STOmicsDB: a comprehensive database for spatial transcriptomics data sharing, analysis and visualization.

Recent technological developments in spatial transcriptomics allow researchers to measure gene expression of cells and their spatial locations at the single-cell level, generating detailed biological insight into biological processes. A comprehensive database could facilitate the sharing of spatial transcriptomic data and streamline the data acquisition process for researchers. Here, we present the Spatial TranscriptOmics DataBase (STOmicsDB), a database that serves as a one-stop hub for spatial transcriptomics. STOmicsDB integrates 218 manually curated datasets representing 17 species. We annotated cell types, identified spatial regions and genes, and performed cell-cell interaction analysis for these datasets. STOmicsDB features a user-friendly interface for the rapid visualization of millions of cells. To further facilitate the reusability and interoperability of spatial transcriptomic data, we developed standards for spatial transcriptomic data archiving and constructed a spatial transcriptomic data archiving system. Additionally, we offer a distinctive capability of customizing dedicated sub-databases in STOmicsDB for researchers, assisting them in visualizing their spatial transcriptomic analyses. We believe that STOmicsDB could contribute to research insights in the spatial transcriptomics field, including data archiving, sharing, visualization and analysis. STOmicsDB is freely accessible at https://db.cngb.org/stomics/.

Role and mechanism of PVN-sympathetic-adipose circuit in depression and insulin resistance induced by chronic stress.

Chronic stress induces depression and insulin resistance, between which there is a bidirectional relationship. However, the mechanisms underlying this comorbidity remain unclear. White adipose tissue (WAT), innervated by sympathetic nerves, serves as a central node in the interorgan crosstalk through adipokines. Abnormal secretion of adipokines is involved in mood disorders and metabolic morbidities. We describe here a brain-sympathetic nerve-adipose circuit originating in the hypothalamic paraventricular nucleus (PVN) with a role in depression and insulin resistance induced by chronic stress. PVN neurons are labelled after inoculation of pseudorabies virus (PRV) into WAT and are activated under restraint stress. Chemogenetic manipulations suggest a role for the PVN in depression and insulin resistance. Chronic stress increases the sympathetic innervation of WAT and downregulates several antidepressant and insulin-sensitizing adipokines, including leptin, adiponectin, Angptl4 and Sfrp5. Chronic activation of the PVN has similar effects. ß-adrenergic receptors translate sympathetic tone into an adipose response, inducing downregulation of those adipokines and depressive-like behaviours and insulin resistance. We finally show that AP-1 has a role in the regulation of adipokine expression under chronic stress.

The effect of aromatic side chains on the dilational rheological properties of N-acyltaurate amphiphiles at water-decane interfaces.

To elucidate the effect of aromatic side chains on dilational rheological properties of N-acyltaurate amphiphiles at the decane-water interface, the interfacial rheological properties of sodium N-2-(2-naphthoxy)-tetradecanoyltaurinate (12+N-T) and sodium N-2-(p-butylphenoxy)-tetradecanoyltaurinate (12+4B-T) were investigated utilizing the drop shape analysis method. The effects of adsorption time, interfacial pressure, oscillating frequency, and bulk concentration on the interfacial dilational modulus and phase angle were explored. The results show that the 12+4B-T molecule with a longer hydrophobic chain shows a higher ability for reducing the interfacial tension (IFT). In addition, the interfacial films of both 12+N-T and 12+4B-T are dominated by diffusion exchange at high concentrations. The rigidity of molecules controls the diffusion exchange at low concentrations, while the molecular hydrodynamic radius determines the diffusion exchange at high concentrations. Thus, at low concentrations, the stronger intermolecular interaction between 12+4B-T molecules results in higher dilational modulus values than 12+N-T. When approaching the CMC (critical micelle concentration) value, the rapid diffusion exchange of 12+4B-T between the sublayer micelles and the interface causes a significant decrease in the dilational modulus, while the relatively rigid structure of 12+N-T enables a higher dilational modulus than 12+4B-T. What's more, the longer hydrophobic chain allows 12+4B-T molecules to escape from the interface more easily, resulting in a higher phase angle at low concentrations. However, the diffusion exchange of 12+4B-T is slower than that of 12+N-T, which results in lower phase angles for 12+4B-T than 12+N-T at high concentrations. In general, the introduction of a rigid naphthalene ring in the molecular structure gives the interfacial film greater strength at high concentration. The research results in this paper provide a new technique for the strength regulation of interfacial surfactant adsorption films.

