RVFScan predicts virulence factor genes and hypervirulence of the clinical metagenome.

Bacterial infections often involve virulence factors that play a crucial role in the pathogenicity of bacteria. Accurate detection of virulence factor genes (VFGs) is essential for precise treatment and prognostic management of hypervirulent bacterial infections. However, there is a lack of rapid and accurate methods for VFG identification from the metagenomic data of clinical samples. Here, we developed a Reads-based Virulence Factors Scanner (RVFScan), an innovative user-friendly online tool that integrates a comprehensive VFG database with similarity matrix-based criteria for VFG prediction and annotation using metagenomic data without the need for assembly. RVFScan demonstrated superior performance compared to previous assembly-based and read-based VFG predictors, achieving a sensitivity of 97%, specificity of 98% and accuracy of 98%. We also conducted a large-scale analysis of 2425 clinical metagenomic datasets to investigate the utility of RVFScan, the species-specific VFG profiles and associations between VFGs and virulence phenotypes for 24 important pathogens were analyzed. By combining genomic comparisons and network analysis, we identified 53 VFGs with significantly higher abundances in hypervirulent Klebsiella pneumoniae (hvKp) than in classical K. pneumoniae. Furthermore, a cohort of 1256 samples suspected of K. pneumoniae infection demonstrated that RVFScan could identify hvKp with a sensitivity of 90%, specificity of 100% and accuracy of 98.73%, with 90% of hvKp samples consistent with clinical diagnosis (Cohen's kappa, 0.94). RVFScan has the potential to detect VFGs in low-biomass and high-complexity clinical samples using metagenomic reads without assembly. This capability facilitates the rapid identification and targeted treatment of hvKp infections and holds promise for application to other hypervirulent pathogens.

Performance of Metagenomic Next-Generation Sequencing of Cell-Free DNA From Vitreous and Aqueous Humor for Diagnoses of Intraocular Infections.

BACKGROUND: Delayed diagnosis and improper therapy for intraocular infections usually result in poor prognosis. Due to limitations of conventional culture and polymerase chain reaction methods, most causative pathogens cannot be identified from vitreous humor (VH) or aqueous humor (AH) samples with limited volume. METHODS: Patients with suspected intraocular infections were enrolled from January 2019 to August 2021. Metagenomic next-generation sequencing (mNGS) was used to detected causative pathogens. RESULTS: This multicenter prospective study enrolled 488 patients, from whom VH (152) and AH (336) samples were respectively collected and analyzed using mNGS of cell-free DNA (cfDNA). Taking final comprehensive clinical diagnosis as the gold standard, there were 39 patients with indefinite final diagnoses, whereas 288 and 161 patients were diagnosed as definite infectious and noninfectious diseases, respectively. Based on clinical adjudication, the sensitivity (92.2%) and total coincidence rate (81.3%) of mNGS using VH samples were slightly higher than those of mNGS using AH samples (85.4% and 75.4%, respectively). CONCLUSIONS: Using mNGS of cfDNA, an era with clinical experience for more rapid, independent, and impartial diagnosis of bacterial and other intraocular infections can be expected.

Rediscovery and systematics of the enigmatic genus Helicostoa reveals a new species of sessile freshwater snail with remarkable sexual dimorphism.

Helicostoa sinensis E. Lamy, 1926 is a unique freshwater gastropod species with a sessile habit. This enigmatic species was first found cemented on river limestones from China about 120 years ago and described together with the genus. It was never collected again and has been considered monotypic. Here, we report the rediscovery of Helicostoa from several rivers in China, and describe a second species of this genus based on a comprehensive study. In addition to the unique sessile habit of both species, the new Helicostoa species presents one of the most remarkable cases of sexual dimorphism within molluscs. Only the adult female is sessile and the original aperture of the female is sealed by shell matter or rock, while an opening on the body whorl takes the function of the original aperture. The male is vagile, with a normal aperture. Our results confirm the recently suggested placement of Helicostoa within the family Bithyniidae. The sessility of Helicostoa species is considered as an adaption to the limestone habitat in large rivers. The extreme sexual dimorphism and secondary aperture of females are considered as adaptations to overcome the obstacles for mating and feeding that come with a sessile life style.

Feasibility, Indications, and Prognostic Significance of Selective Lateral Pelvic Lymph Node Dissection After Preoperative Chemoradiotherapy in Middle/Low Rectal Cancer: Results of a Multicenter Lateral Node Study in China.

