Staged urethroplasty with groin full-thickness skin graft for managing complex anterior urethral strictures: surgical outcomes and predictive factors.

PURPOSE: To describe outcomes of staged-urethroplasty in complex anterior urethral strictures using full-thickness-skin-graft (FTSG) harvested from the hairless groin area, and to identify factors influencing successful outcomes. METHODS: Through retrospective chart review, we identified a total of 67 men who underwent the first-stage operation (grafting) using groin-FTSG for staged-urethroplasty to treat complex anterior urethral strictures unsuitable for one-stage urethroplasty. Among these, 59 underwent the second-stage operation (tubularization) at a median duration of 5.1-months after grafting. Patients were assessed for outcomes as scheduled after tubularization outcomes were analyzed only for 48 patients for whom ≥ 1-year follow-up data after tubularization were available. Their mean follow-up duration was 27.1 months. Success was defined as achieving physiologic voiding without requiring further procedures. RESULTS: Median stricture-length was 5.5 cm in all 67 patients. After grafting, neourethral-opening-narrowing occurred in 18. Partial graft-loss occurred in 8, of whom only 3 underwent re-grafting. The percentage of patients who achieved successful outcomes was 81.3%. Improvements in maximum-urine-flow-rate and post-void-residual-urine-volume were maintained until the last follow-up visit. A urethrocutaneous-fistula occurred in one patient, while meatal-stenosis occurred in two. On multivariate-regression-analysis, the presence of neourethral-opening-narrowing was the only predictor of non-success after tubularization. Furthermore, the presence of hypertension, longer stricture-length, and a history of prior direct-vision-internal-urethrotomy were predictors of the occurrence of neourethral-opening-narrowing. CONCLUSION: Staged-urethroplasty using groin-FTSG is well worth considering as a useful therapeutic option for complex anterior urethral strictures, with an acceptable success rate and low morbidity. The absence of neourethral-opening-narrowing after the first-stage operation leads to success.

Immune signature and therapeutic approach of natural killer cell in chronic liver disease and hepatocellular carcinoma.

Natural killer (NK) cells are one of the key members of innate immunity that predominantly reside in the liver, potentiating immune responses against viral infections or malignant tumors. It has been reported that changes in cell numbers and function of NK cells are associated with the development and progression of chronic liver diseases (CLDs) including non-alcoholic fatty liver disease, alcoholic liver disease, and chronic viral hepatitis. Also, it is known that the crosstalk between NK cells and hepatic stellate cells plays an important role in liver fibrosis and cirrhosis. In particular, the impaired functions of NK cells observed in CLDs consequently contribute to occurrence and progression of hepatocellular carcinoma (HCC). Chronic infections by hepatitis B or C viruses counteract the anti-tumor immunity of the host by producing the sheddases. Soluble major histocompatibility complex class I polypeptide-related sequence A (sMICA), released from the cell surfaces by sheddases, disrupts the interaction and affects the function of NK cells. Recently, the MICA/B-NK stimulatory receptor NK group 2 member D (NKG2D) axis has been extensively studied in HCC. HCC patients with low membrane-bound MICA or high sMICA concentration have been associated with poor prognosis. Therefore, reversing the sMICA-mediated downregulation of NKG2D has been proposed as an attractive strategy to enhance both innate and adaptive immune responses against HCC. This review aims to summarize recent studies on NK cell immune signatures and its roles in CLD and hepatocellular carcinogenesis and discusses the therapeutic approaches of MICA/B-NKG2D-based or NK cell-based immunotherapy for HCC.

Iterative reconstruction for limited-angle CT using implicit neural representation.