Microbial Sources and Sinks of Nitrous Oxide during Organic Waste Composting.

Composting is widely used for organic waste management and is also a major source of nitrous oxide (N2O) emission. New insight into microbial sources and sinks is essential for process regulation to reduce N2O emission from composting. This study used genome-resolved metagenomics to decipher the genomic structures and physiological behaviors of individual bacteria for N2O sources and sinks during composting. Results showed that several nosZ-lacking denitrifiers in feedstocks drove N2O emission at the beginning of the composting. Such emission became negligible at the thermophilic stage, as high temperatures inhibited all denitrifiers for N2O production except for those containing nirK. The nosZ-lacking denitrifiers were notably enriched to increase N2O production at the cooling stage. Nevertheless, organic biodegradation limited energy availability for chemotaxis and flagellar assembly to restrain nirKS-containing denitrifiers for nitrate reduction toward N2O sources but insignificantly interrupt norBC- and nosZ-containing bacteria (particularly nosZ-containing nondenitrifiers) for N2O sinks by capturing N2O and nitric oxide (NO) for energy production, thereby reducing N2O emission at the mature stage. Furthermore, nosZII-type bacteria included all nosZ-containing nondenitrifiers and dominated N2O sinks. Thus, targeted strategies can be developed to restrict the physiological behaviors of nirKS-containing denitrifiers and expand the taxonomic distribution of nosZ for effective N2O mitigation in composting.

JinJiang ablation catheter is no inferior than Johnson ablation catheter in radiofrequency ablation of paroxysmal supraventricular tachycardia.

BACKGROUND: Paroxysmal supraventricular tachycardia (PSVT) is characterized by episodes of rapid tachycardia with sudden onset and sudden termination. PSVT treatment has evolved considerably over the past 30 years. Currently, radiofrequency catheter ablation is the first-line treatment. HYPOTHESIS: We conducted a randomized controlled trial to compare safety and effectiveness of PSVT ablation between the Jinjiang and Johnson (J&J) catheters in 57 patients in our hospital. METHODS AND RESULTS: Patients were randomly assigned to ablation procedures using either the Jinjiang system or the J&J Carto system. Follow-up was performed 3 days, 1, and 6 months after the procedure. Success rate, ablation time, frequency of ablation, and rates of complications and recurrence did not significantly differ between the groups. One Jinjiang group patient (3.6%) experienced arrhythmia recurrence during the 6-month follow-up. CONCLUSIONS: The Jinjiang catheter for radiofrequency ablation of PSVT is as safe and effective as the J&J catheter.

WITHDRAWN: TWIST2 inhibits EMT and induces oxidative stress in lung cancer cells by regulating the FGF21-mediated AMPK/mTOR pathway.

This article has been withdrawn: please see Elsevier Policy on Article Withdrawal (https://www.elsevier.com/about/policies/article-withdrawal). This Expression of Concern has been withdrawn at the request of the editor and publisher after that the authors have approved the proofs of their requested corrigendum. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Multi-stage aeration regime to regulate organic conversion toward gas alleviation and humification in food waste digestate composting.