BACKGROUND: Lateral pelvic lymph node dissection after preoperative chemoradiotherapy can decrease local recurrence to lateral compartments, thereby providing survival benefits. OBJECTIVE: The safety of lateral pelvic lymph node dissection after preoperative chemoradiotherapy was investigated, and the surgical indications and survival benefits of lateral pelvic lymph node dissection were established on the basis of preoperative characteristics. DESIGN: A multicenter retrospective study. SETTINGS: Three hospitals in China. PATIENTS: Four hundred nine patients with clinical evidence of lateral pelvic lymph node metastasis. INTERVENTIONS: Patients who received lateral pelvic lymph node dissection were divided into 2 groups depending on whether they received chemoradiotherapy (n = 139) or not (n = 270). MAIN OUTCOME MEASURES: The safety, indications, and survival benefits of lateral pelvic lymph node dissection after preoperative chemoradiotherapy were investigated. RESULTS: The surgery times were significantly prolonged by preoperative chemoradiotherapy (291.3 vs 265.5 min; p = 0.021). Multivariate analysis demonstrated that poor/mucinous/signet-ring adenocarcinoma (OR = 4.42, 95% CI, 2.24-11.27; p = 0.031) and postchemoradiotherapy lateral pelvic lymph node short-axis diameter ≥7 mm (OR = 15.2, 95% CI, 5.89-53.01; p < 0.001) were independent predictive factors for lateral pelvic lymph node metastasis. Multivariate prognostic analysis showed that swollen lateral pelvic lymph nodes beyond the obturator or internal iliac as well as the involvement of 3 or more lateral pelvic lymph nodes were independent adverse prognostic factors. LIMITATIONS: The retrospective nature of the study and the small sample size were the limitations of this study. CONCLUSIONS: Preoperative chemoradiotherapy combined with lateral pelvic lymph node dissection is a practicable procedure with acceptable morbidity. Postchemoradiotherapy lateral pelvic lymph node short-axis diameter ≥7 mm and poor/signet/mucinous adenocarcinoma could be used for predicting lateral pelvic lymph node metastasis after chemoradiotherapy. However, lateral pelvic lymph node dissection should be carefully considered in patients with swollen lateral pelvic lymph nodes beyond the obturator or internal iliac region or involvement of multiple lateral pelvic lymph nodes. See Video Abstract at http://links.lww.com/DCR/C133 . VIABILIDAD, INDICACIONES E IMPORTANCIA PRONSTICA DE LA DISECCIN SELECTIVA DE GANGLIOS LINFTICOS PLVICOS LATERALES DESPUS DE QUIMIORRADIOTERAPIA PREOPERATORIA EN CNCER DE RECTO MEDIO/INFERIOR RESULTADOS DE UN ESTUDIO MULTICNTRICO DE GANGLIOS LATERALES EN CHINA: ANTECEDENTES:La disección de los ganglios linfáticos pélvicos laterales después de la quimiorradioterapia preoperatoria puede disminuir la recurrencia local en los compartimentos laterales, lo que brinda beneficios de supervivencia.OBJETIVO:Se investigó la seguridad de la disección de los ganglios linfáticos pélvicos laterales después de la quimiorradioterapia preoperatoria, y se establecieron las indicaciones quirúrgicas y los beneficios de supervivencia de la disección de los ganglios linfáticos pélvicos laterales en función de las características preoperatorias.DISEÑO:Estudio retrospectivo multicéntrico.ESCENARIO:Tres hospitales en China.PACIENTES:Cuatrocientos nueve pacientes con evidencia clínica de metástasis en los ganglios linfáticos pélvicos laterales.INTERVENCIONES:Los pacientes que recibieron disección de ganglios linfáticos pélvicos laterales se dividieron en dos grupos dependiendo de si recibieron quimiorradioterapia (n = 139) o no (n = 270).PRINCIPALES MEDIDAS DE RESULTADO:Se investigaron la seguridad, las indicaciones y los beneficios de supervivencia de la disección de los ganglios linfáticos pélvicos laterales después de la quimiorradioterapia preoperatoria.RESULTADOS:Los tiempos de cirugía se prolongaron significativamente con la quimiorradioterapia preoperatoria (291,3 vs 265,5 min, p = 0,021). El análisis multivariable demostró que el adenocarcinoma mal diferenciado/mucinoso/en anillo de sello (odds ratio = 4,42, intervalo de confianza del 95%, 2,24-11,27; p = 0,031) y el diámetro del eje corto de los ganglios linfáticos pélvicos laterales después de la quimiorradioterapia ≥7 mm (odds ratio = 15,2, intervalo de confianza del 95%, 5,89-53,01; p < 0,001) fueron factores predictivos independientes de metástasis en los ganglios linfáticos pélvicos laterales. El análisis pronóstico multivariable mostró que la inflamación de los ganglios linfáticos pélvicos laterales más allá del obturador o la ilíaca interna, así como la afectación de tres o más ganglios linfáticos pélvicos laterales, eran factores pronósticos adversos independientes.LIMITACIONES:La naturaleza retrospectiva del estudio y el pequeño tamaño de la muestra.CONCLUSIONES:La quimiorradioterapia preoperatoria combinada con la disección de los ganglios linfáticos pélvicos laterales es un procedimiento practicable con una morbilidad aceptable. Posterior a la quimiorradioterapia, el diámetro del eje corto de los ganglios linfáticos pélvicos laterales ≥7 mm y el adenocarcinoma pobre/en sello/mucinoso podrían usarse para predecir la metástasis en los ganglios linfáticos pélvicos laterales después de la quimiorradioterapia. Sin embargo, la disección de los ganglios linfáticos pélvicos laterales debe considerarse cuidadosamente en pacientes con ganglios linfáticos pélvicos laterales inflamados más allá del obturador o de la región ilíaca interna o compromiso de múltiples ganglios linfáticos pélvicos laterales. Consulte Video Resumen en http://links.lww.com/DCR/C133 . (Traducción-Dr. Felipe Bellolio ).