Objective.Limited-angle computed tomography (CT) presents a challenge due to its ill-posed nature. In such scenarios, analytical reconstruction methods often exhibit severe artifacts. To tackle this inverse problem, several supervised deep learning-based approaches have been proposed. However, they are constrained by limitations such as generalization issue and the difficulty of acquiring a large amount of paired CT images.Approach.In this work, we propose an iterative neural reconstruction framework designed for limited-angle CT. By leveraging a coordinate-based neural representation, we formulate tomographic reconstruction as a convex optimization problem involving a deep neural network. We then employ differentiable projection layer to optimize this network by minimizing the discrepancy between the predicted and measured projection data. In addition, we introduce a prior-based weight initialization method to ensure the network starts optimization with an informed initial guess. This strategic initialization significantly improves the quality of iterative reconstruction by stabilizing the divergent behavior in ill-posed neural fields. Our method operates in a self-supervised manner, thereby eliminating the need for extensive data.Main results.The proposed method outperforms other iterative and learning-based methods. Experimental results on XCAT and Mayo Clinic datasets demonstrate the effectiveness of our approach in restoring anatomical features as well as structures. This finding was substantiated by visual inspections and quantitative evaluations using NRMSE, PSNR, and SSIM. Moreover, we conduct a comprehensive investigation into the divergent behavior of iterative neural reconstruction, thus revealing its suboptimal convergence when starting from scratch. In contrast, our method consistently produced accurate images by incorporating an initial estimate as informed initialization.Significance.This work showcases the feasibility to reconstruct high-fidelity CT images from limited-angle x-ray projections. The proposed methodology introduces a novel data-free approach to enhance medical imaging, holding promise across various clinical applications.

The Study of an Adaptive Bread Maker Using Machine Learning.

Bread is one of the most consumed foods in the world, and modern food processing technologies using artificial intelligence are crucial in providing quality control and optimization of food products. An integrated solution of sensor data and machine learning technology was determined to be appropriate for identifying real-time changing environmental variables and various influences in the baking process. In this study, the Baking Process Prediction Model (BPPM) created by data-based machine learning showed excellent performance in monitoring and analyzing real-time sensor and vision data in the baking process to predict the baking stages by itself. It also has the advantage of improving the quality of bread. The volumes of bread made using BPPM were 127.54 ± 2.54, 413.49 ± 2.59, 679.96 ± 1.90, 875.79 ± 2.46, and 1260.70 ± 3.13, respectively, which were relatively larger than those made with fixed baking time (p < 0.05). The developed system is evaluated to have great potential to improve precision and efficiency in the food production and processing industry. This study is expected to lay the foundation for the future development of artificial intelligence and the food industry.

Focused Ultrasound, an Emerging Tool for Atherosclerosis Treatment: A Comprehensive Review.

Focused ultrasound (FUS) has emerged as a promising noninvasive therapeutic modality for treating atherosclerotic arterial disease. High-intensity focused ultrasound (HIFU), a noninvasive and precise modality that generates high temperatures at specific target sites within tissues, has shown promising results in reducing plaque burden and improving vascular function. While low-intensity focused ultrasound (LIFU) operates at lower energy levels, promoting mild hyperthermia and stimulating tissue repair processes. This review article provides an overview of the current state of HIFU and LIFU in treating atherosclerosis. It focuses primarily on the therapeutic potential of HIFU due to its higher penetration and ability to achieve atheroma disruption. The review summarizes findings from animal models and human trials, covering the effects of FUS on arterial plaque and arterial wall thrombolysis in carotid, coronary and peripheral arteries. This review also highlights the potential benefits of focused ultrasound, including its noninvasiveness, precise targeting, and real-time monitoring capabilities, making it an attractive approach for the treatment of atherosclerosis and emphasizes the need for further investigations to optimize FUS parameters and advance its clinical application in managing atherosclerotic arterial disease.

Automated Matching of Patients to Clinical Trials: A Patient-Centric Natural Language Processing Approach for Pediatric Leukemia.

PURPOSE: Matching patients to clinical trials is cumbersome and costly. Attempts have been made to automate the matching process; however, most have used a trial-centric approach, which focuses on a single trial. In this study, we developed a patient-centric matching tool that matches patient-specific demographic and clinical information with free-text clinical trial inclusion and exclusion criteria extracted using natural language processing to return a list of relevant clinical trials ordered by the patient's likelihood of eligibility. MATERIALS AND METHODS: Records from pediatric leukemia clinical trials were downloaded from ClinicalTrials.gov. Regular expressions were used to discretize and extract individual trial criteria. A multilabel support vector machine (SVM) was trained to classify sentence embeddings of criteria into relevant clinical categories. Labeled criteria were parsed using regular expressions to extract numbers, comparators, and relationships. In the validation phase, a patient-trial match score was generated for each trial and returned in the form of a ranked list for each patient. RESULTS: In total, 5,251 discretized criteria were extracted from 216 protocols. The most frequent criterion was previous chemotherapy/biologics (17%). The multilabel SVM demonstrated a pooled accuracy of 75%. The text processing pipeline was able to automatically extract 68% of eligibility criteria rules, as compared with 80% in a manual version of the tool. Automated matching was accomplished in approximately 4 seconds, as compared with several hours using manual derivation. CONCLUSION: To our knowledge, this project represents the first open-source attempt to generate a patient-centric clinical trial matching tool. The tool demonstrated acceptable performance when compared with a manual version, and it has potential to save time and money when matching patients to trials.