Aerobic composting has been considered as a pragmatic technique to convert food waste digestate into high-quality biofertiliser. Nevertheless, massive gaseous emission and immature product remain the primary challenges in food waste digestate composting. Thus, the performance of multi-stage aeration regimes to improve gaseous emissions and organic humification during food waste digestate composting was investigated in this study. In addition to continuous aeration with a constant intensity of 0.3 L kg·dry mass (DM)-1·min-1, two multi-stage decreased aeration regimes were designed as "0.3-0.2-0.1" and "0.3-0.1-0.1" L·kg·DM-1·min-1 from the thermophilic to cooling and then mature stages, respectively. Results showed that the decreased aeration regimes could alleviate nitrous oxide (N2O) and ammonia (NH3) emission and slightly enhance humification during composting. The alleviated N2O and NH3 emission were mainly contributed by abiotically reducing gaseous release potential as well as biotically inactivating denitrifers (Pusillimonas and Pseudidiomarina) and proliferating Atopobium to reduce nitrate availability under lower aeration supply. The "0.3-0.2-0.1 L kg·DM-1·min-1" regime exhibited a more excellent performance to alleviate N2O and NH3 emission by 27.5% and 16.3%, respectively. Moreover, the decreased aeration regimes also favored the enrichment of functional bacteria (Caldicoprobacter and Syntrophomonas) to accelerate lignocellulosic biodegradation and thus humic acid synthesis by 6.5%-11.2%. Given its better performance to improve gaseous emissions and humification, the aeration regime of "0.3-0.2-0.1 L kg·DM-1·min-1" are recommended in food waste digestate composting in practice.

Wetting effect of branched anionic Gemini surfactant aqueous solution on PMMA surface.

In this paper, the adsorption behaviour and wetting modification ability of the sodium salts of bis-octadecenoyl succinate (GeminiC3, GeminiC6) and monomers on polymethyl methacrylate (PMMA) surfaces were investigated. The difference in spacer length led to slightly different behaviour of surfactant molecules in solution. The large molecular structure and short flexible spacer of GeminiC3 led to a complex self-aggregation behaviour in solution, forming micelles at low concentrations, leading to a rapid decrease in surface tension and subsequent transition to monolayer or multilayer vesicles. In GeminiC6, the longer flexible spacer groups act as spatial structure modifiers that hinder the formation of vesicles. The adsorption behaviour of the gas-liquid interface was analysed in three stages for the peculiar inflection points where surface tension appears. Combining contact angle measurements, adhesion tension and interfacial tension data showed that GeminiC3 and C6 formed a saturated monolayer on the adsorbed PMMA surface at low concentrations and a bilayer structure at high concentrations. Due to the low resistance of molecular space sites, the monomers adsorbed heavily on the PMMA surface, forming semi-colloidal aggregates with the lowest contact angle of monomeric surfactant solutions reaching 38° on the PMMA surface. Also, the monomer and GeminiC3 and C6 surfactants in this paper have a very high hydrophilic modification ability on the PMMA surface compared to other literature.

Laparoscopic Ladd's procedure for intestinal malrotation in small infants with midterm follow-up.

BACKGROUND: The objective of this study was to evaluate the safety and efficacy of laparoscopic Ladd's procedure (LL) for intestinal malrotation (IM) in small infants. METHODS: All patients aged < 6 months with IM who underwent Ladd's procedures between January 2012 and December 2019 were enrolled. The perioperative demographics and midterm follow-up results were retrospectively reviewed and compared between patients who underwent LL and open Ladd's operation (OL). RESULTS: Fifty-five patients were enrolled for analysis. The baseline characteristics were well matched in the two groups. The rate of volvulus was similar in the two groups (76.2% vs. 73.5%, P = 0.81). Two cases in the LL group were converted to OL due to intraoperative bleeding and intestinal swelling. The operative time (ORT) was not significantly different between the two groups (73.8 ± 18.7 vs. 66.8 ± 11.6 min, P = 0.76). Compared to the OL group, the LL group had a shorter time full feed (TFF) (3.1 ± 1.2 vs. 7.3 ± 1.9 days, P = 0.03) and a shorter postoperative hospital stay (PHS) than the OL group (5.5 ± 1.6 vs. 11.3 ± 2.7 days, P = 0.02). The rate of postoperative complications was similar in the two groups (9.5% vs. 11.8%, P = 0.47). The LL group had a lower rate of adhesive obstruction than the OL group, but the difference was not significant (0.0% vs. 11.8%, P = 0.09). One patient suffered recurrence in the LL group, while 0 patients suffered recurrence in the OL group (4.8% vs. 0.0%, P = 0.07). The rate of reoperation in the two groups was similar (4.8% vs. 8.8%). CONCLUSIONS: The LL procedure for IM in small infants was a safe and reliable method that had a satisfactory cosmetic appearance and shorter TFF and PHS than OL.

