Multilevel effective surgical workflow recognition in robotic left lateral sectionectomy with deep learning: experimental research.

BACKGROUND: Automated surgical workflow recognition is the foundation for computational models of medical knowledge to interpret surgical procedures. The fine-grained segmentation of the surgical process and the improvement of the accuracy of surgical workflow recognition facilitate the realization of autonomous robotic surgery. This study aimed to construct a multigranularity temporal annotation dataset of the standardized robotic left lateral sectionectomy (RLLS) and develop a deep learning-based automated model for multilevel overall and effective surgical workflow recognition. METHODS: From December 2016 to May 2019, 45 cases of RLLS videos were enrolled in our dataset. All frames of RLLS videos in this study are labeled with temporal annotations. The authors defined those activities that truly contribute to the surgery as effective frames, while other activities are labeled as under-effective frames. Effective frames of all RLLS videos are annotated with three hierarchical levels of 4 steps, 12 tasks, and 26 activities. A hybrid deep learning model were used for surgical workflow recognition of steps, tasks, activities, and under-effective frames. Moreover, the authors also carried out multilevel effective surgical workflow recognition after removing under-effective frames. RESULTS: The dataset comprises 4 383 516 annotated RLLS video frames with multilevel annotation, of which 2 418 468 frames are effective. The overall accuracies of automated recognition for Steps, Tasks, Activities, and under-effective frames are 0.82, 0.80, 0.79, and 0.85, respectively, with corresponding precision values of 0.81, 0.76, 0.60, and 0.85. In multilevel effective surgical workflow recognition, the overall accuracies were increased to 0.96, 0.88, and 0.82 for Steps, Tasks, and Activities, respectively, while the precision values were increased to 0.95, 0.80, and 0.68. CONCLUSION: In this study, the authors created a dataset of 45 RLLS cases with multilevel annotations and developed a hybrid deep learning model for surgical workflow recognition. The authors demonstrated a fairly higher accuracy in multilevel effective surgical workflow recognition when under-effective frames were removed. Our research could be helpful in the development of autonomous robotic surgery.

Localization and expression of SLX4 in the testis of sterile male cattle-yak.

Cattle-yak, the hybrid offspring of yak (Bos grunniens) and cattle (Bos taurus), serves as a unique model to dissect the molecular mechanisms underlying reproductive isolation. While female cattle-yaks are fertile, the males are completely sterile due to spermatogenic arrest at the meiosis stage and massive germ cell apoptosis. Interestingly, meiotic defects are partially rescued in the testes of backcrossed offspring. The genetic basis of meiotic defects in male cattle-yak remains unclear. Structure-specific endonuclease subunit (SLX4) participates in meiotic double-strand break (DSB) formation in mice, and its deletion results in defects in spermatogenesis. In the present study, we examined the expression patterns of SLX4 in the testes of yak, cattle-yak, and backcrossed offspring to investigate its potential roles in hybrid sterility. The results showed that the relative abundances of SLX4 mRNA and protein were significantly reduced in the testis of cattle-yak. The results of immunohistochemistry revealed that SLX4 was predominately expressed in spermatogonia and spermatocytes. Chromosome spreading experiments showed that SLX4 was significantly decreased in the pachytene spermatocytes of cattle-yak compared with yak and backcrossed offspring. These findings suggest that SLX4 expression was dysregulated in the testis of cattle-yak, potentially resulting in the failure of crossover formation and collapses of meiosis in hybrid males.

Analysis of the supervision status of intensive countywide medical community in Fujian province based on thematic frame analysis / 中华医院管理杂志