Pyuria as an independent predictor of intravesical recurrence after radical nephroureterectomy in patients with upper tract urothelial carcinoma.

PURPOSE: About one-third of patients who undergo radical nephroureterectomy (RNUx) for upper tract urothelial carcinoma (UTUC) experience intravesical recurrence (IVR). This study investigated whether pyuria is a feasible predictor of IVR after RNUx in patients with UTUC. MATERIALS AND METHODS: Seven hundred forty-three patients with UTUC who underwent RNUx at a single institute were analyzed in this study. The participants were divided into two groups: those without pyuria (non-pyuria) and those with pyuria. Kaplan-Meier survival analysis was performed, and p-values were assessed using the log-rank test. Cox regression analyses were performed to identify the independent predictors of survival. RESULTS: The pyuria group had a shorter IVR-free survival period (p=0.009). The five-year IVR-free survival rate was 60.0% in the non-pyuria group vs. 49.7% in the pyuria group according to the Kaplan-Meier survival analysis. After the multivariate Cox regression analysis, pyuria (hazard ratio [HR]=1.368; p=0.041), a concurrent bladder tumor (HR=1.757; p=0.005), preoperative ureteroscopy (HR=1.476; p=0.013), laparoscopic surgery (HR=0.682; p=0.048), tumor multiplicity (HR=1.855; p=0.007), and a larger tumor (HR=1.041; p=0.050) were predictors of risk for IVR. There was no association between pyuria and recurrence-free survival (p=0.057) or cancer-specific survival (p=0.519) in the Kaplan-Meier survival analysis. CONCLUSIONS: This study concluded that pyuria was an independent predictor of IVR in patients with UTUC after RNUx.

Effect of Patient's Positioning on the Grade of Tendinosis and Visible Range of Infraspinatus Tendon on Ultrasound.

Purpose: To investigate the effect of patient positioning on tendinosis grade, visible range, and infraspinatus tendon (IST) thickness, and to determine the feasibility of internal rotation (IR) position to assess IST on ultrasound (US). Materials and Methods: This study included 52 shoulders of 48 subjects who were evaluated for IST in three different positions: neutral position (N), IR, and position with the ipsilateral hand on the contralateral shoulder (HC). Two radiologists retrospectively graded IST tendinosis from grade 0 to grade 3 and the visible range from grade 1 to grade 4. The thickness of the IST was measured by another radiologist with a short-axis view. A generalized estimating equation was used for statistical analysis. Results: The tendinosis grades were higher in the HC position than in the IR position, with a cumulative odds ratio of 2.087 (0.004, 95% confidence interval [CI]: 1.268-3.433). The tendinosis grades in the HC position (p = 0.370) and IR position (p = 0.146) were not significantly different from those in the N position. The overall difference in IST thickness was significant (p < 0.001), but the visible range (p = 0.530) was not significantly different according to position. Conclusion: Patient positioning significantly affected the grade of tendinosis and thickness but not the visible range of the IST. The IR position is a feasible position for assessing the IST on US.

Sparsier2Sparse: Self-supervised convolutional neural network-based streak artifacts reduction in sparse-view CT images.

BACKGROUND: Sparse-view computed tomography (CT) has attracted a lot of attention for reducing both scanning time and radiation dose. However, sparsely-sampled projection data generate severe streak artifacts in the reconstructed images. In recent decades, many sparse-view CT reconstruction techniques based on fully-supervised learning have been proposed and have shown promising results. However, it is not feasible to acquire pairs of full-view and sparse-view CT images in real clinical practice. PURPOSE: In this study, we propose a novel self-supervised convolutional neural network (CNN) method to reduce streak artifacts in sparse-view CT images. METHODS: We generate the training dataset using only sparse-view CT data and train CNN based on self-supervised learning. Since the streak artifacts can be estimated using prior images under the same CT geometry system, we acquire prior images by iteratively applying the trained network to given sparse-view CT images. We then subtract the estimated steak artifacts from given sparse-view CT images to produce the final results. RESULTS: We validated the imaging performance of the proposed method using extended cardiac-torso (XCAT) and the 2016 AAPM Low-Dose CT Grand Challenge dataset from Mayo Clinic. From the results of visual inspection and modulation transfer function (MTF), the proposed method preserved the anatomical structures effectively and showed higher image resolution compared to the various streak artifacts reduction methods for all projection views. CONCLUSIONS: We propose a new framework for streak artifacts reduction when only the sparse-view CT data are given. Although we do not use any information of full-view CT data for CNN training, the proposed method achieved the highest performance in preserving fine details. By overcoming the limitation of dataset requirements on fully-supervised-based methods, we expect that our framework can be utilized in the medical imaging field.

