, and conus shape. When harvesting multiple flaps, the surgical sequence of events must be meticulously planned to ensure an efficient and successful operation. Preoperative imaging can aid the surgeon in identifying the ideal perforator, assess for side branches for possible intra-flap anastomoses, expedite the operative time, and decrease intraoperative complications. Reconstructive surgeons should be familiar with the variety of configurations with conjoined and/or stacked flaps to address patient-specific reconstructive needs.

A Retrospective Single-Center Comparative Study Between Robot-Assisted and Laparoscopic Radical Nephroureterectomy for Upper-Tract Urothelial Carcinoma on Perioperative Results, Overall Survival, and Recurrence Rate.

Introduction Patients with localized high-risk urothelial carcinoma of the upper urinary tract are advised radical nephroureterectomy, the surgical removal of the kidney and ureter, utilizing robot-assisted versus laparoscopic methods. This study aims to compare the surgical and oncological results of robot-assisted and laparoscopic radical nephroureterectomy for upper-tract urothelial carcinoma. Methods An observational retrospective cohort study compared 14 patients who had robotic-assisted nephroureterctomy (RAN) to 16 patients who had laparoscopic assisted nephroureterctomy (LAN). Results There was no significant difference in age, sex, glomerular filtration rate (GFR), creatinine, Charlson comorbidity score, length of hospital stays, or the need to convert to an open approach. However, there was a statistical difference between the two procedures in terms of lymph dissection (p-value of 0.037) and the length of the procedure (p-value of 0.09). Conclusions The robotic approach has significantly higher use for lymph node dissection, while laparoscopic radical nephroureterectomy has a shorter operation time.

Saturation Effect of Lipid Accumulation Product (LAP) Index on Spinal Bone Mineral Density: A Population-Based Study.

Lipid accumulation product (LAP) has a positive effect on spinal bone mineral density (BMD). However, once LAP levels exceed 27.26, the rate of spinal BMD increase slow down or even decline. This indicates a biphasic relationship between lipid metabolism and BMD, suggesting potential benefits within a certain range and possible adverse effects beyond that range. This study aimed to investigate the potential association between LAP index and BMD in US adults, as well as to explore the presence of a potential saturation effect in this relationship. This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2007 to 2018. A multiple stepwise regression model was employed to examine the association between LAP index and total spinal BMD. Additionally, a generalized additive model and a smooth curve fitting algorithm were utilized to examine the relationship, and saturation effect study was conducted to determine the saturation level. The calculation formula of LAP used in the study was: (LAP = (waist circumstances (WC) (cm) - 58) × triglyceride (TG) (mmol/L)) for women, and (LAP = (WC (cm) - 65) × TG (mmol/L)) for men. The study involved a total of 7913 participants aged 20 years or older. Through multiple stepwise regression analysis, it was found that individuals with higher LAP scores exhibited higher total spinal BMD. In both the crude and partially adjusted models, total spinal BMD was significantly higher in the highest LAP quartile (Q4) compared to the lowest LAP quartile (Q1) (P < 0.05). Utilizing a generalized additive model and smooth curve, a nonlinear relationship between LAP and total spinal BMD was observed. Furthermore, the study identified the saturation value of LAP to be 27.26, indicating a saturation effect. This research highlights a nonlinear relationship between LAP and total spinal BMD, along with the presence of a saturation effect.

Lap-re-Do Keyhole versus Lap-re-Do Sugarbaker techniques in large parastomal hernia repair: a retrospective cohort study.

