Propensity matched analysis of minimally invasive and open radical resection for rectal cancer: comparison of short-term outcomes in elderly/frail patients.

Although minimally invasive surgery (MIS), such as robotic and laparoscopic procedures, is sometimes a better option than open surgery for patients with rectal cancer, it can present challenges for some elderly or frail patients who have a higher risk of chronic illnesses and poor surgical tolerance. On the basis of several pathophysiological characteristics, the patients were grouped according to their age. The time nodes, which are 65 and 80 years old, can clarify the goal of the study and offer some therapeutic benefit. These subgroups stand to gain a great deal from MIS because of its superior arm of machinery and imagery. The short-term oncological outcomes and postoperative conditions of robotic surgery, laparoscopic surgery, and conventional open surgery were compared in this study using a propensity-matched analysis. In this retrospective study, a total of 2049 consecutive patients who underwent proctectomy between September 2017 and June 2023 were chosen. We then carried out a propensity matching analysis based on inclusion criteria. Patients were split into two age groups: 65-80 and > 80. While the secondary objective was to further investigate the similar characteristics between RS and LS, the major objective was to compare oncological outcomes and postoperative conditions between MIS and OS. K-M survival curves were used to represent oncological outcomes and survival conditions. Complication rate and mFI score were used to assess postoperative conditions. Regarding the functional outcomes, the LARS scale was applied to create questionnaires that calculated the anal function of the patients. 110 cases from the group of patients aged 65-80 were successfully merged after matching 1: 1 by propensity score, whereas 73 instances from patients aged > 80 were incorporated while examining the primary objective between OS and MIS. Regarding the secondary goal, each group contained 45 cases for patients above 80 and 65 cases for patients aged 65-80, respectively. Faster recovery from MIS included quicker first flatus passage, earlier switch to liquid nutrition, and shorter hospital stay. In the meantime, MIS also showed benefits in terms of the proportion of low mFI scores and the rates of wound complications in the two age groups. Less blood loss and shorter operational time are further MIS features. On the other hand, MIS experienced more pulmonary complications than OS. Robotic surgery was statistically no different from laparoscopic surgery in patients aged 65-80, although it was superior in terms of operative time and recovery. Comparable and satisfactory oncological and survival results were obtained with all three treatments. For elderly/frail patients with rectal cancer, MIS could be recognized as an effective procedure with favorable outcomes of recovery that are accompanied by better postoperative conditions. While, robotic surgery is slightly better than laparoscopic surgery in some aspects. However, to further demonstrate the effectiveness of three surgical modalities in treating certain groups, multi-center prospective studies are required.

The Effects of Photobiomodulation on Knee Function, Pain, and Exercise Tolerance in Older Adults: A Meta-analysis of Randomized Controlled Trials.

OBJECTIVE: To assess whether photobiomodulation therapy (PBMT) enhances the benefits of exercise in older adults. DATA SOURCES: PubMed, Scopus, Medline, and Web of Science, dated to February 2023. STUDY SELECTION: All included studies were randomized controlled trials of PBMT combined with exercise co-intervention in persons 60 years and older. OUTCOME MEASURES: Western Ontario and McMaster University Osteoarthritis Index (WOMAC-total, pain, stiffness and function), perceived pain intensity, timed Up and Go (TUG) Test, 6-min walk test (6MWT), muscle strength, and knee range of motion were included. DATA EXTRACTION: Two researchers independently performed data extraction. Article data were extracted in Excel and summarized by a third researcher. DATA SYNTHESIS: The meta-analysis included 14 of the 1864 studies searched in the database. No statistical differences were found between the treatment and control groups in terms of WOMAC-stiffness (mean difference [MD]=-0.31, 95% confidence interval [CI] -0.64 to 0.03), TUG (MD=-0.17, 95% CI -0.71 to 0.38), 6MWT (MD=32.2, 95% CI -44.62 to 109.01), or muscle strength (standardized mean difference=0.24, 95% CI -0.02 to 0.50). However, statistically significant differences were found for WOMAC-total (MD=-6.83, 95% CI -12.3 to -1.37), WOMAC-pain (MD=-2.03, 95% CI -4.06 to -0.01), WOMAC-function (MD=-5.03, 95% CI -9.11 to -0.96), visual analog scale/numeric pain rating scale (MD=-1.24, 95% CI -2.43 to -0.06), and knee range of motion (MD=1.47, 95% CI 0.07 to 2.88). CONCLUSIONS: In older adults who exercise regularly, PBMT can potentially provide additional pain relief, improve knee joint function, and increase knee joint range of motion.

Pathways to Improve Provision of Home and Community-Based Services-A Configurational Approach Based on a Fuzzy-Set Qualitative Comparative Analysis From China.