Lowering the percent body fat in the obese population might reduce male lower urinary tract symptoms.

PURPOSE: This study aimed to investigate the practicality of percent body fat (PBF), calculated using bioelectrical impedance analysis (BIA), in predicting benign prostatic hyperplasia/lower urinary tract symptoms (BPH/LUTS). METHODS: This study included 844 men who underwent medical checkups at our institution between 2014 and 2022. Demographic characteristics, serum PSA levels, and prostate volume were collected using TRUS. BPH was defined as a prostate volume ≥ 30 cc. Subjects were divided into two groups according to their quartiles of PBF: the normal PBF group (first to third quartile; PBF < 27.9%) and the high PBF group (fourth quartile; PBF ≥ 27.9%). Characteristics between the groups were compared using the chi-square test and Student's t-test. Multivariate logistic regression analysis was performed to evaluate risk factors for BPH and severe LUTS. RESULTS: The prostate volume (25.21 ± 8.4 vs 27.30 ± 9.0, p = 0.005) and percentage of BPH (22.9% vs. 32.1%, p = 0.007) were greater in the high PBF group. After multivariate analysis, old age (OR = 1.066, p < 0.001), higher appendicular skeletal muscle mass index (ASMI) (OR = 1.544, p = 0.001), and PBF ≥ 27.9% (OR = 1.455, p = 0.037) were risk factors for BPH. Larger prostate volume (OR = 1.035, p = 0.002) and PBF ≥ 27.9% (OR = 1.715, p = 0.025) were risk factors for severe LUTS. However, a greater ASMI had a protective effect against severe LUTS (OR = 0.654, p = 0.011). CONCLUSIONS: This study shows that PBF and ASMI are useful for predicting BPH/LUTS. We suggest that lowering PBF to the normal range in a population with high PBF might prevent BPH, while lowering PBF and maintaining adequate ASMI could lower LUTS.

Predictive Value of KLASS-02-QC Assessment Score on KLASS-02 Surgical Outcomes: Validation of Surgeon Quality Control and Standardization for D2 Lymphadenectomy.

OBJECTIVE: The aim of this study was to audit the 22 items and assessed each item's predictive value on surgical outcomes. BACKGROUND: The KLASS-02 trial revealed that the oncologic outcomes of laparoscopic distal gastrectomy are not inferior to open distal gastrectomy in patients with advanced gastric cancer. The surgeons participating in this trial were chosen based on the assessment scores from the KLASS-02-QC trial, which used 22 items for standardization of D2 lymphadenectomy and quality control. METHODS: We reviewed proficiency scores (PSs) for 22 items for 20 surgeons who participated in KLASS-02. The surgeons were divided into 2 groups according to PS, and the perioperative outcomes of 924 patients enrolled in KLASS-02 were compared between groups. Each item's predictive value for perioperative outcome was then assessed using multivariable regression models. RESULTS: Of the total 924 patients, 529 were operated on by high-score surgeons (high PS) and 395 were operated on by low-score surgeons (low-PS). High-PS group had less intraoperative blood loss, longer operation times, and fewer complications, major complications, reoperations, and shorter first flatus and hospital stay than low-PS group ( P =0.006, P <0.001, P <0.001, P <0.001, P =0.042, P =0.013, and P <0.001, respectively). Some items used in KLASS-02-QC predicted perioperative outcomes, such as intraoperative blood loss, major complications, reoperation, and hospital stay. CONCLUSIONS: Although this study only analyzed data associated with qualified surgeons, the 22 items effectively assessed the surgeons based on PS. A high score was associated with longer operation times, but better perioperative outcomes.

Standard follow-up after curative surgery for advanced gastric cancer: secondary analysis of a multicentre randomized clinical trial (KLASS-02).