Objective:To analyze the supervision mode and problems of intensive countywide medical communities and explore the methods and strategies to improve their supervision system.Methods:From March 2022 to May 2022, a stratified random sampling method was used and the intensive countywide medical communities in the province were selected for field study. In-depth interviews were made with the staff of the healthcare administration departments and health insurance agencies affiliated with intensive countywide medical communities, directors of general hospitals, directors of township hospitals, and heads of functional departments. These interviews mainly covered the principal entities of countywide medical community supervision, supervision measures and contents, supervision effects, supervision weaknesses, and how to improve internal and external supervision mechanisms. The interviews results were analyzed using thematic framework analysis and the data were subject to a descriptive analysis.Results:23 persons of five intensive countywide medical communities were selected for key person interview. The finalized framework of regulatory elements of intensive countywide medical communities consists of such five general themes as regulatory subjects, regulatory content, regulatory measures, regulatory effectiveness and existing problems, comprising 14 level-1 indicators and 52 level-2 indicators. The main regulatory bodies were mainly government departments (15 times), the regulatory content was focused on medical resources (10 times), the regulatory measures cover specific regulations (4 times), specific activities (4 times) and assessment and evaluation (4 times). And the regulatory effectiveness demonstrated a currently strong regulation strength of medical communities (5 times), and the existing problems were insufficient government supervision (12 times), difficulties encountered by social forces in their supervision (11 times) and internal governance (5 times).Conclusions:The supervision system of intensive countywide medical communities should be optimized by improving the governmental supervision mechanism, inviting supervision of social forces and building an effective internal governance.

Constructing theory model for medical quality and safety management based on grounded theory / 中华医院管理杂志

Objective:To construct future-oriented theoretical management model for medical quality and patient safety.Methods:Procedure grounded theory was applied to code data including 30 expert interview records from July 2021 to June 2022 and the qualitative analysis results of 71 core literatures in Chinese and English, and then the theoretical model was constructed.Results:After three-level coding, 555 reference points, 249 initial concepts, 41 categories, 27 main categories and 7 core categories related to medical quality and safety management were sorted out, and the theoretical model of SQ (I-SPORT) matrix for medical quality and safety management was constructed. This model extended the traditional dimension in quality and safety management.Conclusions:Regarding medical quality and safety management, on one hand, should focus on the systematic improvement of structure, process, results, reengineering, education and training in terms of management functions; on the other hand, it is necessary to improve the organization, employees, resources, technology and tools, and patient experience in terms of management elements.

Construction of a generalized structure-process-outcome theoretical model of medical quality and safety management in China / 中华医院管理杂志

Objective:To construct a theoretical model of medical quality and safety management based on the current situation of medical quality and safety management mode in China, providing reference for continuous improvement of medical quality and safety management.Methods:The CNKI database was used as the data source to search literature, with a high citation index H=38 as the judgment standard, the core literature related to the quality and safety management in China was selected. Based on the structure-process-outcome (SPO) model, Nvivo qualitative analysis software was used to code and analyze the included literature, sort out the relevant elements of China′s medical quality and safety management, and clarify the logical relationship between the elements, forming a generalized SPO model of China′s medical quality and safety management.Results:Through a systematic summary and review of relevant literature, a generalized SPO model for medical quality and safety management was proposed, including 5 structural elements (organizational structure, personnel management, resource management, informatization, management standards), 2 process elements (management methods, service processes), and 3 outcome elements (patient outcomes, employee outcomes, organizational results). The logical relationships between and within the three major elements were constructed.Conclusions:To improve the level of medical quality and safety management in China, the structural dimension should be focused on clarifying the responsibilities of the main body of quality management, establishing an independent and perfect quality control department, strengthening the investment and construction of information technology, and promoting the implementation of the medical quality management standard; the process dimension should be focused on promoting the rational application of quality management tools; and the outcome dimension should be focused on strengthening the management of patient safety and improving the individual satisfaction.

The outcome of surgical and non-surgical treatments for traumatic optic neuropathy: a comparative study of 685 cases.

Background: The choice and efficacy of surgical or/and surgical treatments for traumatic optic neuropathy (TON) remained controversial by now. This study aims to present the outcomes of surgical and nonsurgical treatments for TON in our center. Methods: A total of 685 consecutive patients were retrospectively included in the study. And divided into surgical and non-surgical groups. All cases were treated with corticosteroids for 3 days after admission. Endoscopic optic decompression was applied to 479 patients of surgical group; The other 206 patients of nonsurgical were administered with corticosteroids alone. The visual outcomes before and after treatment were compared with Wilcoxon rank and tests. The improvement rate between two groups were compared with chi-square test. Results: The visual acuity (VA) after treatment was significantly better than that before treatment (P=0.000). Overall VA improvement rate in the surgical group was better than that in non-surgical group (42.8% vs. 35.4%) with no significant difference (P=0.072). The VA improvement rate was significant greater in the surgical group than that in the non-surgical group in the patients with NLP before treatment (P=0.028). The VA improvement rate was better in the surgical group than that in the non-surgical group (71.9% vs. 57.8%) but with no significant difference. The final overall VA was 0.1 or better in 43 cases; 104 cases were able to count fingers; hand motion (HM) became perceivable in 132 cases; light perception (LP) was achieved in 53 cases; and no light perception (NLP) remained in 353 cases. Conclusions: Endoscopic optic nerve decompression (EOND) combined with corticosteroids or corticosteroids alone could reach the improvement for patients with TON. The EOND combined with corticosteroids could achieve better VA improvement in patients with NLP.

