Clinical application of ERCP concurrent laparoscopic cholecystectomy in the treatment of cholecystolithiasis complicated with extrahepatic bile duct stones.

Objective: To compare the clinical efficacy of endoscopic retrograde cholangiopancreatography (ERCP) combined with laparoscopic cholecystectomy (LC) and laparoscopic common bile duct exploration and lithotomy (LCBDE) in the treatment of cholecystolithiasis combined with bile duct stones. Methods: From September 2018 to January 2022, 195 patients with cholecystolithiasis complicated with extrahepatic bile duct stones from Department of Department of General Surgery, Shanghai Jiading Central Hospital met the inclusion criteria, including 60 cases in the LC group and 86 cases in the LCBDE group. The general condition, operation success rate, complications and residual stone rate of the two groups were retrospectively analyzed. Results: In the simultaneous operation group, 58 patients successfully performed ERCP, and the indwelling rate of the abdominal drainage tube (41.7 % vs. 95.3 %) was significantly better than that in the LCBDE group. There was no significant difference in the conversion rate to open surgery, operation time, and intraoperative blood loss between the two groups. In the simultaneous surgery group, 4 patients (6.7 %) developed pancreatitis after ERCP, which was cured by conservative treatment. The pain score at 6 h after operation was significantly lower than that in the LCBDE group (3.9 ± 1.6 vs 6.5 ± 2.4). There were no significant differences in biliary leakage (1.7 % vs. 4.7 %), postoperative cholangitis (5.0 % vs. 5.8 %), incision infection (3.3 % vs. 3.5 %), and bile duct stone residue rate (5.0 % vs 3.5 %) between the two groups. There was no severe pancreatitis, second operation or death. The duration of hospital stay was shortened in the concurrent operation group (5.1 ± 2.3d vs 7.9 ± 3.7d), and the operation cost was significantly higher than that in the LCBDE group (48839.9 ± 8549.5 vs 34635.9 ± 5893.7 yuan). Conclusion: ERCP combined with LC and LCBDE are both safe and effective methods for the treatment of cholecystolithiasis combined with extrahepatic bile duct stones. The simultaneous operation group has certain advantages in patient comfort and rapid rehabilitation, which can be popularized in qualified units.

Intermittent Stop-Move Motion Planning for Dual-Arm Tomato Harvesting Robot in Greenhouse Based on Deep Reinforcement Learning.

Intermittent stop-move motion planning is essential for optimizing the efficiency of harvesting robots in greenhouse settings. Addressing issues like frequent stops, missed targets, and uneven task allocation, this study introduced a novel intermittent motion planning model using deep reinforcement learning for a dual-arm harvesting robot vehicle. Initially, the model gathered real-time coordinate data of target fruits on both sides of the robot, and projected these coordinates onto a two-dimensional map. Subsequently, the DDPG (Deep Deterministic Policy Gradient) algorithm was employed to generate parking node sequences for the robotic vehicle. A dynamic simulation environment, designed to mimic industrial greenhouse conditions, was developed to enhance the DDPG to generalize to real-world scenarios. Simulation results have indicated that the convergence performance of the DDPG model was improved by 19.82% and 33.66% compared to the SAC and TD3 models, respectively. In tomato greenhouse experiments, the model reduced vehicle parking frequency by 46.5% and 36.1% and decreased arm idleness by 42.9% and 33.9%, compared to grid-based and area division algorithms, without missing any targets. The average time required to generate planned paths was 6.9 ms. These findings demonstrate that the parking planning method proposed in this paper can effectively improve the overall harvesting efficiency and allocate tasks for a dual-arm harvesting robot in a more rational manner.

Targeting ONECUT3 blocks glycolytic metabolism and potentiates anti-PD-1 therapy in pancreatic cancer.