BACKGROUND: The benefit of regular follow-up after curative resection for gastric cancer is controversial as there is no evidence that it will improve survival. This study assessed whether regular follow-up leads to improved survival in patients after surgery for gastric cancer. METHODS: A secondary analysis was undertaken of patients who participated in an RCT of laparoscopic versus open distal gastrectomy for advanced gastric cancer between November 2011 and April 2015. Depending on whether patients were compliant with the initial trial follow-up protocol or not, they were analysed as having had either regular or irregular follow-up. Clinicopathological characteristics, recurrence patterns, detection, treatments, and survival were compared between the groups. RESULTS: The regular and irregular follow-up groups comprised 712 and 263 patients respectively. Disease recurrence within 36 months was more common in the regular group than in the irregular group (17.0 versus 11.4 per cent; P = 0.041). Recurrence patterns did not differ between the groups. The 3-year recurrence-free survival rate was worse in the regular than in the irregular group (81.2 versus 86.5 per cent; P = 0.031). However, the 5-year overall survival rate was comparable (84.5 versus 87.5 per cent respectively; P = 0.160). Multivariable analysis revealed that type of follow-up was not an independent factor affecting 5-year overall survival. CONCLUSION: Regular follow-up after radical gastrectomy was not associated with improved overall survival.

Electroencephalographic Response of Brain Stimulation by Shock Waves From Laser Generated Carbon Nanotube Transducer.

Neuromodulation is used to treat neurological disorders. Focused ultrasound can deliver acoustic energy to local regions of the brain, including deep brain structures. In addition, it is possible to induce the activation or inhibition of nerves through parameter adjustments of focused ultrasound. Laser-generated focused ultrasound (LGFUS) has demonstrated a potential use in precise therapeutic ultrasound applications owing to the ability to produce high-pressure, broadband frequency of shock waves with a tight focal spot, resulting in confined acoustic exposure of a small area. However, there have been few studies of neurostimulation using shock waves with pulse durations of several nanoseconds. The purpose of this study is to investigate the possibility of neurostimulation by shock waves generated from a focused Carbon Nanotube (fCNT) transducer. We measured electroencephalographic (EEG) signals in three rat brains before and after shock wave stimulation and compared them in the time and frequency domains. In the time domain, the number of peaks of EEG signals was measured significantly higher after shock wave stimulation than before stimulation in all three rats. The three rats showed differences in three frequency bands: theta(4-7 Hz), alpha(8-12), and 1-30 Hz, before and after shock wave stimulation (p < 0.001). These differences in EEG signals after shock wave stimulation of three rats were confirmed mainly because of shock waves. The stimulation of a rat brain was feasible using shock waves generated by the fCNT transducer. This study provides a basis for the applications of shock waves to brain stimulation for precise targeting.

Nutrient-sensing mTORC1 and AMPK pathways in chronic kidney diseases.

Nutrients such as glucose, amino acids and lipids are fundamental sources for the maintenance of essential cellular processes and homeostasis in all organisms. The nutrient-sensing kinases mechanistic target of rapamycin (mTOR) and AMP-activated protein kinase (AMPK) are expressed in many cell types and have key roles in the control of cell growth, proliferation, differentiation, metabolism and survival, ultimately contributing to the physiological development and functions of various organs, including the kidney. Dysregulation of these kinases leads to many human health problems, including cancer, neurodegenerative diseases, metabolic disorders and kidney diseases. In the kidney, physiological levels of mTOR and AMPK activity are required to support kidney cell growth and differentiation and to maintain kidney cell integrity and normal nephron function, including transport of electrolytes, water and glucose. mTOR forms two functional multi-protein kinase complexes, mTOR complex 1 (mTORC1) and mTOR complex 2 (mTORC2). Hyperactivation of mTORC1 leads to podocyte and tubular cell dysfunction and vulnerability to injury, thereby contributing to the development of chronic kidney diseases, including diabetic kidney disease, obesity-related kidney disease and polycystic kidney disease. Emerging evidence suggests that targeting mTOR and/or AMPK could be an effective therapeutic approach to controlling or preventing these diseases.

Accuracy of preoperative clinical staging for locally advanced gastric cancer in KLASS-02 randomized clinical trial.