Providing home and community-based services (HCBS) is critical for active and healthy aging. However, in China, the positive factors for improving HCBS provision are unclear, limiting its contribution to improving older adults' quality of life and promoting active and healthy aging. Therefore, this study examines the configurations that produce differences in HCBS and identifies multiple pathways for improving them and narrowing regional disparities. Using data from multiple datasets comprising 23 cases, we performed configuration analysis using fuzzy-set qualitative comparative analysis. Four pathways producing high HCBS provision and three pathways producing low HCBS provision were found. Different combinations of the aging population, economic development, institutional support, financial support, and development of multiple stakeholders influence HCBS provision. Thus, measures based on the main factor characteristics should be implemented to improve the HCBS provision level.

Adaptive Fast Image Encryption Algorithm Based on Three-Dimensional Chaotic System.

This paper introduces a novel three-dimensional chaotic system that exhibits diverse dynamic behaviors as parameters vary, including phase trajectory offset behaviors and expansion-contraction phenomena. This model encompasses a broad chaotic range and proves suitable for integration within image encryption. Building upon this chaotic system, the study devised a fast image encryption algorithm with an adaptive mechanism, capable of autonomously determining optimal encryption strategies to enhance algorithm security. In pursuit of heightened encryption speed, an FPGA-based chaotic sequence generator was developed for the image encryption algorithm, leveraging the proposed chaotic system. Furthermore, a more efficient scrambling algorithm was devised. Experimental results underscore the superior performance of this algorithm in terms of both encryption duration and security.

Long-term detraining reverses the improvement of lifelong exercise on skeletal muscle ferroptosis and inflammation in aging rats: fiber-type dependence of the Keap1/Nrf2 pathway.

We investigated the effects of lifelong aerobic exercise and 8 months of detraining after 10 months of aerobic training on circulation, skeletal muscle oxidative stress, and inflammation in aging rats. Sprague-Dawley rats were randomly assigned to the control (CON), detraining (DET), and lifelong aerobic training (LAT) groups. The DET and LAT groups began aerobic treadmill exercise at the age of 8 months and stopped training at the 18th and 26th month, respectively; all rats were sacrificed when aged 26 months. Compared with CON, LAT remarkably decreased serum and aged skeletal muscle 4-hydroxynonenal (4-HNE) and 8-hydroxy-2-deoxyguanosine (8-OHdG) levels. Superoxide dismutase 2(SOD2) levels were higher in the LAT group than in the CON group in skeletal muscle. However, DET remarkably decreased SOD2 protein expression and content in the skeletal muscle and increased malondialdehyde (MDA) level compared with LAT. Compared with LAT, DET remarkably downregulated adiponectin and upregulated tumor necrosis factor alpha (TNF-α) expression, while phosphoinositide 3-kinase (PI3K), protein kinase B (AKT), and 70-kDa ribosomal protein S6 kinase (P70S6K) protein expression decreased, and that of FoxO1 and muscle atrophy F-box (MAFbX) proteins increased in the quadriceps femoris. Adiponectin and TNF-α expression in the soleus muscle did not change between groups, whereas that of AKT, mammalian target of rapamycin (mTOR), and P70S6K was lower in the soleus in the DET group than in that in the LAT group. Compared with that in the LAT group, sestrin1 (SES1) and nuclear factor erythroid 2-related factor 2 (Nrf2) protein expression in the DET group was lower, whereas Keap1 mRNA expression was remarkably upregulated in the quadriceps femoris. Interestingly, the protein and mRNA levels of SES1, Nrf2, and Keap1 in soleus muscle did not differ between groups. LAT remarkably upregulated ferritin heavy polypeptide 1(FTH), glutathione peroxidase 4(GPX4), and solute carrier family 7member 11 (SLC7A11) protein expression in the quadriceps femoris and soleus muscles, compared with CON. However, compared with LAT, DET downregulated FTH, GPX4, and SLC7A11 protein expression in the quadriceps femoris and soleus muscles. Long-term detraining during the aging phase reverses the improvement effect of lifelong exercise on oxidative stress, inflammation, ferroptosis, and muscle atrophy in aging skeletal muscle. The quadriceps femoris is more evident than the soleus, which may be related to the different changes in the Keap1/Nrf2 pathway in different skeletal muscles.

Age-related changes in adipose tissue metabolomics and inflammation, cardiolipin metabolism, and ferroptosis markers in female aged rat model.