BACKGROUND: Reprogramming glucose metabolism, also known as the Warburg effect (aerobic glycolysis), is a hallmark of cancers. Increased tumor glycolysis not only favors rapid cancer cell proliferation but reprograms the immune microenvironment to enable tumor progression. The transcriptional factor ONECUT3 plays key roles in the development of the liver and pancreas, however, limited is known about its oncogenic roles, particularly metabolic reprogramming. METHODS: Immunohistochemistry and Western blotting are applied to determine the expression pattern of ONECUT3 and its clinical relevance in pancreatic ductal adenocarcinoma (PDAC). Knockdown and overexpression strategies are employed to determine the in vitro and in vivo functions of ONECUT3. Chromatin immunoprecipitation, luciferase reporter assay, and gene set enrichment analysis are used to decipher the molecular mechanisms. RESULTS: The glycolytic metabolism is inversely associated with T-cell infiltration in PDAC. ONECUT3 is identified as a key regulator for PDAC glycolysis and CD8+ T-cell infiltration. Genetic silencing of ONECUT3 inhibits cell proliferation, promotes cell apoptosis, and reduces glycolytic metabolism as evidenced by glucose uptake, lactate production, and extracellular acidification rate. Opposite effects of ONECUT3 are observed in overexpression studies. ONECUT3 enhances aerobic glycolysis via transcriptional regulation of PDK1. Targeting ONECUT3 effectively suppresses tumor growth, increases CD8+ T-cell infiltration, and potentiates anti-PD-1 therapy in PDAC. Pharmacological inhibition of PDK1 also shows a synergistic effect with anti-PD-1 therapy. In clinical setting, ONECUT3 is closely associated with PDK1 expression and T-cell infiltration in PDAC and acts as an independent prognostic factor. CONCLUSIONS: Our study reveals a previous unprecedented regulatory role of ONECUT3 in PDAC glycolysis and provides in vivo evidence that increased glycolysis is linked to an immunosuppressive microenvironment. Moreover, targeting ONECUT3-PDK1 axis may serve as a promising therapeutic approach for the treatment of PDAC.

Benefits and safety of photodynamic therapy in patients with hilar cholangiocarcinoma: A meta-analysis.

BACKGROUND: Photodynamic therapy (PDT) is a therapy evaluated for the treatment of cancers resistant to standard oncological treatments. PDT might be beneficial for the palliation of hilar cholangiocarcinoma. AIM: To evaluate the efficacy and safety of PDT for treating hilar cholangiocarcinoma. METHODS: PubMed, Embase, the Cochrane Library, and Web of Science were searched for articles published up to May 2021. The patients were grouped as PDT+stent vs. stent alone. The outcomes were survival, quality of life, and adverse events (AEs). Data were summarized using hazard ratios (HRs), odds ratios (ORs), and 95% confidence intervals (CIs). RESULTS: Six studies were included in this meta-analysis. There were 235 and 211 patients in the PDT+stent and stent groups, respectively. The 1-year survival rate of the PDT+stent group was 0.56, and that of the control group was 0.25. The 2-year survival rate of the PDT+stent group was 0.16, and that of the control group was 0.07. PDT significantly prolonged overall survival compared to the controls (P = 0.002). No differences were detected in the occurrence of cholangitis (P = 0.996) and all other AEs (early complications, stent malfunction, total AEs, acute pancreatitis, liver abscess, and biliary hemorrhage) between the two groups. CONCLUSION: PDT in patients with hilar cholangiocarcinoma could improve survival without additional AEs. Large-scale randomized controlled trials are needed to confirm the findings.

Atrial natriuretic peptide protects vertebral endplate chondrocytes against H2O2­induced apoptosis and oxidative stress through activation of the Nrf2/HO­1 signaling pathway.