Purpose: The discrepancy between preoperative and final pathological staging has been a long-standing challenge for the application of clinical trials or appropriate treatment options. This study aimed to demonstrate the accuracy of preoperative staging of locally advanced gastric cancer using data from a large-scale randomized clinical trial. Materials and methods: Of the 1050 patients enrolled in the clinical trial, 26 were excluded due to withdrawal of consent (n = 20) or non-surgery (n = 6). The clinical and pathological staging was compared. Risk factor analysis for underestimation was performed using univariate and multivariate analyses. Results: Regarding T staging by computed tomography, accuracy rates were 74.48, 61.62, 58.56, and 85.16% for T1, T2, T3 and T4a, respectively. Multivariate analysis for underestimation of T staging revealed that younger age, ulcerative gross type, circular location, larger tumor size, and undifferentiated histology were independent risk factors. Regarding nodal status estimation, 54.9% of patients with clinical N0 disease were pathologic N0, and 36.4% of patients were revealed to have pathologic N0 among clinical node-positive patients. The percentage of metastasis involvement at the D1, D1+, and D2 lymph node stations significantly increased with the advanced clinical N stage. Among all patients, 29 (2.8%), including 26 with peritoneal seeding, exhibited distant metastases. Conclusions: Estimating the exact pathologic staging remains challenging. A thorough evaluation is mandatory before treatment selection or trial enrollment. Moreover, we need to set a sufficient case number when we design the clinical trial considering the stage migration.

Insight into glucocorticoids glucosylation by glucosyltransferase: A combined experimental and in-silico approach.

Glucosyltransferases catalyze the glucosidic bond formation by transferring a glucose molecule from an activated sugar donor to an acceptor substrate. Glucocorticoids (GCs) are adrenal-derived steroid hormones most widely used for anti-inflammatory treatments. In this study, we biotransformed two selected GCs, cortisone and prednisone, into their O-glucoside derivatives using a versatile UDP-glycosyltransferase UGT-1. Complete structural assignment of glucosylated products revealed that the bioconversion by regio-selective glucosylation of cortisone and prednisone produced cortisone 21-glucoside and prednisone 21-glucoside, respectively. We also combined molecular dynamics (MD) simulation to study the binding feature and mechanism of glucosylation. MD simulation studies showed the formation of a stable complex between protein, glucose donor, and substrate, stabilized by hydrogen bonds. Overall, we were able to provide explanations for the experimentally observed selectivity for glucosylation by integrating experimental and computational techniques.

Revitalization of the Waterfront Park Based on Industrial Heritage Using Post-Occupancy Evaluation-A Case Study of Shanghai (China).

With the rapid development of urban construction, the waterfront industrial heritage park has played an active role in shaping the city's image, regional economic development and environmental improvement, and the continuation of the city's waterfront history. The waterfront park based on industrial heritage using post-occupancy evaluation will help improve the sustainable management, maintenance, and design level of the project in the future. However, there is insufficient research on the waterfront industrial heritage park using post-occupancy evaluation. This paper takes Shanghai Houtan Park and Xuhui Binjiang Park, the representative industrial heritage parks in China, as the research objects. Through field investigation and nearly 200 questionnaires and interviews regarding user behavior, the importance of design elements (place characteristics, natural environmental characteristics, usability characteristics, and administrative characteristics) and the correlation of satisfaction help us to understand the use of the two parks and analyze and organize the survey data, carrying out the analysis of the questionnaire results using frequency analysis, IPA analysis, t-test, variance analysis, and multiple regression analysis. The research results include: (1) Both parks are mainly used by people in their twenties and forties, and the trail received the highest utilization rate as the main facility, while the visitor center in charge of guiding functions had the lowest utilization rate. (2) While Houtan Park received high satisfaction with natural environmental characteristics, it was found that Xu Hui Binjiang Park had relatively high satisfaction with the place and usability characteristics. (3) The natural environmental characteristics of Houtan Park have a positive impact on overall satisfaction and return visit satisfaction. Site characteristics and utilization characteristics of Xuhui Binjiang Industrial Park have a positive impact on overall satisfaction, while usability characteristics have a positive impact on return visit satisfaction. Finally, according to the questions and suggestions raised by users, an optimization strategy is proposed for the renewal of the park, and it is hoped that it can provide suggestions for the reconstruction and design of similar Chinese waterfront industrial heritage parks.

Association Between Gut Regulatory Hormones and Post-operative Weight Loss Following Gastrectomy in Patients With Gastric Cancer.