Stereopsis-Inspired 3D Visual Imaging System Based on 2D Ruddlesden-Popper Perovskite.

Stereopsis is of great important functions for humans to perceive and interact with the world. To realize the function of stereoscopic imaging, optoelectronic sensors shall possess good photoresponsive performance, multidirectional sensing, and 3D building capabilities. However, the current imaging sensors are mainly focused on 2D imaging, limiting their practical application scenarios. In this study, a stereopsis-inspired flexible 3D visual imaging system (VIS) based on 2D Ruddlesden-Popper perovskite is demonstrated. The 3D-VIS consists of 800 device units, each of which demonstrates excellent photoresponse performance, mechanical characteristics, and environmental stability. In addition to the capability of detecting 2D reflective images, the 3D-VIS realizes the function of detecting the depth of field and fusing object projections of two directions to invert the 3D image by utilizing voxels to rebuild the spatial structure of the object. In the future, the 3D-VIS will have broad application prospects in medical imaging, virtual reality, industrial automation, and other fields.

CMOS-Compatible Tellurium/Silicon Ultra-Fast Near-Infrared Photodetector.

High-quality photodetectors are always the main way to obtain external information, especially near-infrared sensors play an important role in remote sensing communication. However, due to the limitation of Silicon (Si) wide bandgap and the incompatibility of most near infrared photoelectric materials with traditional integrated circuits, the development of high performance and wide detection spectrum near infrared detectors suitable for miniaturization and integration is still facing many obstacles. Herein, the monolithic integration of large area tellurium optoelectronic functional units is realized by magnetron sputtering technology. Taking advantage of the type II heterojunction constructed by tellurium (Te) and silicon (Si), the photogenerated carriers are effectively separated, which prolongs the carrier lifetime and improves the photoresponse by several orders of magnitude. The tellurium/silicon (Te/Si) heterojunction photodetector demonstrates excellent detectivity and ultra-fast turn-on time. Importantly, an imaging array (20 × 20 pixels) based on the Te/Si heterojunction is demonstrated and high-contrast photoelectric imaging is realized. Because of the high contrast obtained by the Te/Si array, in comparison with the Si arrays, it significantly improve the efficiency and accuracy of the subsequent processing tasks when the electronic pictures are applied to artificial neural network (ANN) to simulate the artificial vision system.

The impact of primary tumor resection for asymptomatic colorectal cancer patients with unresectable metastases: a systematic review and meta-analysis.