Lox as the Potential Key Gene of Clear Cell Renal Carcinoma.

Clear cell renal carcinoma (CCRC) is the most common type of renal carcinoma. We hope to find out the potential key genes playing important roles in CCRC genesis and progression by analysing the recent expression profiling by array from 2014 to 2016. In order to find out the differentially expressed genes (DEGs) between CCRC and normal renal tissue. Gene Ontology (GO) and Kyoto Encyclopedia of Genes, and Genomes (KEGG) pathway enrichment were carried out by the Database for Annotation, Visualization and Integrated Discovery (DAVID) v6.8. Protein-Protein Interaction (PPI) Networks Functional Enrichment Analysis of these DEGs was analyzed using the Search Tool for Recurring Instances of Neighbouring Genes (STRING). The results were then visualized by the software Cytoscape. The authors also used the online tool of Kaplan-Meier plotter survival analysis to assess the significance of the top ten genes in the prognosis of CCRC. A total of 192 DEGs were identified and the top ten key genes were picked out by the software Cytoscape. FN1, CXCR4, LOX, and PLG were then further screened out based on the overall survival analysis; SLC12A1 and LOX were screened out after the recurrence-free survival analysis. LOX was finally believed to be the most reliable prognostic factor since it has prognostic value for both overall survival and recurrence-free survival analysis. Our analysis suggests that LOX is the most reliable prognostic factor for CCRC patients. Key Words: Renal clear cell carcinoma, Microarray datasets, Bioinformatics approach, Prognostic factor, LOX.

MicroRNAs/LncRNAs Modulate MDSCs in Tumor Microenvironment.

Myeloid-derived suppressor cells (MDSCs) are a heterogeneous group of immature cells derived from bone marrow that play critical immunosuppressive functions in the tumor microenvironment (TME), promoting cancer progression. According to base length, Non-coding RNAs (ncRNAs) are mainly divided into: microRNAs (miRNAs), lncRNAs, snRNAs and CircRNAs. Both miRNA and lncRNA are transcribed by RNA polymerase II, and they play an important role in gene expression under both physiological and pathological conditions. The increasing data have shown that MiRNAs/LncRNAs regulate MDSCs within TME, becoming one of potential breakthrough points at the investigation and treatment of cancer. Therefore, we summarize how miRNAs/lncRNAs mediate the differentiation, expansion and immunosuppressive function of tumor MDSCs in TME. We will then focus on the regulatory mechanisms of exosomal MicroRNAs/LncRNAs on tumor MDSCs. Finally, we will discuss how the interaction of miRNAs/lncRNAs modulates tumor MDSCs.

Investigation of preoperative physical activity level in kidney transplant recipients and its impact on early postoperative recovery: A retrospective cohort study.

Objective: To retrospectively investigate the preoperative physical activity (PA) level in kidney transplant recipients (KTRs) and its impact on early postoperative recovery. Methods: A total of 113 patients who received kidney transplantation at West China Hospital of Sichuan University were enrolled in this retrospective cohort study. According to the PA level measured by the Chinese version of the International Physical Activity Questionnaire-Long Version, the patients were allocated into the low PA level group (Group L, n = 55) and medium to high PA level group (Group MH, n = 58). The kidney function recovery indicators, including estimated glomerular filtration rate (eGFR), postoperative complications, postoperative length of stay (LOS), and unscheduled readmission within three months of discharge, were evaluated and documented. A association analysis was applied to analyze and compare the association between indicators. Results: The median PA levels of the KTRs were 1701.0 MTEs * min/week. Regarding the postoperative recovery indicators, the KTRs spent a mean time of 19.63 h to achieve transfer out of bed after the operation (Group L: 19.67 h; Group MH: 19.53 h; P = 0.952) and reached a mean distance of 183.10 m as the best ambulatory training score within two days after the operation (Group L: 134.91 m; Group MH: 228.79 m; P < 0.001). The preoperative PA level showed a moderate positive association with early postoperative ambulation distance (ρ = 0.497, P < 0.001). However, no significant between-group difference in eGFR on postoperative days 1, 3, and 5 (P = 0.913, 0.335, and 0.524) or postoperative complications, including DGF (P = 0.436), infection (P = 0.479), postoperative LOS (P = 0.103), and unscheduled readmission (P = 0.698), was found. Conclusions: The preoperative PA level of KTRs is lower than that of the general population. KTRs with moderate or high preoperative PA levels showed higher ambulatory function in the early postoperative period than those with low preoperative PA levels, but no between-group differences in other early recovery indicators were observed.

