Identification and validation of major and stable quantitative trait locus for falling number in common wheat (Triticum aestivum L.).

KEY MESSAGE: A major and stable QTL, QFn.sau-1B.2, which can explain 13.6% of the PVE in FN and has a positive effect on resistance in SGR, was mapped and validated. The falling number (FN) is considered one of the most important quality traits of wheat grain and is the most important quality evaluation index for wheat trade worldwide. The quantitative trait loci (QTLs) for FN were mapped in three years of experiments. 23, 30, and 58 QTLs were identified using the ICIM-BIP, ICIM-MET, and ICIM-EPI methods, respectively. Among them, seven QTLs were considered stable. QFn.sau-1B.2, which was mapped to the 1BL chromosome, can explain 13.6% of the phenotypic variation on average and is considered a major and stable QTL for FN. This QTL was mapped in a 1 cM interval and is flanked by the markers AX-110409346 and AX-108743901. Epistatic analysis indicated that QFN.sau-1B.2 has a strong influence on FN through both additive and epistatic effects. The Kompetitive Allele-Specific PCR marker KASP-AX-108743901, which is closely linked to QFn.sau-1B.2, was designed. The genetic effect of QFn.sau-1B.2 on FN was successfully confirmed in Chuannong18 × T1208 and CN17 × CN11 populations. Moreover, the results of the additive effects of favorable alleles for FN showed that the QTLs for FN had significant effects not only on FN but also on the resistance to spike germination. Within the interval of QFn.sau-1B.2, 147 high-confidence genes were found. According to the gene annotation and the transcriptome data, four genes might be associated with FN. QFn.sau-1B.2 may provide a new resource for the high-quality breeding of wheat in the future.

MCNN-DIC: a mechanical constraints-based digital image correlation by a neural network approach.

Digital image correlation (DIC) is a widely used photomechanical method for measuring surface deformation of materials. Practical engineering applications of DIC often encounter challenges such as discontinuous deformation fields, noise interference, and difficulties in measuring boundary deformations. To address these challenges, a new, to the best of our knowledge, DIC method called MCNN-DIC is proposed in this study by incorporating mechanical constraints using neural network technology. The proposed method applied compatibility equation constraints to the measured deformation field through a semi-supervised learning approach, thus making it more physical. The effectiveness of the proposed MCNN-DIC method was demonstrated through simulated experiments and real deformation fields of nuclear graphite material. The results show that the MCNN-DIC method achieves higher accuracy in measuring non-uniform deformation fields than a traditional mechanical constraints-based DIC and can rapidly measure deformation fields without requiring extensive pre-training of the neural network.

Identification and Validation of a Stable Major-Effect Quantitative Trait Locus for Kernel Number per Spike on Chromosome 2D in Wheat (Triticum aestivum L.).

A recombinant inbred line population including 371 lines was developed by a high kernel number per spike (KNPS) genotype T1208 and a low KNPS genotype Chuannong18 (CN18). A genetic linkage map consisting of 11,583 markers was constructed by the Wheat55K SNP Array. The quantitative trait loci (QTLs) related to KNPS were detected in three years. Eight, twenty-seven, and four QTLs were identified using the ICIM-BIP, ICIM-MET, and ICIM-EPI methods, respectively. One QTL, QKnps.sau-2D.1, which was mapped on chromosome 2D, can explain 18.10% of the phenotypic variation (PVE) on average and be considered a major and stable QTL for KNPS. This QTL was located in a 0.89 Mb interval on chromosome 2D and flanked by the markers AX-109283238 and AX-111606890. Moreover, KASP-AX-111462389, a Kompetitive Allele-Specific PCR (KASP) marker which closely linked to QKnps.sau-2D.1, was designed. The genetic effect of QKnps.sau-2D.1 on KNPS was successfully confirmed in two RIL populations. The results also showed that the significant increase of KNPS and 1000-kernel weight (TKW) was caused by QKnps.sau-2D.1 overcoming the disadvantage due to the decrease of spike number (SN) and finally lead to a significant increase of grain yield. In addition, within the interval in which QKnps.sau-2D.1 is located in Chinese Spring reference genomes, only fifteen genes were found, and two genes that might associate with KNPS were identified. QKnps.sau-2D.1 may provide a new resource for the high-yield breeding of wheat in the future.