The strategy of laparoscopic surgery for asymptomatic antenatally diagnosed choledochal cyst.

BACKGROUND: The aim was to investigate the characteristics, surgical management, and outcomes of asymptomatic patients with antenatally diagnosed choledochal cysts (ADCCs) and to justify the strategy of laparoscopic surgery (LS) for them in our hospital. METHODS: We developed our LS strategy for asymptomatic ADCCs. Patients with asymptomatic ADCCs who underwent LS or open surgery (OS) during January 2010 and January 2020 were included. Patients with recorded symptomatic ADCCs were exclude. All data of group LS and group OS were statistically compared and analyzed. RESULTS: Twenty-five patients received LS and 18 patients received OS were included. There was no significant difference in baseline characteristics between the groups. A total of 65.1% of biliary sludge formation was detected preoperatively by ultrasonography (US) (72.0% in group LS, 55.6% in group OS, P = 0.26). Compared to the OS group, the LS group had a longer operative time (313.4 ± 27.2 vs. 154.0 ± 11.9 min, P = 0.02), shorter postoperative fasting period (3.1 ± 1.2 vs. 6.2 ± 2.3 days, P = 0.03), and shorter postoperative hospital stay (5.1 ± 1.9 vs. 9.2 ± 1.1 days, P = 0.03). The incidence of late complications, such as reflux cholangitis, adhesive intestinal obstruction, and biliary enteric anastomotic stricture with stone formation, was not significantly different between the two groups. The liver function and liver stiffness of all patients in the two groups were normal. CONCLUSIONS: Based on the strategy for asymptomatic ADCCs in our hospital, the perioperative safety and midterm follow-up results after LS were satisfactory and comparable to those after OS.

Dysfunction of Prkcaa Links Social Behavior Defects with Disturbed Circadian Rhythm in Zebrafish.

Protein kinase Cα (PKCα/PRKCA) is a crucial regulator of circadian rhythm and is associated with human mental illnesses such as autism spectrum disorders and schizophrenia. However, the roles of PRKCA in modulating animal social behavior and the underlying mechanisms remain to be explored. Here we report the generation and characterization of prkcaa-deficient zebrafish (Danio rerio). The results of behavioral tests indicate that a deficiency in Prkcaa led to anxiety-like behavior and impaired social preference in zebrafish. RNA-sequencing analyses revealed the significant effects of the prkcaa mutation on the expression of the morning-preferring circadian genes. The representatives are the immediate early genes, including egr2a, egr4, fosaa, fosab and npas4a. The downregulation of these genes at night was attenuated by Prkcaa dysfunction. Consistently, the mutants demonstrated reversed day-night locomotor rhythm, which are more active at night than in the morning. Our data show the roles of PRKCA in regulating animal social interactions and link the social behavior defects with a disturbed circadian rhythm.

The Interfacial Dilational Rheology Properties of Betaine Solutions: Effect of Anionic Surfactant and Polymer.