Theoretical discussion and countermeasure analysis on the construction of county medical communities in China / 中华医院管理杂志

Objective:To provide reference for the sustainable development of county medical communities through analyzing key issues in the construction of such communities in China.Methods:Such Database websites as CNKI, Wanfang Data and VIP Information were selected to retrieve journal papers and dissertations with the keywords of " county medical community" " county medical alliance" " county medical and health community" and " medical alliance" . The time period ranged from the establishment of the database to December 2021. Content analysis and social network analysis were used to classify and sort key issues of county medical community construction in the included literature, and the descriptive analysis was used for all the data.Results:274 literatures were obtained in this study, 82 high-frequency issues were extracted for the construction process of county medical communities. It was divided into 3 dimensions of service system, operation mechanism and fund guarantee, including 14 items of integration of resources, integrated management, resource intensification, information construction, medical services, medical quality, family doctors, public health, management system, personnel system, salary system, supervision mechanism, medical insurance fund and financial input. The results of social network analysis showed that the top three high-frequency issues of point centrality and intermediary centrality were lack of highly unified information exchange platform (107.00, 514.48), insufficient service capacity of primary medical institutions (61.00, 238.48) and lack of sustainable benefit distribution mechanism (45.00, 192.38).Conclusions:The construction of county medical community covered three aspects: medical service system, operation mechanism and fund guarantee.The shortage of primary medical service capacity, the lack of coordination of an information platform, the general shortage of essential drugs, the imperfect internal assessment and incentive system, the imperfect supervision system and the imperfect medical insurance supporting policy becomed the main roadblocks in building county medical communities in China. In order to promote the sustainable development of county medical community, the authors recommend to further upgrade the county integrated medical service system, perfect the operation mechanism, and strengthen the input into county health care.

An Auxiliary Tasks Based Framework for Automated Medical Skill Assessment with Limited Data.

Automated medical skill assessment facilitates medical education by merging varying clinical experiences across instructors for standardizing medical training. However, medical datasets for training such automated assessment rarely have satisfactory sizes due to the cost of data collection, safety concerns and privacy restrictions. Current medical training relies on evaluation rubrics that usually include multiple auxiliary labels to support the overall evaluation from varying aspects of the procedure. In this paper, we explore machine learning algorithms to design a generalizable auxiliary task-based framework for medical skill assessment to address training automated systems with limited data. Our framework exhaustively mines valid auxiliary information in the evaluation rubric to pre-train the feature extractor before training the skill assessment classifier. Notably, a new regression-based multitask weighting method is the key to pre-train a meaningful feature representation comprehensively, ensuring the evaluation rubric is well imitated in the final model. The overall evaluation task can be fine-tuned based on the pre-trained rubric-based feature representation. Our experimental results on two medical skill datasets show that our work can significantly improve performance, achieving 85.9% and 97.4% accuracy in the intubation dataset and surgical skill dataset, respectively.

Protective effects of sodium selenite on insulin secretion and diabetic retinopathy in rats with type 1 diabetes mellitus.

