Objective:To design a novel electromagnetic ejection device for endoscopic suturing to achieve continuous deployment of suture nails.Methods:An electromagnetic ejection device and its accompanying suture nail structure were designed and a prototype was fabricated based on electromagnetic ejection principles. A finite element model of the electromagnetic ejection device was constructed to study the effects of armature-coil center distance and different driving voltages on suture nail ejection speed. An experimental platform for testing electromagnetic ejection velocity was constructed, and a high-speed camera was used to detect the ejection velocity. A platform for the suture embedding experiment was built to measure the effects of different voltages on the inserting speed of suture into the gastric wall tissue. A platform for a suture extraction force experiment was built to evaluate the extraction force of sutures embedded in tissues under different driving voltages.Results:A suture nail structure and electromagnetic ejection device were designed, and a prototype was fabricated. The ejection velocity increased and then decreased with the increase of the armature-coil center distance, and the maximum ejection velocity was 15.81 m/s at the center distance of 18 mm. At this distance, the voltage was linearly related to the ejection velocity, and the experimental values of the staple basically coincided with the simulated values. When the driving voltage was in the range of 150 to 180 V, the suture nails could successfully insert in the tissues, and the 180 V voltage group had a greater insertion depth. The extraction force of the suture nails at 120, 150, 180, and 210 V voltages were (0.49 ± 0.19), (1.14 ± 0.19), (1.23 ± 0.15), and (1.85 ± 0.31) N, respectively.Conclusions:A novel electromagnetic ejection device for endoscopic suturing is proposed that is capable of continuous firing of suture nails. This device provides a new long-distance driving method for intelligent, minimally invasive surgical instruments.

Objectives:To investigate the effect of the expression of low-density lipoprotein receptor associated protein (LDLR) on the vascular abnormalities in hepatocellular carcinoma (HCC) and its mechanisms.Methods:Based on the information of Oncomine Cancer GeneChip database, we analyzed the correlation between the expression level of LDLR and the expression level of carcinoembryonic antigen (CEA) and CD31 in hepatocellular carcinoma tissues. Lentiviral transfection of short hairpin RNA target genes was used to construct LDLR-knockdown MHCC-97H and HLE hepatocellular carcinoma cells. The differential genes and their expression level changes in LDLR-knockdown hepatocellular carcinoma cells were detected by transcriptome sequencing, real-time fluorescence quantitative polymerase chain reaction, and protein immunoblotting. The gene-related signaling pathways that involve LDLR were clarified by enrichment analysis. The effect of LDLR on CEA was assessed by the detection of CEA content in conditioned medium of hepatocellular carcinoma cells. Angiogenesis assay was used to detect the effect of LDLR on the angiogenic capacity of human umbilical vein endothelial cells, as well as the role of CEA in the regulation of angiogenesis by LDLR. Immunohistochemical staining was used to detect the expression levels of LDLR in 176 hepatocellular carcinoma tissues, and CEA and CD31 in 146 hepatocellular carcinoma tissues, and analyze the correlations between the expression levels of LDLR, CEA, and CD31 in the tissues, serum CEA, and alanine transaminase (ALT).Results:Oncomine database analysis showed that the expressions of LDLR and CEA in the tissues of hepatocellular carcinoma patients with portal vein metastasis were negatively correlated ( r=-0.64, P=0.001), whereas the expressions of CEA and CD31 in these tissues were positively correlated ( r=0.46, P=0.010). The transcriptome sequencing results showed that there were a total of 1 032 differentially expressed genes in the LDLR-knockdown group and the control group of MHCC-97H cells, of which 517 genes were up-regulated and 515 genes were down-regulated. The transcript expression level of CEACAM5 was significantly up-regulated in the cells of the LDLR-knockdown group. The Gene Ontology (GO) function enrichment analysis showed that the differential genes were most obviously enriched in the angiogenesis function. The Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway enrichment analysis showed that the relevant pathways involved mainly included the cellular adhesion patch, the extracellular matrix receptor interactions, and the interactions with the extracellular matrix receptors. The CEA content in the conditioned medium of the LDLR-knockdown group was 43.75±8.43, which was higher than that of the control group (1.15±0.14, P＜0.001). The results of angiogenesis experiments showed that at 5 h, the number of main junctions, the number of main segments, and the total area of the lattice formed by HUVEC cells cultured with the conditioned medium of MHCC-97H cells in the LDLR-knockdown group were 295.3±26.4, 552.5±63.8, and 2 239 781.0±13 8211.9 square pixels, which were higher than those of the control group (113.3±23.5, 194.8±36.5, and 660 621.0±280 328.3 square pixels, respectively, all P＜0.01).The number of vascular major junctions, the number of major segments, and the total area of the lattice formed by HUVEC cells cultured in conditioned medium with HLE cells in the LDLR-knockdown group were 245.3±42.4, 257.5±20.4, and 2 535 754.5±249 094.2 square pixels, respectively, which were all higher than those of the control group (113.3±23.5, 114.3±12.2, and 1 565 456.5±219 259.7 square pixels, respectively, all P＜0.01). In the conditioned medium for the control group of MHCC-97H cells,the number of main junctions, the number of main segments, and the total area of the lattice formed by the addition of CEA to cultured HUVEC cells were 178.9±12.0, 286.9±12.3, and 1 966 990.0±126 249.5 spixels, which were higher than those in the control group (119.7±22.1, 202.7±33.7, and 1 421 191.0±189 837.8 square pixels, respectively). The expression of LDLR in hepatocellular carcinoma tissues was not correlated with the expression of CEA, but was negatively correlated with the expression of CD31 ( r=-0.167, P=0.044), the level of serum CEA ( r=-0.061, P=0.032), and the level of serum ALT (r=-0.147, P=0.05). The expression of CEA in hepatocellular carcinoma tissues was positively correlated with the expression of CD31 ( r=0.192, P=0.020). The level of serum CEA was positively correlated with the level of serum ALT ( r=0.164, P=0.029). Conclusion:Knocking down LDLR can promote vascular abnormalities in HCC by releasing CEA.