BACKGROUND: Whether patients with asymptomatic primary tumors and unresectable metastases of colorectal cancer (CRC) should undergo primary tumor resection (PTR) remains controversial. This study aims to determine the appropriateness of PTR for these individuals by evaluating a number of outcome measures. METHODS: A systematic literature search was performed. Outcome measures included overall survival, emergency surgery rates, incidence of postoperative complications, time to initiate chemotherapy, conversion rates, and chemotherapy-related toxicities. RESULTS: Patients who received PTR in addition to chemotherapy had a better overall survival rate than those who only received chemotherapy (HR = 0.62, 95%CI, 0.50-0.78, I2 = 84%, p < 0.00001). In the RCT subgroup, there were no significant differences with a HR of 0.72 (95%CI, 0.45-1.13, I2 = 17%, p = 0.15). More patients in the chemotherapy alone group could be converted to resectable status (OR = 0.47, 95%CI, 0.27-0.82, I2 = 0%, p = 0.008), but the incidence of emergency surgery was 23% (95%CI, 17-29%, I2 = 14%). The risk of chemotherapy-related toxicity was not significantly higher in the PTR group (OR = 1.5, 95%CI, 0.94-2.43, p = 0.09, I2 = 0%), with a 7% incidence of postoperative complications (95%CI, 0-14%, p = 0.05, I2 = 0%). The time to initiate chemotherapy after PTR was approximately 33.06 days (95%CI, 25.55-40.58, I2 = 0%). CONCLUSION: PTR plus chemotherapy may be associated with improved survival in asymptomatic CRC patients with unresectable metastases. However, PTR did not provide a significant survival benefit in the subgroup of RCTs. Additionally, PTR did not result in a significantly increased risk of chemotherapy-related toxicity, with a postoperative complication rate of approximately 7%, and chemotherapy could be initiated at approximately 33.06 days after PTR. Compared with the PTR plus chemotherapy, chemotherapy alone could result in a significantly higher conversion rate. However, about 23% of patients receiving chemotherapy alone required emergency surgery for primary tumor-related symptoms. The above results needed to be validated in future larger prospective randomized trials.

Neural-network-based wavefront solution algorithm for a wide field survey telescope.

The wide field survey telescope (WFST) is a 2.5 m optical survey telescope currently under construction in China. The telescope employs a primary-focus optical design to achieve a wide field of view of 3 deg, and its focal plane is equipped with four pairs of curvature sensors to perform wavefront sensing and active optics. Currently, there are several wavefront solution algorithms available for curvature sensors, including the iterative fast Fourier transform method, orthogonal series expansion method, Green's function method, and sensitivity matrix method. However, each of these methods has limitations in practical use. This study proposes a solution method based on a convolutional neural network model with a U-Net structure for the curvature wavefront sensing of the WFST. Numerical simulations show that the model, when properly trained, has a high accuracy and performs a curvature wavefront solution effectively. Upon a comparison with the sensitivity matrix method, this new method demonstrates its superiority. Finally, the study is summarized, and the drawbacks of the proposed method are discussed, which leads to direction for future optimizations.

High diffraction efficiency varied-line-space concave gratings for the Lyman ultraviolet explorer.

In this paper we present the design and fabrication of the reflection varied-line-space concave grating (VLSCG) for the project of CAFE (the Census of warm-hot intergalactic medium, Accretion, and Feedback Explorer), which aims to detect and map the warm-hot circumgalactic medium via OVI emission at 103.2 nm and 103.8 nm, using two off-Rowland-circle spectrograph channels. High diffraction efficiency at LUV is supposed for the VLSCG and an aperture ratio as small as $F/3.6$ is desired for a compact design. The gratings are fabricated by holographic lithography and ion beam etching techniques. We introduce an additional lens into the normal holographic exposing system to generate the varied-line-space grating patterns. Grooves with triangle profiles are obtained to increase the diffraction efficiency by oblique ion beam bombardment during the etching process. Finally, several VLSCGs with a central line density of 3300 lines/mm have been fabricated successfully. The measured results show that the groove efficiency reaches 51% at 106.4 nm and 31% at 127.4 nm. We imitated the working optical path of the spectrometer and used the ${-}{1}$ order of the VLSCG to measure the image near the exit slit. The results showed that the image of the point source has a vertical extent of 0.68 mm, and the aberrations have been corrected.

Comparison of functional and oncological outcome of conformal sphincter preservation operation, low anterior resection, and abdominoperineal resection in very low rectal cancer: a retrospective comparative cohort study with propensity score matching.