The aim of the present study was to determine the effects of sodium selenite on pancreatic ß cells and diabetic retinopathy in type 1 diabetes mellitus (T1DM) rats. Diabetes was induced by administration of streptozotocin (STZ) and both diabetic and control animals were treated with sodium selenite to measure body weight, food and water intake as well as blood glucose level. Additionally, immunohistochemistry was performed to detect the levels of insulin secretion in pancreatic ß cells. Apoptosis level of pancreatic cells in rats was determined by apoptosis kit. Retinal tissues were stained with hematoxylin-eosin and the area of retinal capillary was measured by Image-Pro Plus 6.0 software. Food and water intake coupled with blood glucose level were increased while body weight of rats was decreased in STZ group. After treatment with sodium selenite, High-Sel group and Low-Sel group showed decreased food intake coupled with blood glucose level and concomitantly increased body weight (vs. STZ group). Of note, the insulin secretion in pancreatic ß cells as well as serum insulin levels were strikingly heightened while apoptosis level of pancreatic tissues was lowered in the High-Sel group (vs. STZ and Low-Sel groups). Additionally, both High-Sel and Low-Sel groups showed a small area of retinal capillary (vs. STZ group). Sodium selenite could promote the levels of insulin secretion in pancreatic ß cells of T1DM rats, and concomitantly ameliorate diabetic retinopathy.

Naringin improves sepsis-induced intestinal injury by modulating macrophage polarization via PPARγ/miR-21 axis.

Naringin exhibited various pharmacological activities. However, its biological function and underlying mechanism in regulating macrophage polarization remain elusive. This study aimed to investigate the regulatory network between naringin and macrophage polarization in sepsis-induced intestinal injury. Cecal ligation and puncture (CLP) was used to establish the animal model of sepsis. Chromatin immunoprecipitation and a luciferase reporter assay were used to determine the interplay between peroxisome proliferator-activated receptor γ (PPARγ) and miR-21 promoter, as well as miR-21 and its target genes. Naringin enhanced the overall survival of septic mice and alleviated the CLP-induced inflammatory response and intestinal damage. This was accompanied by the increased expression of PPARγ in the intestines and the stimulation of ileal macrophages toward the M2 phenotype. Furthermore, in lipopolysaccharide-stimulated bone marrow-derived macrophages, naringin stimulated M2 polarization. Mechanistically, PPARγ inhibition attenuated the promotion of M2 polarization caused by naringin, and the naringin/PPARγ regulatory work was compromised by miR-21 inhibition. The present study suggested that naringin promoted M2 polarization via the PPARγ/miR-21 axis, thus relieving sepsis-induced intestinal injury. This study provides novel insights into the mechanism by which naringin alleviated sepsis-induced intestinal injury through regulation of macrophage polarization.

MiR-20b-5p modulates inflammation, apoptosis and angiogenesis in severe acute pancreatitis through autophagy by targeting AKT3.

BACKGROUND: Severe acute pancreatitis (SAP) is a common acute abdominal disease with high morbidity and mortality. However, the mechanism underlying SAP is still unclear. METHODS: Cerulean and LPS (Cer-LPS) was used to establish a rat model and an in vitro model of SAP. qRT-PCR, western blot and IHC were determined to analyse the expression of mRNA and proteins. IL-1ß, TNF-α and IL-6 levels were measured applying ELISA. H&E staining was determined to observe the pathological changes. Apoptosis was tested by AV-PI staining using flow cytometry. CCK8 assay was taken to detect cell viability. Cell migration was assessed by transwell assay. Tube formation assay was conducted to evaluate angiogenesis. Luciferase assay was used to detect relationship of miR-20b-5p and AKT3. RESULTS: MiR-20b-5p was lowly expressed in SAP models both in vivo and in vitro. Overexpression of miR-20b-5p restrained inflammation and apoptosis in Cer-LPS treated pancreatic acinar cells. Furthermore, miR-20b-5p promoted the angiogenesis of vascular endothelial cells, since the viability, migration and the capability of tube formation were increased by miR-20b-5p. Mechanically, miR-20b-5p directly targeted AKT3 to promote autophagy. Furthermore, miR-20b-5p could prevent the inflammation, apoptosis and enhance angiogenesis via enhancing autophagy, which was verified in vivo. CONCLUSION: This study demonstrated miR-20b-5p attenuates SAP through directly targeting AKT3 to regulate autophagy, subsequently inhibit inflammation and apoptosis, and promote angiogenesis. Our findings suggested a novel target of miR-20b-5p for the therapy of SAP.

Role of Xanthoceras sorbifolium MYB44 in tolerance to combined drought and heat stress via modulation of stomatal closure and ROS homeostasis.