Objective:To establish and validate a gallstones classification method based on deep learning.Methods:A total of 618 gallstones samples were collected from East Hospital Affiliated to Tongji University, and 1 023 high-definition cross-sectional gallstones profile images were captured to construct a cross-sectional gallstones profile image dataset. Based on the traditional eight-category gallstones classification method, a lightweight network model, MobileNet V3, was trained using deep learning and transfer learning methods. The classification performance of MobileNet was evaluated using a confusion matrix with metrics such as accuracy rate, precision rate, F1 score, and recall rate. The MobileNet V3 was improved and further validated using accuracy and loss values.Results:The accuracy rate (94.17%), precision rate (94.03%), F1 score (92.96%) and recall rate (92.99%) of the improved MobileNet V3 model were better than other networks. The improved MobileNet V3 model achieved the highest accuracy rate (94.17%) in gallstones profile classification and was validated by the test set. The confusion matrix showed a weighted average of accuracy rate (92.0%), precision rate (92.6%), and F1 score (92.2%) for each category of gallstones.Conclusions:Based on deep learning, a high-accuracy gallstones classification method is proposed, which provides a new idea for the intelligent identification of gallstones.

Objectives:To investigate the effect of the expression of low-density lipoprotein receptor associated protein (LDLR) on the vascular abnormalities in hepatocellular carcinoma (HCC) and its mechanisms.Methods:Based on the information of Oncomine Cancer GeneChip database, we analyzed the correlation between the expression level of LDLR and the expression level of carcinoembryonic antigen (CEA) and CD31 in hepatocellular carcinoma tissues. Lentiviral transfection of short hairpin RNA target genes was used to construct LDLR-knockdown MHCC-97H and HLE hepatocellular carcinoma cells. The differential genes and their expression level changes in LDLR-knockdown hepatocellular carcinoma cells were detected by transcriptome sequencing, real-time fluorescence quantitative polymerase chain reaction, and protein immunoblotting. The gene-related signaling pathways that involve LDLR were clarified by enrichment analysis. The effect of LDLR on CEA was assessed by the detection of CEA content in conditioned medium of hepatocellular carcinoma cells. Angiogenesis assay was used to detect the effect of LDLR on the angiogenic capacity of human umbilical vein endothelial cells, as well as the role of CEA in the regulation of angiogenesis by LDLR. Immunohistochemical staining was used to detect the expression levels of LDLR in 176 hepatocellular carcinoma tissues, and CEA and CD31 in 146 hepatocellular carcinoma tissues, and analyze the correlations between the expression levels of LDLR, CEA, and CD31 in the tissues, serum CEA, and alanine transaminase (ALT).Results:Oncomine database analysis showed that the expressions of LDLR and CEA in the tissues of hepatocellular carcinoma patients with portal vein metastasis were negatively correlated ( r=-0.64, P=0.001), whereas the expressions of CEA and CD31 in these tissues were positively correlated ( r=0.46, P=0.010). The transcriptome sequencing results showed that there were a total of 1 032 differentially expressed genes in the LDLR-knockdown group and the control group of MHCC-97H cells, of which 517 genes were up-regulated and 515 genes were down-regulated. The transcript expression level of CEACAM5 was significantly up-regulated in the cells of the LDLR-knockdown group. The Gene Ontology (GO) function enrichment analysis showed that the differential genes were most obviously enriched in the angiogenesis function. The Kyoto Encyclopedia of Genes and Genomes (KEGG) signaling pathway enrichment analysis showed that the relevant pathways involved mainly included the cellular adhesion patch, the extracellular matrix receptor interactions, and the interactions with the extracellular matrix receptors. The CEA content in the conditioned medium of the LDLR-knockdown group was 43.75±8.43, which was higher than that of the control group (1.15±0.14, P＜0.001). The results of angiogenesis experiments showed that at 5 h, the number of main junctions, the number of main segments, and the total area of the lattice formed by HUVEC cells cultured with the conditioned medium of