Background/Aims: Post-operative weight loss in patients with gastric cancer lead to a poor quality of life and long-term survival. This study aims to evaluate the effects of gut regulatory hormones on post-operative weight loss in patients with subtotal gastrectomy for gastric cancer. Methods: This prospective study was conducted for 12 months post-surgery in 14 controls and 13 gastrectomy patients who underwent subtotal gastrectomy for gastric cancer. Serum plasma ghrelin, glucagon-like peptide-1, gastric inhibitory peptide-1, peptide YY, insulin, and homeostatic model assessment for insulin resistance responses to a standardized test meal were recorded at multiple time points before and after gastrectomy at 4 and 12 months. Results: The mean weight difference between the pre-operative state and the 4-month period was significantly reduced to 6.6 kg (P = 0.032), but significant weight reduction was not observed from 4 months to 12 months. The plasma levels of glucagon-like peptide-1, gastric inhibitory peptide-1, and peptide YY were significantly increased 4 months postoperatively compared to the pre-operative state (all P = 0.035); however, pre-operative levels and relative changes over a period of 0-4 months of hormones were not correlated with body weight changes. Only the pre-operative ghrelin at peak had a negative correlation with changes in weight reduction in the 4 months after surgery (ρ = -0.8, P = 0.024). Conclusions: Significant weight reduction was common after subtotal gastrectomy for gastric cancer with a negative correlation pre-operative plasma ghrelin levels. Incretin hormones are modestly but significantly increased after subtotal gastrectomy; however, these changes did not affect the weight changes.

Laparoscopic vs Open Distal Gastrectomy for Locally Advanced Gastric Cancer: 5-Year Outcomes of the KLASS-02 Randomized Clinical Trial.

Importance: The long-term safety of laparoscopic distal gastrectomy for locally advanced gastric cancer (AGC) remains uncertain given the lack of 5-year follow-up results. Objective: To compare the 5-year follow-up results in patients with clinically AGC enrolled in the Korean Laparoendoscopic Gastrointestinal Surgery Study (KLASS)-02 randomized clinical trial who underwent laparoscopic or open distal gastrectomy. Design, Setting, and Participants: The KLASS-02, a multicenter randomized clinical trial, showed that laparoscopic surgery was noninferior to open surgery for patients with locally AGC. The present study assessed the 5-year follow-up results, including 5-year overall survival (OS) and relapse-free survival (RFS) rates and long-term complications, in patients enrolled in KLASS-02. From November 21, 2011, to April 29, 2015, patients aged 20 to 80 years diagnosed preoperatively with locally AGC were enrolled. Final follow-up was on June 15, 2021. Data were analyzed June 24 to September 9, 2021. Interventions: Patients were treated with R0 resection either by laparoscopic gastrectomy or open gastrectomy as the full analysis set of the KLASS-02 trial. Main Outcomes and Measures: Five-year OS and RFS rates, recurrence patterns, and long-term surgical complications were evaluated. Results: This study enrolled a total of 1050 patients. A total of 974 patients were treated with R0 resection; 492 (50.5%) in the laparoscopic gastrectomy group (mean [SD] age, 59.8 [11.0] years; 351 men [71.3%]) and 482 (49.5%) in the open gastrectomy group (mean [SD] age, 59.4 [11.5] years; 335 men [69.5%]). In patients who underwent laparoscopic and open distal gastrectomy, the 5-year OS (88.9% vs 88.7%) and RFS (79.5% vs 81.1%) rates did not differ significantly. The most common types of recurrence were peritoneal carcinomatosis (73 of 173 [42.1%]), hematogenous metastases (36 of 173 [20.8%]), and locoregional recurrence (23 of 173 [13.2%]), with no between-group differences in types of recurrence at each cancer stage. The correlation between 3-year RFS and 5-year OS at the individual level was highest in patients with stage III gastric cancer (ρ = 0.720). The late complication rate was significantly lower in the laparoscopic than in the open surgery group (32 of 492 [6.5%] vs 53 of 482 [11.0%]). The most common type of complication in both groups was intestinal obstruction (13 of 492 [2.6%] vs 24 of 482 [5.0%]). Conclusions and Relevance: The 5-year outcomes of the KLASS-02 trial support the 3-year results, which is the noninferiority of laparoscopic surgery compared with open gastrectomy for locally AGC. The laparoscopic approach can be recommended in patients with locally AGC to achieve the benefit of low incidence of late complications. Trial Registration: ClinicalTrials.gov Identifier: NCT01456598.