PURPOSE: To review the safety and efficacy of Lap-re-Do technique in the treatment of large parastomal hernia. METHODS: We retrospectively analyzed the recurrence and complications of 81 patients with large parastomal hernia who underwent Lap-re-Do technique in Huashan Hospital of Fudan University from May 2010 to December 2019. And the patients should be able to complete follow-up. With such criteria, we included 40 Lap-re-Do Keyhole patients and 41 Lap-re-Do Sugarbaker patients. Observation time was defined as time to recurrence, death, or last nonevent visit. RESULTS: In large parastomal hernias, Lap-re-Do had a recurrence rate of 25.9% and complication rate of 16.0%, and reoperation rate of 9.9% during the average follow-up time of 41.1 ± 17.8 months. Recurrence rates were 40% (16/40) after Lap-re-Do Keyhole repair and 12.2% (5/41) after Lap-re-Do Sugarbaker repair. Complication rates were 12.5% after Lap-re-Do keyhole and 19.5% after Lap-re-Do Sugarbaker repair Re-operation rates referred to Lap-re-Do keyhole repair were 15% and Lap-re-Do Sugarbaker repair 4.9% during follow-up.The majority of reoperations were indicated by recurrence. CONCLUSIONS: Large parastomal hernias are still difficult to be treated. Lap-re-Do Sugarbaker is recommended as an appropriate procedure to close the hernia ring, removing the lengthy colostomy, and effectively reduce recurrence and complication rates.

Comparative Analysis of Learning Curves in Robotic Versus Laparoscopic Cholecystectomy: A Systematic Review.

Robotic surgery has undergone much development and increased use over the years; it has offered many benefits for the operating surgeon compared to the more restrictive nature of conventional laparoscopic surgery (CLS) which is the current standard of care. However, to the best of our knowledge, no studies have attempted to draw a comparison between the two in terms of the cases required for the learning curve to be achieved. The systematic review was performed at Barts Cancer Institute. A search of Cochrane, PubMed and Embase was made on 15 March 2024. Screening and risk of bias were done by two reviewers. Screening was done via the eligibility criteria by two reviewers. Data collection was done using Excel (Microsoft® Corp., Redmond, USA) and information was double-checked by another reviewer and transferred into a tabulated format. Seventeen studies were included, with the learning curve reported in 14 studies. The cases required to achieve the learning curve for multiport robotic cholecystectomy (MRC) ranged from 16 to 134 and for single-site robotic cholecystectomy (SSRC), it ranged from 10 to over 102 cases. Conventional laparoscopic cholecystectomy (CLC) was from 7 to 200. The improvement in operating times was measured in very different ways and was reported in 10 of the 17 studies. The studies that were available had a high level of heterogeneity making it difficult for comparisons to be made between studies. Several studies included only one surgeon resulting in the sample size of surgeons being too small and vulnerable to bias. As robotic surgery is still relatively novel, higher-quality studies have to be made in order for more conclusive conclusions to be made on the benefits of the learning curve of MRC and SSRC.

A Study of the Effects of Moisture on Composite-to-Metal Double-Lap Shear Joints.

This work investigated the effects of moisture absorption treatment on composite-to-metal double-lap shear joints (DLSJs) bonded with epoxy adhesive film through experiments and simulations. The composite-to-metal DLSJ can be divided into five parts (the interface between the composite and adhesive, the interface between the adhesive and metal, the composite adherend, the metal adherend, and the adhesive layer). First, the wet-dependent properties of the adhesive and interfaces were obtained through adhesive tensile tests and GC tests, which showed that the properties of the adhesive and interfaces were significantly affected by the moist environment. Then, tensile tests of the composite-to-metal double-lap shear joints were carried out in dry and wet environments. Finally, based on the experimental investigations, a finite element (FE) model that considered cohesive damage was established for simulating damage evolution and predicting the failure loads and failure modes of the DLSJs. The results of both the experimental and numerical tests show that the DLSJ failure load decreases significantly after immersion in 95 °C water, and the major failure mode transfers from adhesive failure to interface failure. The research results provide a theoretical basis or basic data for the structural design of adhesively bonded composite-to-metal.

Robotic Removal of Spilled Gallstones After Laparoscopic Cholecystectomy: Resolving Chronic Abdominal Pain Using New Technology.