MHCC-97H cells in the LDLR-knockdown group were 295.3±26.4, 552.5±63.8, and 2 239 781.0±13 8211.9 square pixels, which were higher than those of the control group (113.3±23.5, 194.8±36.5, and 660 621.0±280 328.3 square pixels, respectively, all P＜0.01).The number of vascular major junctions, the number of major segments, and the total area of the lattice formed by HUVEC cells cultured in conditioned medium with HLE cells in the LDLR-knockdown group were 245.3±42.4, 257.5±20.4, and 2 535 754.5±249 094.2 square pixels, respectively, which were all higher than those of the control group (113.3±23.5, 114.3±12.2, and 1 565 456.5±219 259.7 square pixels, respectively, all P＜0.01). In the conditioned medium for the control group of MHCC-97H cells,the number of main junctions, the number of main segments, and the total area of the lattice formed by the addition of CEA to cultured HUVEC cells were 178.9±12.0, 286.9±12.3, and 1 966 990.0±126 249.5 spixels, which were higher than those in the control group (119.7±22.1, 202.7±33.7, and 1 421 191.0±189 837.8 square pixels, respectively). The expression of LDLR in hepatocellular carcinoma tissues was not correlated with the expression of CEA, but was negatively correlated with the expression of CD31 ( r=-0.167, P=0.044), the level of serum CEA ( r=-0.061, P=0.032), and the level of serum ALT (r=-0.147, P=0.05). The expression of CEA in hepatocellular carcinoma tissues was positively correlated with the expression of CD31 ( r=0.192, P=0.020). The level of serum CEA was positively correlated with the level of serum ALT ( r=0.164, P=0.029). Conclusion:Knocking down LDLR can promote vascular abnormalities in HCC by releasing CEA.

Objective:The microstructure, tensile strength, and bursting strength of different brands of hernia meshes were compared and analyzed through experiments to evaluate the performance of different meshes.Methods:The balance and microscope were used to test the weight and microstructure of 15 common meshes and the tensile testing machine and burst testing machine were used to test the tensile and bursting properties of the mesh, and the mechanical properties of the mesh were analyzed.Results:The woven structures of the mesh are diamond, polygon and circle. The average weight of inguinal meshes is 0.08 mg/mm 2, and the average weight of abdominal wall hernia meshes is 0.18 mg/mm 2. The wire diameters of G3 - G6 meshes are larger, while the mesh opening ratio of G12 is lower. In the tensile performance test, it is known that G15 has the highest tensile strength, G12 and G14 have lower tensile strengths in lightweight meshes, and G1, G2, and G7 have lower tensile strengths in lightweight meshes. In the burst performance test, it is known that G3, G9, and G15 have the highest burst strength, while G12, G13, and G14 have the lowest burst strength in lightweight meshes. G1, G2, and G4 have the lowest burst strength in lightweight meshes. Conclusions:The mesh with a polygonal mesh and a large mesh opening ratio has better mechanical properties. The results of this study provide experimental evidence for optimizing hernia meshes, which is expected to provide better support for related research and applications.

Exhaled ammonia(NH3)is an essential noninvasive biomarker for disease diagnosis.In this study,an acetone-modifier positive photoionization ion mobility spectrometry(AM-PIMS)method was developed for accurate qualitative and quantitative analysis of exhaled NH3 with high selectivity and sensitivity.Acetone was introduced into the drift tube along with the drift gas as a modifier,and the characteristic NH3 product ion peak of(C3H6O)4NH4+(K0=1.45 cm2/V·s)was obtained through the ion-molecule reaction with acetone reactant ions(C3H6O)2H+(K0=1.87 cm2/V·s),which significantly increased the peak-to-peak resolution and improved the accuracy of exhaled NH3 qualitative identification.Moreover,the interference of high humidity and the memory effect of NH3 molecules were significantly reduced via online dilution and purging sampling,thus realizing breath-by-breath measurement.As a result,a wide quantitative range of 5.87-140.92 μmol/L with a response time of 40 ms was achieved,and the exhaled NH3 profile could be synchronized with the concentration curve of exhaled CO2.Finally,the analytical capacity of AM-PIMS was demonstrated by measuring the exhaled NH3 of healthy subjects,demon-strating its great potential for clinical disease diagnosis.