Aging adipose tissue exhibits elevated inflammation and oxidative stress that are major sources of age-related metabolic dysfunction. However, the exact metabolic changes associated with inflammation and oxidative stress are unclear. To address this topic, we assessed variation in metabolic phenotypes of adipose tissue from 18 months adult sedentary (ASED), 26 months old sedentary (OSED), and 8 months young sedentary (YSED). The results of metabolomic analysis showed that ASED and OSED group had higher palmitic acid, elaidic acid, 1-heptadecanol, and α-tocopherol levels than YSED, but lower sarcosine levels. Furthermore, stearic acid was specifically elevated in ASED compared with YSED. Cholesterol was upregulated specifically in the OSED group compared with YSED, whereas linoleic acid was downregulated. In addition, ASED and OSED had more inflammatory cytokines, lower antioxidant capacity, and higher expression of ferroptosis-related genes than YSED. Moreover, mitochondrial dysfunction associated with abnormal cardiolipin synthesis was more pronounced in the OSED group. In conclusion, both ASED and OSED can affect the FA metabolism and increase oxidative stress in adipose tissue, leading to inflammation. In particular, linoleic acid content specifically decreases in OSED, which associated with abnormal cardiolipin synthesis and mitochondrial dysfunction in adipose tissue.

Indirect regulation of HIPPO pathway by miRNA mediates high-intensity intermittent exercise to ameliorate aging skeletal muscle function.

Exercise-induced microRNA (miRNA) and HIPPO pathways participate in the regulation of skeletal muscle plasticity but their underlying mechanisms remain unclear. We aimed to investigate the effect of high-intensity interval training (HIIT) on miRNA expression and the HIPPO pathway in the skeletal muscle of aging rats to determine its role in the amelioration of muscle aging. Thirty-six 18-month-old female rats were randomly divided into sedentary control (SED, n = 12), moderate-intensity continuous training (MICT, n = 12), and HIIT (n = 12) groups, with continuous exercise for 8 months. Quantitative reverse transcription-polymerase chain reaction, immunoblotting, KEGG enrichment, and dual-luciferase assays were performed on the target skeletal muscle. Compared with the SED group, the MICT and HIIT groups showed a significant trend of improvement in Lee's index and grip strength and a marked increase in skeletal muscle mitochondrial function, apoptosis, antioxidant, and lipolysis-related protein expression. They also exhibited PI3K/AKT pathway activation and a decrease in expression of HIPPO pathway-related proteins; 20 miRNAs were differentially expressed and enriched in the exercise group compared with the SED group, including the HIPPO pathway and metabolic pathways. Further analysis of L6 cells confirmed that miR-182 may target PTEN, which indirectly regulates HIPPO signaling, but not Mob1. the combined application of HIIT and MICT increased the antioxidant and lipolytic capacities of skeletal muscle and improved atrophy of aging skeletal muscle; HIIT was more effective than MICT. This may be related to HIIT-mediated AKT pathway activation and HIPPO pathway inhibition by miRNAs (miR-486 and miR-182).

Clinical value of echocardiography in evaluating hemodynamics and right ventricular function in patients with chronic thromboembolic pulmonary hypertension after balloon pulmonary angioplasty.

Background: Patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) are eligible for balloon pulmonary angioplasty (BPA). However, the short-term effects of BPA on pulmonary hemodynamics and right ventricular (RV) function in patients with CTEPH have not been elucidated. In the current study, echocardiography was conducted to explore the short-term effects of BPA on inoperable CTEPH patients. Methods: A total of 30 inoperable CTEPH patients who underwent echocardiography before and after BPA were enrolled to the present retrospective study. Right heart catheterization (RHC) parameters, echocardiography function parameters, and echocardiography structural parameters of patients were evaluated at baseline and within 24 hours after BPA and the results were compared. Results: RHC parameters including pulmonary artery systolic pressure (PASP), pulmonary artery diastolic pressure (PADP), mean pulmonary artery pressure (mPAP), and pulmonary vascular resistance (PVR), and echocardiography structural parameters including right atrium diameter (RAD), right ventricular end-diastolic area (RVEDA), right ventricular end-systolic area (RVESA), right atrium end-diastolic area (RAEDA) and right atrium end-systolic area (RAESA) significantly improved within 24 h after BPA compared with the baseline results (P<0.05). However, there were no significant differences in echocardiography function parameters including tissue Doppler-derived tricuspid lateral annular systolic velocity (S'), tricuspid annular plane systolic excursion (TAPSE), right ventricular index of myocardial performance (RIMP), right ventricular fractional area change (RVFAC) and left ventricular stroke volume (LVSV) before and after BPA. Conclusions: The findings show that a single BPA procedure significantly improves RV volume load and reduces the pulmonary blood pressure in CTEPH patients in the short-term. However, BPA does not improve RV systolic function 24 hours after the procedure. The results indicate that evaluation of RV structural and function with echocardiography is an effective approach for non-invasive monitoring of patient status after BPA.

The Strain Rate Sensitivity and Creep Behavior for the Tripler Plane of Potassium Dihydrogen Phosphate Crystal by Nanoindentation.