Interfacial dilational rheology is one of the important means to explore the interfacial properties of adsorption films. In this paper, the interfacial rheological properties of the mixed system of sulfobetaine ASB with a linear alkyl group and two anionic surfactants, petroleum sulfonate (PS) and alkyl polyoxyethylene carboxylate (AEC), were investigated by interfacial dilational rheology. The effect of the introduction of polymer hydrophobically modified polyacrylamide (HMPAM) on the interfacial properties of the mixed system was analyzed. In this experiment, the surfactant solution was used as the external phase and n-decane was used as the internal phase. A periodic sinusoidal disturbance of 0.1 Hz was applied to the n-decane droplets, and the changes of parameters such as droplet interfacial tension and interfacial area were monitored in real time with the help of a computer. The results show that the betaine ASB molecule responds to the dilation and compression of the interface through the change of ion head orientation, while the feedback behavior of petroleum sulfonate PS and AEC molecules embedded with oxygen vinyl groups in the molecule is diffusion and exchange between the interface and the bulk phase. Therefore, the interface film formed by ASB alone is higher, and the film formed by PS and AEC molecules alone is relatively lower. After adding two kinds of anionic surfactants to the betaine system, the ionic head of PS or AEC molecules will be attached to the positive center of the hydrophilic group of ASB molecules by electrostatic attraction and no longer adsorb and desorb with the interface deformation. The interfacial rheological properties of the compound system are still dominated by betaine, with higher dilational modulus and lower phase angle. When a small amount of HMPAM is added, or the content of hydrophobic monomer AMPS in the bulk phase is low, the intermolecular interaction at the interface is enhanced, the slow relaxation process is intensified, and the interfacial film strength is increased. As the content of AMPS further increases, hydrophobic blocks and surfactant molecules will form interfacial aggregates similar to mixed micelles at the oil-water interface, which will regulate the properties of the film by affecting the adsorption of surfactants at the interface. As long as the interfacial tension is the same, the properties of the interfacial film are the same. Based on the colloid interface science and the background of enhanced oil recovery, this study provides a reference for the field application of chemical flooding formulations.

The Study of Interfacial Adsorption Behavior for Hydroxyl-Substituted Alkylbenzene Sulfonates by Interfacial Tension Relaxation Method.

In order to explore the interface adsorption mechanism of hydroxyl-substituted alkylbenzene sulfonates, the interfacial tension relaxation method was used to investigate the dilational rheology properties of sodium 2-hydroxy-3-octyl-5-octylbenzene sulfonate (C8C8OHphSO3Na) and sodium 2-hydroxy-3-octyl-5-decylbenzene sulfonate (C8C10OHphSO3Na) at the gas-liquid interface and oil-water interface. The effect of the length of the hydroxyl para-alkyl chain on the interfacial behavior of the surfactant molecules was investigated, and the main controlling factors of the interfacial film properties under different conditions were obtained. The experimental results show that for the gas-liquid interface, the long-chain alkyl groups adjacent to the hydroxyl group in the hydroxyl-substituted alkylbenzene sulfonate molecules tend to extend along the interface, showing strong intermolecular interaction, which is the main reason why the dilational viscoelasticity of the surface film is higher than that of ordinary alkylbenzene sulfonates. The length of the para-alkyl chain has little effect on the viscoelastic modulus. With the increase in surfactant concentration, the adjacent alkyl chain also began to extend into the air, and the factors controlling the properties of the interfacial film changed from interfacial rearrangement to diffusion exchange. For the oil-water interface, the presence of oil molecules will hinder the interface tiling of the hydroxyl-protic alkyl, and the dilational viscoelasticity of C8C8 and C8C10 will be greatly reduced relative to the surface. The main factor controlling the properties of the interfacial film is the diffusion exchange of surfactant molecules between the bulk phase and the interface from the beginning.

Semiconductor saturable absorber mirror in the 3-5†µm mid-infrared region.

Semiconductor saturable absorber mirrors (SESAMs) have been regarded as a revolutionary technology for ultrafast mode-locked lasers, producing numerous landmark laser breakthroughs. However, the operating wavelength of existing SESAMs is limited to less than 3 µm. In this study, we create a 3-5 µm mid-infrared (MIR) SESAM by engineering an InAs/GaSb type-II superlattice. Bandgap engineering and the strong coupling between potential wells in a superlattice enable a broadband response of saturable absorption in the 3-5 µm spectral range. Using the fabricated SESAM, we realize a SESAM mode-locked Er:ZBLAN fiber laser at 3.5 µm, which delivers MIR ultrashort pulses with high long-term stability. The breakthrough of SESAM fabrication in the MIR will promote the development of MIR ultrafast coherent sources and related application fields.

TWIST2 inhibits EMT and induces oxidative stress in lung cancer cells by regulating the FGF21-mediated AMPK/mTOR pathway.