Spilled gallstones during laparoscopic cholecystectomy can potentially lead to serious complications in patients. We present a case of a patient with gallstone spillage during cholecystectomy who was found years later to have gallstones stuck in a difficult location, requiring robotic surgery. A robotic approach allows for greater visual angles compared to conventional laparoscopy. The patient tolerated the robotic procedure successfully, and no patient symptoms were reported during follow-up. This case addresses retained gallstones for difficult anatomical positions and confirms that a robotic abdominal approach is a safe, minimally invasive option.

Ultrasound-Guided External Oblique Intercostal Block as Part of Multimodal Analgesia for Unplanned Open Cholecystectomy.

We present the case of a 56-year-old female with a significant medical history of cholelithiasis and recurrent choledocholithiasis. Following an elective cholecystectomy, an obstructing gallstone in the common bile duct led to a series of interventions, including endoscopic retrograde cholangiopancreatography and stent placement. The patient was scheduled for a robot-assisted laparoscopic common bile duct exploration. Due to severe adhesions, the procedure was converted to open with a large right upper quadrant incision. Intraoperative continuous external oblique block and catheter placement were performed at the end of surgery in the OR. Peripheral nerve blocks have become an integral part of multimodal pain management strategies. This case report describes the successful implementation of an ultrasound-guided right external oblique intercostal block and catheter placement for postoperative pain control and minimization of opioids. This case highlights the efficacy and safety of ultrasound-guided peripheral nerve blocks for postoperative pain management. Successful pain control contributed to the patient's overall postoperative recovery.

The relationship between depression and lipid accumulation product: a population-based study.

Background: Lipid Accumulation Product (LAP) is a new type of obesity index. The relationship between LAP and depression is unclear, and this cross-sectional study was conducted to explore the relationship between LAP and depression using the National Health and Nutrition Examination Survey (NHANES) database from 2005-2018. Methods: In our study, logistic regression analysis was used to calculate the odds ratio between depression and LAP, and subgroup analysis and sensitivity analysis were also performed to verify the robustness of the results. Results: The analysis included 13,240 participants aged 20 years or older. After adjusting for multiple variables, LAP was positively associated with depression, OR 1. 50 (95% CI, 1. 05-2. 12). In subgroup analysis, LAP was significantly positively, associated with depression among male (2. 52, OR; 95% CI, 1. 39,4. 57), non-Hispanic Black (2. 55, OR; 95% CI, 1. 49,4. 36), those without diabetes (1. 67, OR; 95% CI, (1. 06,2. 61) or in the overweight (2. 09, OR; 95% CI, (1. 23,3. 54) subgroups. After inverse probability of treatment weighting (IPTW), the OR for the highest versus lowest quartile was 1. 55 (95% CI: 1. 24 - 1. 95). Conclusion: There are positive results between LAP and depression after adjusting for multiple potential variables, and prospective studies are needed to verify the results.

Assessment of Non-canonical Functions of the Autophagy Proteins in LC3-Associated Phagocytosis and LC3-Associated Endocytosis.

The identification and characterization of noncanonical functions within the autophagy pathway have unveiled intricate cellular processes, including LC3-associated phagocytosis (LAP) and LC3-associated endocytosis (LANDO). These phenomena play pivotal roles in the conjugation of ATG8 with single-membrane phagosomes and endosomes, shedding light on the dynamic interplay between autophagy and cellular homeostasis. Here, we present detailed protocols for both qualitative and quantitative assessment of LAP, including immunofluorescence, flow cytometry, and Western blotting of isolated LAPosomes. Additionally, the protocol for the evaluation of LANDO through immunofluorescent detection of receptor recycling is outlined. The methodologies presented herein serve as a practical guide for researchers seeking to unravel the intricacies of LAP and LANDO. By providing step-by-step instructions, accompanied by insights into potential challenges and optimization strategies, this chapter aims to empower investigators in the exploration of these noncanonical functions of autophagy proteins.