Time series RNA-seq analysis identifies MAPK10 as a critical gene in diabetes mellitus-induced atrial fibrillation in mice.

Atrial fibrillation (AF) is a major complication of type 2 diabetes mellitus (T2DM) and plays critical roles in the pathogenesis of atrial remodeling. However, the differentially expressed genes in atria during the development of AF induced by hyperglycemia have rarely been reported. Here, we showed time-dependent increased AF incidence and duration, atrial enlargement, inflammation, fibrosis, conduction time and action potential duration in db/db mice, a model of T2DM. RNA sequencing analysis showed that 2256 genes were differentially expressed in the atria at 12, 14 and 16 weeks. Gene Ontology analysis showed that these genes participate primarily in cell adhesion, cellular response to interferon-beta, immune system process, positive regulation of cell migration, ion transport and cellular response to interferon-gamma. Analysis of significant pathways revealed the IL-17 signaling pathway, TNF signaling pathway, MAPK signaling pathway, chemokine signaling pathway, and cAMP receptor signaling. Additionally, these differentially expressed genes were classified into 50 profiles by hierarchical clustering analysis. Twelve of these profiles were significant and comprised 1115 genes. Gene coexpression network analysis identified that mitogen-activated protein kinase 10 (MAPK10) was localized in the core of the gene network and was the most highly expressed gene at different time points. Knockdown of MAPK10 markedly attenuated DM-induced AF incidence, atrial inflammation, fibrosis, electrical disorder and apoptosis in db/db mice. In summary, the present findings revealed that many genes are involved in DM-induced AF and that MAPK10 plays a central role in this disease, indicating that strategies targeting MAPK10 may represent a potential therapeutic approach to treat DM-induced AF.

Hyperglycemia promotes myocardial dysfunction via the ERS-MAPK10 signaling pathway in db/db mice.

Recent studies have demonstrated that hyperglycemia is a major risk factor for the development and exacerbation of cardiovascular disease (CVD). However, the molecular mechanisms involved in diabetic cardiomyopathy (DCM) have not been fully elucidated. In this study, we focused on the underlying mechanism of DCM. Leptin receptor-deficient db/db mice were used to model a type 2 diabetes mellitus (T2DM) model in our study. WT mice and db/db mice received 4-phenylbutyric acid (4-PBA) (25 mg/kg/day) and saline by intraperitoneal injection every other day for 4 weeks. WT and db/db mice were given tail vein injections of 100 µL of rAAV9-Sh-MAPK10 and rAAV9-Sh-GFP at the age of 6-8 weeks. Echocardiography was performed to measure cardiac function, histological examinations were used to evaluate ventricular hypertrophy and fibrosis. Quantitative RT-qPCR was used to assess the mRNA expression of Jun N-terminal kinase 3 (JNK3, MAPK10), atrial natriuretic factor (ANF), brain natriuretic peptide (BNP), and collagen I and III. Immunoblotting was performed to measure the levels of cardiac hypertrophy-related proteins, fibrosis-related proteins, endoplasmic reticulum stress (ERS)-related proteins and apoptosis-related proteins. TUNEL staining was performed to examine cardiomyocyte apoptosis. In contrast to 12-week-old db/db mice, 16-week-old db/db mice showed the most severe myocardial dysfunction. The DCM induced by hyperglycemia was largely alleviated by 4-PBA (25 mg/kg/day, intraperitoneal injection). Similarly, tail vein injection of rAAV9-Sh-MAPK10 reversed the phenotype of the heart in db/db mice including cardiac hypertrophy and apoptosis in db/db mice. The mechanistic findings suggested that hyperglycemia initiated the ERS response through the negative regulation of sirtuin 1 (SIRT1), leading to the occurrence of myocardial dysfunction, and specific knockdown of MAPK10 in the heart directly reversed myocardial dysfunction induced by hyperglycemia. We demonstrated that hyperglycemia promotes DCM in db/db mice through the ERS-MAPK10 signaling pathway in diabetic mice.

Disordered Low Molecular Weight Spiropyran Exhibiting Photoregulated Adhesion Ability.