PURPOSE: Conformal sphincter preservation operation (CSPO) procedure is a sphincter preservation procedure for preserving the anal canal function for very low rectal cancers. This study investigated the functional and oncological outcome of conformal sphincter preservation operation by comparing with low anterior resection (LAR) and abdominoperineal resection (APR). METHODS: This is a retrospective comparative study. Patients who received conformal sphincter preservation operation (n = 52), low anterior resection (n = 54), or abdominoperineal resection (n = 69) were included between 2011 and 2016 in a tertiary referral hospital. Propensity score matching was applied to adjust the baseline characteristics which may influence the choice of the surgical procedure. RESULTS: Twenty-one pairs of conformal sphincter preservation operation vs. low anterior resection and 29 pairs of conformal sphincter preservation operation vs. abdominoperineal resection were selected. The first group had a higher tumor location than the second group. Compared with the low anterior resection group, the conformal sphincter preservation operation group had shorter distal resection margins; however, no significant differences were identified in daily stool frequency, Wexner incontinence score, local recurrence, distant metastasis, overall survival, and disease-free survival between both groups. Compared with the abdominoperineal resection group, the conformal sphincter preservation operation group had shorter operative time and shorter postoperative hospital stay. No significant differences were identified in local recurrence, distant metastasis, overall survival, and disease-free survival. CONCLUSION: Conformal sphincter preservation operation is oncologically safe compared to APR and LAR, and has similar functional findings to LAR. Studies comparing CSPO with intersphincteric resection should be performed.

Global, regional, and national time trends in incidence, prevalence, years lived with disability for uterine fibroids, 1990-2019: an age-period-cohort analysis for the global burden of disease 2019 study.

BACKGROUND: Uterine fibroids are the most common benign neoplasm of the uterus and a major source of morbidity for women. We report an overview of trends in uterine fibroids of incidence rate, prevalence rate, years lived with disability (YLDs) rate in 204 countries and territories over the past 30 years and associations with age, period, and birth cohort. METHODS: The incident case, incidence rate, age-standardized rate (ASR) for incidence, prevalent case, prevalence rate, ASR for prevalence, number of YLDs, YLD rate, and ASR for YLDs were derived from the Global Burden of Disease 2019 (GBD 2019) study. We utilized an age-period-cohort (APC) model to estimate overall annual percentage changes in the rate of incidence, prevalence, and YLDs (net drifts), annual percentage changes from 10 to 14 years to 65-69 years (local drifts), period and cohort relative risks (period/cohort effects) between 1990 and 2019. RESULTS: Globally, the incident cases, prevalent cases, and the number of YLDs of uterine fibroids increased from 1990 to 2019 with the growth of 67.07%, 78.82% and 77.34%, respectively. High Socio-demographic Index (SDI) and high-middle SDI quintiles with decreasing trends (net drift < 0.0%), and increasing trends (net drift > 0.0%) were observed in middle SDI, low-middle SDI, and low SDI quintiles in annual percentage change of incidence rate, prevalence rate and YLDs rate over the past 30 years. There were 186 countries and territories that showed an increasing trend in incidence rate, 183 showed an increasing trend in prevalence rate and 174 showed an increasing trend in YLDs rate. Moreover, the effects of age on uterine fibroids increased with age and peaked at 35-44 years and then declined with advancing age. Both the period and cohort effects on uterine fibroids showed increasing trend in middle SDI, low-middle SDI and low SDI quintiles in recent 15 years and birth cohort later than 1965. CONCLUSIONS: The global burden of uterine fibroids is becoming more serious in middle SDI, low-middle SDI and low SDI quintiles. Raising awareness of uterine fibroids, increasing medical investment and improving levels of medical care are necessary to reduce future burden.

Gardnerella vaginalis purulent meningitis in an adolescent male: a case report.

BACKGROUND: We report a rare case of Gardnerella vaginalis found in the cerebrospinal fluid of a young boy. CASE PRESENTATION: A 14-year-old boy was admitted to hospital with headache, vomiting, fever, drowsiness and positive meningeal irritation signs on examination. Cerebrospinal fluid (CSF) shows white blood cell and protein were elevated, and glucose was low. Traditional aerobic and anaerobic culture of CSF did not grow any organisms. However, metagenomic next-generation sequencing (mNGS) reveals G. vaginalis in his CSF. The patient was diagnosed with purulent meningitis, and treated with intravenous meropenem and linezolid for a week, followed by oral administration of amoxicillin for two weeks. He recovered without sequelae. CONCLUSIONS: Purulent meningitis caused by Gardnerella vaginalis is extremely rare. Metagenomic next-generation sequencing of CSF should be highlighted for early diagnosis. With effective antibiotic treatment, the prognosis was excellent.