The present study aimed to investigate the effect of atrial natriuretic peptide (ANP) on cell apoptosis and oxidative stress in H2O2­induced vertebral endplate chondrocytes (EPCs), and to assess the associated mechanisms involved. Cell viability and apoptosis were evaluated using the Cell Counting Kit­8 method and TUNEL assay, respectively. In addition, the scavenging capability was detected using various enzymatic assays, and the quantity of nitric oxide (NO) and malondialdehyde (MDA), and activity of superoxide dismutase (SOD) were assessed. The expression levels of apoptosis­related proteins, activation of the nuclear factor erythroid 2­related factor 2 (Nrf2)/heme oxygenase­1 (HO­1) signaling pathway induced by H2O2 and the effect of treatment with ANP on vertebral EPCs were detected by western blotting. The results revealed that ANP protected EPCs from H2O2­induced cell damage. H2O2­induced intracellular MDA was decreased by ANP, and the levels of SOD and NO were increased in the presence of ANP. ANP also inhibited the H2O2­induced alterations in the expression levels of cleaved­caspase­3, Bax and Bcl­2. Finally, ANP blocked H2O2­induced oxidative stress through activating the Nrf2/HO­1 signaling pathway. These findings suggested that ANP may effectively protect EPCs through inhibition of H2O2­induced oxidant injury and cell death by activating the Nrf2/HO­1 signaling pathway.

Effect of continuous nursing on quality of life of hemodialysis patients: A protocol for systematic review and meta-analysis.

BACKGROUND: Hemodialysis is a common treatment for patients with end-stage renal failure. Long-term hemodialysis will lead to a series of complications and reduce the quality of life of patients. At present, routine nursing is only limited to in-hospital patients, whereas continuous nursing is an extension of hospital nursing work, which can solve the follow-up health problems of some patients and meet the health needs of patients in their daily life. A number of clinical studies have shown that continuous nursing can improve the quality of life of hemodialysis patients, but there is a lack of evidence-based medicine. Therefore, the purpose of this study is to explore the effect of continuous nursing on the quality of life of hemodialysis patients through systematic evaluation. METHOD: The Cochrance Library, PubMed, Embase, Web of Science, CNKI, VP Information Chinese Journal Service Platform (VIP), and Wanfang will be searched by computer. In addition, Baidu academic and Google academic are searched manually, and all randomized controlled trials on the effects of continuous nursing on the quality of life of hemodialysis patients are collected. The retrieval time is of the establishment of the database to January 31, 2021. Two evaluators screens, extract and evaluate the literature, and the data are analyzed by RevMan5.3 software. RESULT: The purpose of this study is to evaluate the effect of continuous nursing on the quality of life of hemodialysis patients by the MOS item short from health survey, exercise of self-care agency, and the incidence of complications. CONCLUSION: This study will provide reliable evidence for the application of continuous nursing in hemodialysis patients. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/HZKUA.

[Detecting the information of cucumber in greenhouse for picking based on NIR image].

For the cucumber harvesting robot, the identification of target information is one of important tasks in the automation of fruit-picking. In order to implement spatial fruit localization and quality discrimination in greenhouse, this paper presented a machine vision algorithm for the recognition and detection of cucumber fruits based on near-infrared spectral imaging. By comparing the spectral reflectance of cucumber plant (fruit, leaf and stem) from visible to infrared region (325-1 075 nm) measured by ASD FieldSpec Pro VNIR spectrometer, a monospectral near-infrared image at the 850 nm sensitive wavelength was captured to cope with the similar-color segmentation problem in complex environment. Then, a method of fruit extraction was developed on the basis of the following steps. Firstly, from the gray level histogram it was observed that the pixels of fruit distributed on the right are lesser than that of background, so "P parameter threshold method" was used to image segmentation. Subsequently, divided local image was partitioned into several sub-blocks by the application of adaptive template mining, which was feasible for processing the fruit with long-column feature. Finally, noises including parts of stem and leaf were eliminated using estimation condition of barycentre position and area size, proved by relative experiment In addition, the region for robotic grasping was established by gray variation between fruit-handle and fruit pedicel, as the quality feature was extracted with morphological characteristics of the centre-line length and the fruit flexure degree. A detecting experiment was carried out on 30 images with cucumber fruits and 10 images with no fruits, which were taken in a changing greenhouse environment. The results indicate that the accuracy rate of the recognition was 83.3% and 100%, while the success rate of effectively acquiring the grasping region was 83.3%, which can meet the demand of robotic fruit-harvesting.