The functions of the materials composed of small molecules are highly dependent on their ordered molecular arrangements in both natural and artificial systems. Without ordered structure, small molecules hardly gain complicated functions, due to the absence of intermolecular covalent bond connection or strong network. Here, a low molecular weight spiropyran that could exhibit attractive photochromism and powerful adhesion property in disordered solid state is demonstrated. With maximum up to ∼8 MPa, the adhesion strength could be photoregulated in multiple levels, which also shows one-to-one correspondence to the specific color state. The working mechanism analysis on the photoregulated adhesion reveals that the isomer ratio of merocyanine form and the molecular packing density of spiropyran are the determining factors for the adhesion ability. The discovery of photoregulated adhesion from pure spiropyran provides a new strategy for developing functional materials by employing low molecular weight compounds.

Identification of a stable major-effect quantitative trait locus for pre-harvest sprouting in common wheat (Triticum aestivum L.) via high-density SNP-based genotyping.

KEY MESSAGE: A major and stable QTL cQSGR.sau.3D, which can explain 33.25% of the phenotypic variation in SGR, was mapped and validated, and cQSGR.sau.3D was found to be independent of GI. In this study, a recombinant inbred line (RIL) population containing 304 lines derived from the cross of Chuan-nong17 (CN17) and Chuan-nong11 (CN11) was genotyped using the Wheat55K single-nucleotide polymorphism array. A high-density genetic map consisting of 8329 markers spanning 4131.54 cM and distributed across 21 wheat chromosomes was constructed. QTLs for whole spike germination rate (SGR) were identified in multiple years. Six and fourteen QTLs were identified using the Inclusive Composite Interval Mapping-Biparental Populations and Multi-Environment Trial methods, respectively. A total of 106 digenic epistatic QTLs were also detected in this study. One of the additive QTLs, cQSGR.sau.3D, which was mapped in the region from 3.5 to 4.5 cM from linkage group 3D-2 on chromosome 3D, can explain 33.25% of the phenotypic variation in SGR and be considered a major and stable QTL for SGR. This QTL was independent of the seeds' germination traits, such as germination index. One Kompetitive Allele-Specific PCR (KASP) marker, KASP-AX-110772653, which is tightly linked to cQSGR.sau.3D, was developed. The genetic effect of cQSGR.sau.3D on SGR in the RIL and natural populations was successfully confirmed. Furthermore, within the interval in which cQSGR.sau.3D is located in Chinese Spring reference genomes, thirty-seven genes were found. cQSGR.sau.3D may provide new resources for pre-harvest sprouting resistance breeding of wheat in the future.

Recurrent dynamics of rupture transitions of giant lipid vesicles at solid surfaces.

Single giant unilamellar vesicles (GUVs) rupture spontaneously from their salt-laden suspension onto solid surfaces. At hydrophobic surfaces, the GUVs rupture via a recurrent, bouncing ball rhythm. During each contact, the GUVs, rendered tense by the substrate interactions, porate, and spread a molecularly transformed motif of a monomolecular layer on the hydrophobic surface from the point of contact in a symmetric manner. The competition from pore closure, however, limits the spreading and produces a daughter vesicle, which re-engages with the substrate. At solid hydrophilic surfaces, by contrast, GUVs rupture via a distinctly different recurrent burst-heal dynamics; during burst, single pores nucleate at the contact boundary of the adhering vesicles, facilitating asymmetric spreading and producing a "heart"-shaped membrane patch. During the healing phase, the competing pore closure produces a daughter vesicle. In both cases, the pattern of burst-reseal events repeats multiple times, splashing and spreading the vesicular fragments as bilayer patches at the solid surface in a pulsatory manner. These remarkable recurrent dynamics arise, not because of the elastic properties of the solid surface, but because the competition between membrane spreading and pore healing, prompted by the surface-energy-dependent adhesion, determine the course of the topological transition.

Tailoring effects of the chain length and terminal substituent on the photochromism of solid-state spiropyrans.

Recently, by constructing a haloalkyl chain, a new class of solid-state spiropyrans showing advanced photochromic activity has been developed, but the tailoring effect of the haloalkyl chain on photochromism is unclear. Here, the photochromism of solid-state spiropyrans with different chain lengths and end substituents is investigated, which gives a clear correlation between the chain length/end substituent and the thermodynamic stability of zwitterionic merocyanine. This work provides a useful designing strategy for tailoring the photochromism of solid-state spiropyrans.