As an excellent multifunctional single crystal, potassium dihydrogen phosphate (KDP) is a well-known, difficult-to-process material for its soft-brittle and deliquescent nature. The surface mechanical properties are critical to the machining process; however, the characteristics of deformation behavior for KDP crystals have not been well studied. In this work, the strain rate effect on hardness was investigated on the mechanically polished tripler plane of a KDP crystal relying on nanoindentation technology. By increasing the strain rate from 0.001 to 0.1 s-1, hardness increased from 1.67 to 2.07 GPa. Hence, the strain rate sensitivity was determined as 0.053, and the activation volume of dislocation nucleation was 169 Å3. Based on the constant load-holding method, creep deformation was studied at various holding depths at room temperature. Under the spherical tip, creep deformation could be greatly enhanced with increasing holding depth, which was mainly due to the enlarged holding strain. Under the self-similar Berkovich indenter, creep strain could be reduced at a deeper location. Such an indentation size effect on creep deformation was firstly reported for KDP crystals. The strain rate sensitivity of the steady-state creep flow was estimated, and the creep mechanism was qualitatively discussed.

Experimental investigation of the tip leakage flow in a low-speed multistage axial compressor.

Casing pressure measurements and Stereoscopic Particle-Image Velocimetry (SPIV) measurements are used together to characterize the behavior of the rotor tip leakage flow at both the design and near-stall conditions in a low-speed multistage axial compressor. A three-dimensional Navier-Stokes solver is also performed for the multistage compressor and the prediction of tip leakage flow is compared with SPIV data and casing dynamic static pressure data. During the experiment 10 high-frequency Kulite transducers are mounted in the outer casing of the rotor 3 to investigate the complex flow near the compressor casing and Fourier analyses of the dynamic static pressure on the casing of the rotor 3 are carried out to investigate the tip leakage flow characteristics. At the same time, the two CCD cameras are arranged at the same side of the laser light sheet, which is suitable for investigating unsteady tip leakage flow in the multistage axial compressor. The SPIV measurements identify that the tip leakage flow exists in the rotor passage. The influence of tip leakage flow leads to the existence of low axial velocity region in the rotor passage and the alternating regions of positive and negative radial velocity indicates the emergence of tip leakage vortex (TLV). The trajectory of the tip leakage vortex moves from the suction surface toward the pressure surface of adjacent blade, which is aligned close to the rotor at the design point (DP). However, the tip leakage vortex becomes unstable and breaks down at the near-stall point (NS), making the vortex trajectory move upstream in the rotor passage and causing a large blockage in the middle of the passage.

Uncertainty analysis of industrial energy conservation management in China's iron and steel industry.

There are remarkable uncertainty factors in the industrial sector that enhance the difficulties of setting energy conservation strategies, such as the macro economy, industrial structures, and technical uncertainties. However, current studies simply predict the possible trends or conduct scenario analyses, and neglect uncertainty factors in the management of industrial energy conservation. In response, this article considers China's iron and steel industry as an example and builds the Industrial Energy Conservation Uncertainty Analysis (IECUA) model to recognize and analyze the uncertainty factors via a 200-thousand-time Latin hypercube sampling. Then, we propose some management measures, including setting energy conservation targets and energy conservation strategies. The results show that energy conservation targets should be more flexible than just the predicted values, to enhance the feasibility of their realization. In addition, energy conservation strategies are set at industrial and technique levels. On the one hand, such key parameters as production output, the coke/steel ratio, and pig iron/steel ratio, should be strictly controlled to avoid non-compliance risks. On the other hand, energy conservation technologies can be considered under four quadrants depending on their sensitivity to energy conservation and economic efficiency. Finally, some differentiated technologies promotion suggestions are made, such as economic stimulation, market entry standards and technical application guidelines.

Particulate matter, gaseous and particulate polycyclic aromatic hydrocarbons (PAHs) in an urban traffic tunnel of China: Emission from on-road vehicles and gas-particle partitioning.

Traffic vehicles are a main source of polycyclic aromatic hydrocarbon (PAH) emission in urban area. It is vital to understand PAH gas-particle partitioning in real traffic environment and assess PAH vehicular emission factors in developing China. Concentrations of particulate matter, carbonaceous products, gaseous and particulate PAHs were measured during 2011-2012 in a road tunnel of Shanghai, China. Time variation of them reflected basic traffic operation of the tunnel. PAHs approached equilibrium between gas and particle phases and the partitioning was predicted better by a dual sorption model combining absorption into organic matter and adsorption onto black carbon. The influence of black carbon adsorption on the partitioning behavior of PAHs was important. The difference in isomer ratios of gaseous and particulate PAHs was attributed to PAH contributions from different traffic-related PAHs sources. Real-world vehicle emission factors of gaseous and particulate PAHs were quantified based on fuel burned model and vehicle kilometer traveled model.