Twist related protein 2 (TWIST2) plays an important role in bone development, tumorigenesis, tumour progression and epithelial mesenchymal transition (EMT). At present, there are few reports about the role of TWIST2 in lung cancer, which need to be further explored. Therefore, the purpose of this study is to explore the role and molecular mechanism of TWIST2 in the occurrence and development of lung cancer. The expression of TWIST2 in tissues of patients and cell lines was measured using RT-qPCR and western blotting. MTT and CCK8 assays were used to detect cell proliferation and viability. Western blotting was used to measure the expression of EMT-related proteins, including E-cadherin, N-cadherin, Vimentin and Slug. The results revealed that TWIST2 is lowly expressed in the tissues of lung cancer patients and cell lines. Further studies found that overexpression of TWIST2 significantly induced apoptosis and promoted the expression of E-cadherin, as well as inhibiting the expression of N-cadherin, Vimentin and Slug. More importantly, TWIST2 induced oxidative stress in lung cancer cells. In addition, TWIST2 regulated the FGF21 and AMPK/mTOR signalling pathway, which is involved in the molecular mechanism of the gene in lung cancer cells. We suggest that the mechanism of TWIST2 inhibition of the progression of lung cancer is by regulating the FGF21-mediated AMPK/mTOR signalling pathway.

Transumbilical single-site two incision laparoscopic pyloromyotomy for pediatric hypertrophic pyloric stenosis.

PURPOSE: A new novel technique for the treatment of pediatric hypertrophic pyloric stenosis (HPS), transumbilical single-site laparoscopic pyloromyotomy with a single instrument (TUSSLP), was introduced. TUSSLP was compared with the transabdominal three-site laparoscopic pyloromyotomy (TATSLP) procedure. METHODS: Patients with HPS who underwent TUSSLP and TATSLP between January 2016 and September 2020 were assigned to group A and group B, respectively. The descriptive variables, perioperative clinical characteristics and postoperative follow-up results were retrospectively analyzed and compared between the 2 groups. The primary outcome of this study was the rate of switching to conventional pyloromyotomy. RESULTS: Sixty-four patients were enrolled in this study. Of these patients, 29 (22 males, 7 females, 54.4 ± 22.6 days) who received TUSSLP were assigned to group A. The remaining 35 (28 males, 7 females, 54.5 ± 27.6 days) who received TATSLP were assigned to group B. The data of preoperative patient variables were comparable between the 2 groups (P > 0.05). The mean operative time (ORT) was 28.1 ± 5.6 min in group A, which was not significantly different from 25.8 ± 3.1 min in group B (P = 0.25). The other perioperative features were not significantly different between the 2 groups (P > 0.05). During follow-up (39.1 ± 14.7 m in group A and 35.4 ± 16.1 m in group B, P = 0.51), no significant difference was observed in the overall incidence of vomiting between the 2 groups (P = 0.26). CONCLUSIONS: TUSSLP is a feasible and reliable minimally invasive method for HPS. It has the advantages of an improved cosmetic appearance. The postoperative follow-up results of TUSSLP are comparable with those of TATSLP.

Microtia Part II: Post-Operation and Complications Management Lessons from 1012 Ear Reconstruction Operations.

BACKGROUND: Ear reconstruction presents challenges for surgeons, not only during the pre-operation and in-operation stages, but also post-operation. The post-operation stage and the treatment of complications are critical to the overall success of ear reconstruction surgery. METHODS: This article, the second of two articles setting out details and precautions for each step of the ear reconstruction process for microtia patients, covers post-operative care: negative pressure drainage, bandaging and fixing, nursing, treatment of complications and satisfaction survey. RESULTS: Over the period Jan 2015-July 2021, our surgical team treated 77 complications in 1012 microtia ear reconstructions. This article presents the key learnings from this high volume of operations. All complications were treated promptly and the shape of the auricle was preserved as much as possible. Patients were surveyed after the operation and expressed satisfaction with the shape of the reconstructed external auricle. Three typical cases involving different types of complications are described. CONCLUSIONS: This article deals in detail with the post-operation stage. We share our cumulative surgical experience gained over 20 years, especially the latest practical lessons gleaned over the last six and a half years. LEVEL OF EVIDENCE II: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266 .