Yellowhorn (Xanthoceras sorbifolium) is an important edible woody oil tree species that is endemic to China. Drought and heat stresses are factors severely limiting the high-quality development of the yellowhorn industry. Transcription factors (TFs) play critical roles in regulating the response of woody plant species to water deficit or high temperature. However, the MYB TFs that respond to combined drought and heat stress in yellowhorn remain unclear. Here, we first investigated the physiological changes in 5 yellowhorn varieties in response to combined stress treatments. We observed significant changes in antioxidant enzyme activities and photosynthesis. The Maigaiti variety yielded the best results and was selected for subsequent experiments. An R2R3-type MYB TF, designated XsMYB44, was isolated from the leaves of yellowhorn. XsMYB44 expression was strongly induced by combined stress. Suppression of XsMYB44 expression via virus-induced gene silencing weakened yellowhorn tolerance to both individual and combined drought and heat stress, and the increased susceptibility was coupled with decreased plant height, fresh weight and relative water content and inhibited stomatal closure. Moreover, compared with the individual stresses, the combined stress caused increased reactive oxygen species levels and decreased antioxidant enzyme activities and proline content in XsMYB44-silenced plants. Furthermore, the expression levels of several defense-related genes were reduced in the XsMYB44-silenced plants. Overall, we studied the physiological characteristics of 5 yellowhorn varieties, and the results demonstrated that XsMYB44 acts as a positive regulator in the yellowhorn response to combined stress by triggering stomatal closure to maintain water levels and by modulating ROS homeostasis.

Role of delayed wider endoscopic optic decompression for traumatic optic neuropathy: a single-center surgical experience.

BACKGROUND: The aim of the present study was to discuss the efficacy of delayed wider endoscopic optic decompression in traumatic optic neuropathy (TON). METHODS: A total of 479 patients were treated with corticosteroids and delayed wider endoscopic optic decompression, including the injury-to-surgery interval, within 2 weeks in patients with no light perception (NLP), and within 1 month in patients with residual eyesight. Based on the traditional decompression range, the superior wall of the optic canal was further decompressed. The preoperative and postoperative visual acuities (VAs) were reviewed, and the therapeutic efficacy was analyzed. RESULTS: The final VA was 0.1 or better in 29 cases, finger count in 79 cases, hand motion in 99 cases, light perception (LP) in 25 cases, and NLP in 247 cases. A total of 136 patients (136/383, 35.5%) recovered after NLP treatment, and 78 patients (69/96, 71.9%) had improved residual eyesight. The improvement rate in patients with residual eyesight was significantly higher than that of patients with NLP (P<0.01). Moreover, the total VA after treatment was better than that before surgery (P<0.01). CONCLUSIONS: Delayed wider optic nerve decompression plus corticosteroids remains an effective and safe therapeutic strategy for patients with delayed treatment intervals of more than 1 week, especially for those with residual eyesight within 1 month.

Long Non-coding RNA FENDRR Modulates Autophagy Through Epigenetic Suppression of ATG7 via Binding PRC2 in Acute Pancreatitis.

Acute pancreatitis (AP) is an inflammatory, complicated pancreatic disease, carrying significant morbidity and mortality. However, the molecular and cellular mechanisms involved in AP pathogenesis remain to be elucidated. Here, we explore the role of FOXF1 adjacent non-coding developmental regulatory RNA (FENDRR) in AP progression. Caerulein with or without LPS- induced or taurolithocholic acid 3-sulfate (TLC-S)-induced AP mouse models and cell models were performed for the validation of FENDRR expression in vivo and in vitro, respectively. Histopathological examinations of pancreatic tissues were performed to evaluate the severity of AP. Transmission electron microscopy was utilized to visualize the autophagic vacuoles. siRNA specifically targeting FENDRR was further applied. Flow cytometry was employed to assess cell apoptosis. ELISA, immunoflureoscence, and western blotting analysis were also performed to determine the levels of inflammatory cytokines and autophagy activity. RNA immunoprecipitation (RIP) and chromatin immunoprecipitation (ChIP) assays were carried out to reveal the epigenetic regulation of FENDRR on ATG7. Additionally, silencing FENDRR was also verified in AP mouse models. Higher FENDRR and impaired autophagy were displayed in both AP mouse models and cell models. FENDRR knockdown dramatically attenuated caerulein- or TLC-S-induced AR42J cells apoptosis and autophagy suppression. Further mechanistic experiments implied that the action of FENDRR is moderately attributable to its repression of ATG7 via direct interaction with the epigenetic repressor PRC2. Moreover, the silencing of FENDRR significantly induced the promotion of ATG7, thus alleviating the development of AP in vivo. Our study highlights FENDRR as a novel target that may contribute to AP progression, suggesting a therapeutic target for AP treatment.