B Cell Endosomal RAB7 Promotes TRAF6 K63 Polyubiquitination and NF-κB Activation for Antibody Class-Switching.

Upon activation by CD40 or TLR signaling, B lymphocytes activate NF-κB to induce activation-induced cytidine deaminase and, therefore, Ig class switch DNA recombination, as central to the maturation of the Ab and autoantibody responses. In this study, we show that NF-κB activation is boosted by colocalization of engaged immune receptors, such as CD40, with RAB7 small GTPase on mature endosomes, in addition to signals emanating from the receptors localized on the plasma membrane, in mouse B cells. In mature endosomes, RAB7 directly interacts with TRAF6 E3 ubiquitin ligase, which catalyzes K63 polyubiquitination for NF-κB activation. RAB7 overexpression in Cd19+/creRosa26fl-STOP-fl-Rab7 mouse B cells upregulates K63 polyubiquitination activity of TRAF6, enhances NF-κB activation and activation-induced cytidine deaminase induction, and boosts IgG Ab and autoantibody levels. This, together with the extensive intracellular localization of CD40 and the strong correlation of RAB7 expression with NF-κB activation in mouse lupus B cells, shows that RAB7 is an integral component of the B cell NF-κB activation machinery, likely through interaction with TRAF6 for the assembly of "intracellular membrane signalosomes."

Risk factors and prognostic significance of postoperative complications following lateral pelvic lymph node dissection for rectal cancer: results of the multicenter lateral node study in China.

OBJECTIVE: Total mesorectal excision (TME) plus lateral pelvic lymph node (LPN) dissection (LPND) is a technically complex and challenging procedure with higher morbidity than TME alone. We aimed to investigate the risk factors for postoperative complications after TME + LPND, and the impact of complications on patient prognosis. METHODS: A total of 387 rectal cancer patients with clinical LPN metastasis (LPNM) who underwent TME + LPND at three institutions affiliated with the Chinese Lateral Node Collaborative Group were included. Logistic regression models were used to identify the risk factors for post-surgical complications, and the log-rank test was used to compare the prognosis. Severe complications were described as grade III-V. RESULTS: The incidence rates of overall complications and severe complications after TME + LPND were 15.2% (59/387) and 7.8% (30/387), respectively. Multivariate analysis showed that a duration of operation ≥260 min was an independent risk factor for both overall (odds ratio [OR] = 3.03, 95% confidence interval [CI] = 1.57-5.85, P = 0.001) and severe postoperative complications (OR = 2.67, 95% CI = 1.06-6.73, P = 0.037). The development of overall postoperative complications (P = 0.114) and severe postoperative complications (P = 0.298) had no significant impact on the overall survival. However, patients with overall complications (P = 0.015) or severe complications (P = 0.031) with a postoperative hospital stay >30 days had significantly an overall worse survival. CONCLUSION: A surgical duration of ≥260 min is a significant risk factor for both overall and severe postoperative complications after TME + LPND for middle-low rectal cancer. Furthermore, the development of overall complications or severe complications that require a postoperative hospital stay >30 days significantly worsens the prognosis.

Short- and long-term outcomes of laparoscopic versus open selective lateral pelvic lymph node dissection for locally advanced middle-low rectal cancer: Results of a multicentre lateral node study in China.

AIM: Lateral pelvic lymph node dissection (LPND) is a technically challenging procedure, and the safety and feasibility of laparoscopic LPND remains undetermined. Here, we compared the short- and long-term survival outcomes of laparoscopic LPND with those of open LPND. METHODS: From January 2012 to December 2019, locally advanced middle-low rectal cancer patients with clinical evidence of lateral pelvic lymph node metastasis (LPNM) who underwent total mesorectal excision with LPND at three institutions were included. Propensity score matching was used to minimize selection bias. The short-term and oncological outcomes of open and laparoscopic LPND were compared. RESULTS: Overall, 384 patients were enrolled into the study including 277 and 107 patients who underwent laparoscopic and open LPND, respectively. After matching, patients were stratified into laparoscopic (n = 100) and open (n = 100) LPND groups. Patients in the laparoscopic LPND group had a shorter operation time (255 vs. 300 min, p = 0.001), less intraoperative blood loss (50 vs. 300 ml, p < 0.001), lower incidence of postoperative complications (32.0% vs. 15.0%, p = 0.005), shorter postoperative hospital stay (8 vs. 14 days, p < 0.001), and excision of more lateral pelvic lymph nodes (9 vs. 7, p = 0.025) than those in the open LPND group. The 3-year overall survival (p = 0.581) and 3-year disease-free survival (p = 0.745) rates were similar between the groups, and LPNM was an independent predictor of survival. CONCLUSION: Laparoscopic LPND is technically safe and feasible with favourable short-term results and similar oncological outcomes as open surgery in selected patients.