TMEM16A, a Homoharringtonine Receptor, as a Potential Endogenic Target for Lung Cancer Treatment.

Lung cancer has the highest rate of incidence and mortality among all cancers. Most chemotherapeutic drugs used to treat lung cancer cause serious side effects and are susceptible to drug resistance. Therefore, exploring novel therapeutic targets for lung cancer is important. In this study, we evaluated the potential of TMEM16A as a drug target for lung cancer. Homoharringtonine (HHT) was identified as a novel natural product inhibitor of TMEM16A. Patch-clamp experiments showed that HHT inhibited TMEM16A activity in a concentration-dependent manner. HHT significantly inhibited the proliferation and migration of lung cancer cells with high TMEM16A expression but did not affect the growth of normal lung cells in the absence of TMEM16A expression. In vivo experiments showed that HHT inhibited the growth of lung tumors in mice and did not reduce their body weight. Finally, the molecular mechanism through which HHT inhibits lung cancer was explored by western blotting. The findings showed that HHT has the potential to regulate TMEM16A activity both in vitro and in vivo and could be a new lead compound for the development of anti-lung-cancer drugs.

Extensive serum biomarker analysis in patients with non-small-cell lung carcinoma.

Lung cancer is a common malignant disease, nearly 2.09 million new patients occurred last year. Approximately 85% of the patients are classified as non-small-cell lung cancer (NSCLC). It is therefore important to identify new diagnostic and prognostic biomarkers for the early detection of this disease. The presented study identifies biomarkers in the serum of NSCLC patients. The expression of 274 cytokines was measured by a novel antibody array methodology and ELISA was applied to validate the array results. The levels of MIP-1 α, IL-8, MIP-1 ß, Resistin, GDF-15, HGF, CA125, FLRG, VCAM-1, DKK-3, sTNF-R1, CTACK, Acrp30, CXCL-16 and LYVE-1 were significantly higher in serum from NSCLC patients, while the level of TIMP-2 and IGFBP-6 were lower. More importantly, the validation supported the result of the antibody array. The result of the antibody array indicates that these cytokines might be novel auxiliary biomarkers in the diagnosis and prognosis of NSCLC.

Selective mercury(ii) detection in aqueous solutions upon the absorption changes corresponding to the transition moments polarized along the short axis of an azobenzene chemosensor.

A completely water soluble azobenzene chemosensor 1 for selective detection of Hg2+ was synthesized. Taking advantage of the absorption changes corresponding to the transition moments polarized along the short axis of an azobenzene, 1 showed characteristic UV-Vis signal changes in the band around 240 nm for Hg2+ in wide pH ranges, which also showed good tolerance to various metal ions and photoirradiation. Upon addition of Hg2+ into the solution of 1, a favored formation of trans-1 was observed, which is attributed to an intramolecular coordination of the PEG chain and Nß to Hg2+ confirmed by a control experiment test.

Molecular epidemiology and characteristic of virulence gene of community-acquired and hospital-acquired methicillin-resistant Staphylococcus aureus isolates in Sun Yat-sen Memorial hospital, Guangzhou, Southern China.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of both hospital and community infections globally. It's important to illuminate the differences between community-acquired MRSA (CA-MRSA) and hospital-acquired MRSA (HA-MRSA), but there have been confusions on the definition, especially for the MRSA isolates identified within 48 h of admission. This study aimed to determine the molecular characteristics and virulence genes profile of CA and HA-MRSA isolates identified less than 48 h after hospital admission in our region. METHODS: A total 62 MRSA isolates identified within 48 h after admission and the clinical data were collected. Antimicrobial susceptibility test (AST) of collected isolates were performed according to the guidelines of Clinical and Laboratory Standards Institute (CLSI) 2015, and staphylococcal cassette chromosome mec (SCCmec) typing, multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE) and virulence gene profiling were performed to explore the molecular diversity. RESULTS: SCCmec III and sequence type (ST) 239 were the most prevalent SCCmec type and ST in both CA and HA-MRSA groups. HA-MRSA group had higher prevalence of SCCmec III (87.2 %) and ST239 (79.5 %) compared with CA-MRSA (60.9 and 43.4 %, both P < 0.001), while the frequency of SCCmec IV (26.0 %) and ST59 (21.7 %) were higher in CA-MRSA than its counterpart (P < 0.001 and P = 0.003). MRSA-ST239-III was the predominant type in this study (61.3 %, 38/62), especially in HA-MRSA group (76.9 %, 30/39). However, CA-MRSA strains exhibited more diversity in genotypes in this study. Meanwhile, CA-MRSA tended to have lower resistant percentage to non-ß-lactams antibiotics but more virulence genes carriage, especially the staphylococcal enterotoxins (SE) genes. Notably, seb gene was only detected in CA-MRSA isolates (52.2 %), likely a significant marker for CA-MRSA isolates. Panton-Valentine leukocidin gene (PVL) was highly detected in both groups, while appeared no significantly different between CA-MRSA (47.8 %) and HA-MRSA (43.6 %). CONCLUSIONS: Our findings support a difference in the molecular epidemiology and virulence genes profile of CA-MRSA and HA-MRSA. Furthermore, this study indicates a possible transmission from HA-MRSA to CA-MRSA, which may cause the overlap of the definition.