Microtia Part I: Preoperation and In-operation Lessons from 1012 Ear Reconstruction Operations.

BACKGROUND: Organ reconstruction is one of the most challenging tasks in plastic and reconstructive surgery. This is particularly true of ear reconstruction, which requires enormous attention to detail. METHODS: In the first of two articles, we set out details and precautions for each step of the preoperative and intraoperative stages of the ear reconstruction process for microtia patients. We cover preoperative screening and assessment of surgical conditions, the design of intraoperative incisions, flap separations, costal cartilage extraction, framework carving and cranial ear angle surgery. RESULTS: Over the period Jan 2015-July 2021, our surgical team carried out 1012 microtia ear reconstructions, at the rate of 3-4 per week. This article presents the key learnings from this high volume of operations. Two typical cases involving different types of microtia are presented in order to illustrate the process of total ear reconstruction. CONCLUSIONS: This article describes in detail the preoperative and intraoperative stages of the ear reconstruction process. We share our cumulative surgical experience gained over 20 years, especially the latest practical lessons gleaned over the last six and a half years. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

The short-term outcome of modified laparoscopic Kasai portoenterostomy for biliary atresia.

OBJECTIVES: Laparoscopic Kasai portoenterostomy (LKPE) has been shown to be a safe and feasible procedure in patients with biliary atresia (BA). The purpose of this study was to investigate the efficacy of modified LKPE (MLKPE) in the treatment of BA. METHODS: Data of 58 BA patients undertaken MLPKE from July 2014 to December 2015 were retrospectively analyzed (group B), and compared with that of 43 BA patients received open Kasai portoenterostomy (OKPE) during the same period (group C). In addition, 195 BA patients who had undergone LKPE during May 2009 to June 2014 were also included (group A). RESULTS: All 296 patients enrolled in this study were non-syndromic type III BA. Compared with group A, group B had shorter operative time (ORT) (P < 0.01) and fewer intraoperative blood transfusion (IOBT) (P < 0.05). The conversion rate and cholangitis rate were also significantly lower in group B than that in group A (P < 0.05). The postoperative oral intake resumed (POOR), any postoperative complications (APOC), clearance of jaundice (CJ), 1-year and 3-year survival rate with native liver (SNL) were not significantly different between group A and group B (P > 0.05). The ORT, IOBT, POOR, APOC, CJ, 1-year and 3-year SNL in group B were much better than that of group C (P < 0.05). CONCLUSION: The MLKPE was associated with good perioperative with ORT, IOBT, POOR, and APOC. The short-term outcomes in MLKPE were no worse than that of OKPE and LKPE. MLKPE can be regarded as a treatment option for BA.

Laparoscopic Kasai portoenterostomy for cystic biliary atresia: midterm follow-up results of 35 patients.

PURPOSE: To investigate the clinical characteristics of cystic biliary atresia (CBA) and evaluate the midterm follow-up outcomes after laparoscopic treatment. METHODS: We analyzed and compared data retrospectively on CBA patients (group A) and nonsyndromic type III biliary atresia (BA) patients (group B), who underwent laparoscopic Kasai portoenterostomy (LKPE) during the same period. RESULTS: There were no significant differences in operative time, conversion rate, or the incidence of any postoperative complications between groups A and B (P > 0.05). The mean age at surgery (P < 0.01), rates of clearance of jaundice (CJ), cholangitis (P < 0.05), and 5-year survival with a native liver (SNL) were significantly lower in group A than in group B. Among the 35 patients with CBA, the CJ and 5-year SNL rates were significantly better in those with type I (n = 27) than in those with type IIId (n = 8) (P < 0.05). CONCLUSIONS: LKPE is a feasible and safe procedure for CBA. The 5-year SNL after LKPE was better in patients with CBA than in those with nonsyndromic type III BA. The 5-year SNL after LKPE for type I CBA was better than that for type IIId CBA.