Measurement of distal intramural spread and the optimal distal resection by naked eyes after neoadjuvant radiation for rectal cancers.

BACKGROUND: The safe distance between the intraoperative resection line and the visible margin of the distal rectal tumor after preoperative radiotherapy is unclear. We aimed to investigate the furthest tumor intramural spread distance in fresh tissue to determine a safe distal intraoperative resection margin length. METHODS: Twenty rectal cancer specimens were collected after preoperative radiotherapy. Tumor intramural spread distances were defined as the distance between the tumor's visible and microscopic margins. Visible tumor margins in fresh specimens were identified during the operation and were labeled with 5 - 0 sutures under the naked eye at the distal 5, 6, and 7 o'clock directions of visible margins immediately after removal of the tumor. After fixation with formalin, the sutures were injected with nanocarbon particles. Longitudinal tissues were collected along three labels and stained with hematoxylin and eosin. The spread distance after formalin fixation was measured between the furthest intramural spread of tumor cells and the nanocarbon under a microscope. A positive intramural spread distance indicated that the furthest tumor cell was distal to the nanocarbon, and a negative value indicated that the tumor cell was proximal to the nanocarbon. The tumor intramural spread distance in fresh tissue during the operation was 1.75 times the tumor intramural spread distance after formalin fixation according to the literature. RESULTS: At the distal 5, 6, and 7 o'clock direction, seven (35%), five (25%), and six (30%) patients, respectively, had distal tumor cell intramural spread distance > 0 mm. The mean and 95% confidence interval of tumor cell intramural spread distance in fresh tissue during operation was - 0.3 (95%CI - 4.0 ~ 3.4) mm, - 0.9 (95%CI - 3.4 ~ 1.7) mm, and - 0.4 (95%CI - 3.5 ~ 2.8) mm, respectively. The maximal intraoperative intramural spread distances in fresh tissue were 8.8, 7, and 7 mm, respectively. CONCLUSIONS: The intraoperative distance between the distal resection line and the visible margin of the rectal tumor after radiotherapy should not be less than 1 cm to ensure oncological safety.

Pelvic floor peritoneum reconstruction is a protective factor for defecation dysfunction after laparoscopic anterior resection in patients with middle and low rectal cancer.

PURPOSE: The pelvic cavity is a monolithic structure whose integrity plays an important role in the pelvic organ function. Currently, pelvic floor peritoneum reconstruction (PFPR) is rarely performed during laparoscopic surgery for middle and low rectal cancer patients. This study evaluated the effect of PFPR using barbed wire during laparoscopic surgery on the postoperative defecation function in middle and low rectal cancer patients. METHODS: This was a retrospective study involving a total of 252 middle and low rectal cancer patients who had been subjected to laparoscopic-assisted anterior resection of rectal cancer at Shanghai Changhai Hospital from March 2018 to April 2020. The Wexner and low anterior resection syndrome (LARS) scores were used to evaluate the postoperative defecation function among patients. A Wexner score ≥ 8 and LARS score ≥ 30 were considered to indicate major defecation dysfunction. RESULTS: A total of 229 patients (52 patients subjected to PFPR) were followed up, and the Wexner and LARS scores were recorded. The follow-up rate was 90.87%, the mean follow-up time was 22.88 ± 6.93 months, the stoma rate was 64.29%, the ileostomy reduction surgical rate was 90.74%, and the stoma duration was 7.64 ± 2.94 months. Regarding the assessment of postoperative defecation dysfunction using the Wexner score, a multivariate analysis revealed that a long operation time (odds ratio [OR], 0.991; 95% confidence interval [CI], 0.984-0.999, p = 0.026) and radiotherapy (OR, 0.352; 95% CI, 0.156-0.797, p = 0.012) were independent risk factors for major defecation dysfunction, while a high tumor location (OR, 1.318; 95% CI, 1.151-1.657, p = 0.001) and PFPR (OR, 4.770; 95% CI, 1.435-15.857, p = 0.011) were independent protective factors for major defecation dysfunction. Regarding the assessment of the postoperative defecation function using the LARS score, a multivariate analysis revealed that a high tumor location (OR, 1.293; 95% CI, 1.125-1.486, p < 0.001) and PFPR (OR, 3.010; 95% CI, 1.345-6.738, p = 0.007) were independent protective factors for major defecation dysfunction. A subgroup analysis showed that the postoperative Wexner score (3.13 ± 2.79 vs. 4.71 ± 3.45 p = 0.003) and LARS score (21.77 ± 8.62 vs. 25.14 ± 8.78 p = 0.015) were lower for patients with PFPR than for patients without PFPR. Regarding patients with low rectal cancer, those with PFPR had a lower LARS score than those without it (23.62 ± 8.94 vs. 28.40 ± 7.90, p = 0.022), but there was no significant difference in the Wexner score between the groups. A total of 9.76% of patients with PFPR and 48.89% of those without PFPR showed an intestinal accumulation in the sacral front (p < 0.001). CONCLUSIONS: PFPR and a high tumor location are protective factors for postoperative defecation dysfunction in middle and low rectal cancer patients. PFPR can be routinely performed during laparoscopic surgery.