Mussel-inspired tissue adhesive composite hydrogel with photothermal and antioxidant properties prepared from pectin for burn wound healing.

Biodegradable self-healing hydrogels with antibacterial property attracted growing attentions in biomedication as wound dressings since they can prevent bacterial infection and promote wound healing process. In this research, a biodegradable self-healing hydrogel with ROS scavenging performance and enhanced tissue adhesion was fabricated from dopamine grafted oxidized pectin (OPD) and naphthoate hydrazide terminated PEO (PEO NH). At the same time, Fe3+ ions were incorporated to endow the hydrogel with near-infrared (NIR) triggered photothermal property to obtain antibacterial activity. The composite hydrogel showed good hemostasis performance based on mussel inspired tissue adhesion with biocompatibility well preserved. As expected, the composition of FeCl3 improved conductivity and endowed photothermal property to the hydrogel. The in vivo wound repairing experiment revealed the 808 nm NIR light triggered photothermal behavior of the hydrogel reduced the inflammation response and promoted wound repairing rate. As a result, this composite FeCl3/hydrogel shows great potential to be an excellent wound dressing for the treatment of infection prong wounds with NIR triggers.

GlmS plays a key role in the virulence factor expression and biofilm formation ability of Staphylococcus aureus promoted by advanced glycation end products.

Staphylococcus aureus (S. aureus) is well known for its biofilm formation ability and is responsible for serious, chronic refractory infections worldwide. We previously demonstrated that advanced glycation end products (AGEs), a hallmark of chronic hyperglycaemia in diabetic tissues, enhanced biofilm formation by promoting eDNA release via sigB upregulation in S. aureus, contributing to the high morbidity and mortality of patients presenting a diabetic foot ulcer infection. However, the exact regulatory network has not been completely described. Here, we used pull-down assay and LC-MS/MS to identify the GlmS as a candidate regulator of sigB in S. aureus stimulated by AGEs. Dual-luciferase assays and electrophoretic mobility shift assays (EMSAs) revealed that GlmS directly upregulated the transcriptional activity of sigB. We constructed NCTC 8325 ∆glmS for further validation. qRT-PCR analysis revealed that AGEs promoted both glmS and sigB expression in the NCTC 8325 strain but had no effect on NCTC 8325 ∆glmS. NCTC 8325 ∆glmS showed a significant attenuation in biofilm formation and virulence factor expression, accompanied by a decrease in sigB expression, even under AGE stimulation. All of the changes, including pigment deficiency, decreased haemolysis ability, downregulation of hla and hld expression, and less and sparser biofilms, indicated that sigB and biofilm formation ability no longer responded to AGEs in NCTC 8325 ∆glmS. Our data extend the understanding of GlmS in the global regulatory network of S. aureus and demonstrate a new mechanism by which AGEs can upregulate GlmS, which directly regulates sigB and plays a significant role in mediating biofilm formation and virulence factor expression.

A bi-level optimized approach for promoting the mixed treatment of municipal sludge and food waste.