Automated Assessment of Neonatal Endotracheal Intubation Measured by a Virtual Reality Simulation System.

Manual assessment from experts in neonatal endotracheal intubation (ETI) training is a time-consuming and tedious process. Such subjective, highly variable, and resource-intensive assessment method may not only introduce inter-rater/intra-rater variability, but also represent a serious limitation in many large-scale training programs. Moreover, poor visualization during the procedure prevents instructors from observing the events occurring within the manikin or the patient, which introduces an additional source of error into the assessment. In this paper, we propose a physics-based virtual reality (VR) ETI simulation system that captures the entire motions of the laryngoscope and the endotracheal tube (ETT) in relation to the internal anatomy of the virtual patient. Our system provides a complete visualization of the procedure, offering instructors with comprehensive information for accurate assessment. More importantly, an interpretable machine learning algorithm was developed to automatically assess the ETI performance by training on the performance parameters extracted from the motions and the scores rated by experts. Our results show that the leave-one-out-cross-validation (LOOCV) classification accuracy of the automated assessment algorithm is 80%, which indicates that our system can reliably conduct a consistent and standardized assessment for ETI training.

Automated Assessment System for Neonatal Endotracheal Intubation Using Dilated Convolutional Neural Network.

Neonatal endotracheal intubation (ETI) is an important, complex resuscitation skill, which requires a significant amount of practice to master. Current ETI practice is conducted on the physical manikin and relies on the expert instructors' assessment. Since the training opportunities are limited by the availability of expert instructors, an automatic assessment model is highly desirable. However, automating ETI assessment is challenging due to the complexity of identifying crucial features, providing accurate evaluations and offering valuable feedback to trainees. In this paper, we propose a dilated Convolutional Neural Network (CNN) based ETI assessment model, which can automatically provide an overall score and performance feedback to pediatric trainees. The proposed assessment model takes the captured kinematic multivariate time-series (MTS) data from the manikin-based augmented ETI system that we developed, automatically extracts the crucial features of captured data, and eventually provides an overall score as output. Furthermore, the visualization based on the class activation mapping (CAM) can automatically identify the motions that have significant impact on the overall score, thus providing useful feedback to trainees. Our model can achieve 92.2% average classification accuracy using the Leave-One-Out-Cross-Validation (LOOCV).

Yellowhorn drought-induced transcription factor XsWRKY20 acts as a positive regulator in drought stress through ROS homeostasis and ABA signaling pathway.

Yellowhorn (Xanthoceras sorbifolium) is a peculiar woody edible oil-bearing tree in China. WRKY transcription factors have specific roles in plant multiple abiotic stress responses. However, it is still not clear that the molecular mechanisms of WRKYs involve in drought tolerance in yellowhorn. In this study, we isolated a drought-induced group I WRKY gene from yellowhorn, designated as XsWRKY20. Expression of XsWRKY20 was strongly induced by PEG6000, NaCl, ABA and SA. Virus-induced gene silencing (VIGS) of XsWRKY20 reduced tolerance to drought stress in yellowhorn, as determined through physiological analyses of POD activity, SOD activity and proline content. This susceptibility was coupled with decreased expression of stress-related genes. In contrast, overexpression of XsWRKY20 in tobacco notably improved drought tolerance. Compared with the WT plants, the XsWRKY20-transgenic lines exhibited lower ROS and MDA content and higher antioxidant enzyme activity and proline content after drought treatment. Moreover, overexpression of XsWRKY20 enhanced the expression of several genes associated with encoding these antioxidant enzymes, proline biosynthesis and ABA signaling pathway. Taken together, XsWRKY20 functions as a positive regulator contributing to drought stress tolerance through either ROS homeostasis by antioxidant systems or ABA-dependent/independent gene expression pathway.