Micro-Nano Processing of Active Layers in Flexible Tactile Sensors via Template Methods: A Review.

Template methods are regarded as an important method for micro-nano processing in the active layer of flexible tactile sensors. These template methods use physical/chemical processes to introduce micro-nano structures on the active layer, which improves many properties including sensitivity, response/recovery time, and detection limit. However, since the processing process and applicable conditions of the template method have not yet formed a perfect system, the development and commercialization of flexible tactile sensors based on the template method are still at a relatively slow stage. Despite the above obstacles, advances in microelectronics, materials science, nanoscience, and other disciplines have laid the foundation for various template methods, enabling the continuous development of flexible tactile sensors. Therefore, a comprehensive and systematic review of flexible tactile sensors based on the template method is needed to further promote progress in this field. Here, the unique advantages and shortcomings of various template methods are summarized in detail and discuss the research progress and challenges in this field. It is believed that this review will have a significant impact on many fields of flexible electronics, which is beneficial to promote the cross-integration of multiple fields and accelerate the development of flexible electronic devices.

Wide-field optical design for a 60 m submillimeter telescope.

We present a practical wide-field optical design for a 60 m aperture submillimeter telescope, which is currently under conceptual design study in China. The telescope is specified to operate over a wavelength range of 0.65-3 mm and provide a wide field of view (FOV) of 1° in diameter. We designed an F/6 Ritchey Chrétien (RC) system with a quasi-planar tertiary corrector, which cancels all spherical, coma, and astigmatism aberrations. It also achieves a good balance among the mirror sizes, central obscuration, and focal-plane curvature. The problems of focal surface curvature and nontelecentricity are treated in the subfield instrumental design, which employs a simple silicon wedge prism to obtain flat and telecentric focal planes for each subfield instrument module. Our studies show that by such a design, more than ${{10}^5}$105 detector pixels can be efficiently and uniformly fed at the shortest wavelength band with Strehl ratios above 0.85 across the entire 1° FOV. Several practical issues related to the telescope optics are also discussed.

Flexible Smart Noncontact Control Systems with Ultrasensitive Humidity Sensors.

The development of noncontact humidity sensors with high sensitivity, rapid response, and a facile fabrication process is urgently desired for advanced noncontact human-machine interaction (HMI) applications. Here, a flexible and transparent humidity sensor based on MoO3 nanosheets is developed with a low-cost and easily manufactured process. The designed humidity sensor exhibits ultrahigh sensitivity, fast response, great stability, and high selectivity, exceeding the state-of-the-art humidity sensors. Furthermore, a wearable moisture analysis system is assembled for real-time monitoring of ambient humidity and human breathing states. Benefiting from the sensitive and rapid response to fingertip humidity, the sensors are successfully applied to both a smart noncontact multistage switch and a novel flexible transparent noncontact screen for smart mobile devices, demonstrating the potential of the MoO3 nanosheets-based humidity sensors in future HMI systems.