The mixed treatment of municipal sludge and food waste can generate renewable energy, solve the environmental and economic challenges caused by this waste, and has attracted significant research attention. Using environmentally friendly anaerobic co-digestion of municipal sludge and food waste can improve the effects of anaerobic mono-digestion and produce more biogas. However, as the municipal sludge and food waste managers are different, balancing the interests of both managers is needed to encourage anaerobic co-digestion development. By fully considering the interests of the local authority, the waste water treatment plants, and the food waste anaerobic digestion treatment plants, this paper developed a bi-level optimization approach based on Stackelberg equilibrium theory to resolve the conflicts between the different stakeholders, in which uncertain parameters were used to describe the uncertainties. The proposed model was then applied to a real case in Chongqing, China, to test its practicality, and scenario analyses under different policy parameter values were conducted to provide guidance for local authorities, waste water treatment plants, and food waste treatment plants. The proposed approach was found to provide balanced strategies for all three stakeholders, increase the renewable energy output of municipal sludge and food waste treatment 14.2 times, and reduce carbon emissions by 50%, thereby protecting the environment and achieving a circular economy.

Spatial correlation and coupling between industrial enterprise agglomeration and water pollutant discharge.

Industrial wastewater discharge has become the main cause of water pollution in China. However, the spatial interaction mechanism between industrial structure and water pollution is still unclear. Accordingly, we evaluated and analyzed spatiotemporal changes of the agglomeration pattern of pollution-intensive industrial enterprises and the evolution of the water environmental pollution pattern, as well as the correlation between them. The study results show that the polluting industrial enterprises were located mainly along the Yangtze River and Taihu Lake Basin in southern Jiangsu in 2013 and 2018. However, we observed a spatial trend of pollution transfer to northern Jiangsu. The industrial water pollution discharge presents the distribution pattern of facing rivers, seas, lakes and cities. Papermaking and paper products industry are the leading factors of COD and NH3-N pollution, with explanatory power of 0.3666 and 0.6201 respectively. The spatial positive coupling effect between the concentration degree of polluting enterprises and the intensity of water environment pollution discharge is 94.95% of the region. The spatial agglomeration of polluting industrial enterprises is an important cause of water environment pollution. They promote and couple each other, proving the existence of "Pollution haven" and "Porter hypothesis".

Effects of Low-Frequency Electromagnetic Field on the Physicochemical Properties of Freeze-Thawed Mongolian Cheese.

To verify whether a low-frequency electromagnetic field (LFE field) can help reduce structural damage during the freeze-thaw process and maintain shelf life, Mongolian cheese was frozen at -10, -20, and -30 °C, then thawed at microwave or room temperature. Results showed that LFE field-assisted frozen treatment could reduce ice crystal size and protect the protein matrix structure of cheese. Frozen-thawed cheese retained 96.5% of its hardness and showed no significant difference from the fresh one in elasticity, cohesion, and chewiness. Frozen cheese showed similar but slower ripening behavior during storage, suggesting a potential application of the LFE field in the frozen storage of high-protein foods.

Semi-Supervised Medical Image Segmentation Guided by Bi-Directional Constrained Dual-Task Consistency.

BACKGROUND: Medical image processing tasks represented by multi-object segmentation are of great significance for surgical planning, robot-assisted surgery, and surgical safety. However, the exceptionally low contrast among tissues and limited available annotated data makes developing an automatic segmentation algorithm for pelvic CT challenging. METHODS: A bi-direction constrained dual-task consistency model named PICT is proposed to improve segmentation quality by leveraging free unlabeled data. First, to learn more unmarked data features, it encourages the model prediction of the interpolated image to be consistent with the interpolation of the model prediction at the pixel, model, and data levels. Moreover, to constrain the error prediction of interpolation interference, PICT designs an auxiliary pseudo-supervision task that focuses on the underlying information of non-interpolation data. Finally, an effective loss algorithm for both consistency tasks is designed to ensure the complementary manner and produce more reliable predictions. RESULTS: Quantitative experiments show that the proposed PICT achieves 87.18%, 96.42%, and 79.41% mean DSC score on ACDC, CTPelvic1k, and the individual Multi-tissue Pelvis dataset with gains of around 0.8%, 0.5%, and 1% compared to the state-of-the-art semi-supervised method. Compared to the baseline supervised method, the PICT brings over 3-9% improvements. CONCLUSIONS: The developed PICT model can effectively leverage unlabeled data to improve segmentation quality of low contrast medical images. The segmentation result could improve the precision of surgical path planning and provide input for robot-assisted surgery.