ObjectiveTo establish the category and structure of sports activities of autistic children and adolescents, and systematically review the functioning effects of physical activity on autistic children and adolescents, using International Classification of Functioning, Disability and Health-Children and Youth Version (ICF-CY). MethodsRandomized controlled trials (RCT) about the the health benefits of physical activity interventions for autistic children and adolescents were retrieved from CNKI, Wanfang Data, VIP, Web of Science, PubMed and EBSCO databases, from 2016 to 2022, and screened and reviewed. ResultsA total of 13 RCT from seven countries were included finally, involving 437 participants (aged 3 to 13 years). The main sources were journals in fields of medicine, public health, autism, sports and other fields, published from 2018 to 2022. The types of physical activities that benefit children and adolescents with autism include physical fitness, skills and sports programs, including physical activity in daily life, recreational and leisure activities, sports training, school physical education programs and exercise rehabilitation; 30 to 90 minutes a time, one to three times a week, for six weeks to ten months, medium to high intensity. Physical activity might promote the functional recovery for autistic children and adolescents. For body function of emotional response, physical activity improved fear or anxiety, executive function, inhibition function, working memory, cognitive flexibility, social cognitive level, balance, flexibility, grip strength. For activities and participation of interaction, physical activity enhanced interpersonal interaction, communication, social skills, quality of life, well-being, social support, motor self-efficacy, participation in various leisure and sports activities, and range of mobility at level of activity and participation. ConclusionThe main disabilities of children and adolescents with autism manifest in dimensions of body function, activity and participation, and quality of life and well-being. The benefits of physical activity on children and adolescents with autism manifest the improvement of physical function, activity and participation, specifically motor skills, social communication and interaction, language skills, balance and coordination, control, attention, and executive function, as well as quality of life, social participation, self-efficacy and well-being.

Objective:To examine the prognosis factors for non-reversal of defunctioning ileostomy in rectal cancer surgery.Methods:The data of 234 patients with rectal cancer undergoing radical resection and defunctioning ileostomy in the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from January 2013 to June 2020 was analyzed retrospectively. There were 166 males and 68 females, aging ( M(IQR)) 62(12) years (range: 33 to 89 years). Telephone following-up was conducted intensively in July 2021 to investigate whether stoma was reversed, causes of reversal failure, and tumor recurrence or metastasis after surgery. The non-reversal stoma was defined as stoma not being reversed during the follow-up period (more than 12 months). The χ 2 test or Fisher′s exact test was used to conduct a univariate analysis of clinical data related to reversal failure, and the factors with P<0.05 were selected into Logistic regression for multivariate analysis. Results:A total of 165 patients received stoma reversal postoperatively with an interval time of (6.5±2.4) months (range: 0.9 to 17.8 months), but 69 patients failed to closure of stoma. Univariate analysis showed that age, concomitant diseases, surgical methods, preoperative hemoglobin, preoperative carcinoembryonic antigen, tumor maximum diameter, depth of invasion, lymph node metastasis, TNM stage, anastomotic-related complications, postoperative tumor local recurrence or distant metastasis were associated with non-reversal of diverting ileostomy in rectal cancer surgery (all P<0.05). Multivariate analysis showed that age ( OR=2.270, 95% CI: 1.150 to 4.479, P=0.018), open surgery ( OR=7.249, 95% CI: 1.977 to 26.587, P=0.003), preoperative hemoglobin<120 g/L ( OR=3.092, 95% CI: 1.566 to 6.105, P<0.01), anastomotic-related complications ( OR=4.375, 95% CI: 1.686 to 11.349, P=0.002), postoperative local recurrence or distant metastasis ( OR=7.065, 95% CI: 2.591 to 19.264, P<0.01) were independent prognosis factors for reversal failure of defunctioning stoma in rectal cancer surgery. Conclusions:There is a high risk of reversal failure of defunctioning ileostomy among rectal cancer patients with age>65 years, open surgery, preoperative hemoglobin<120 g/L, anastomotic-related complications, postoperative local recurrence or distant metastasis. Colorectal surgeons should fully evaluate the outcome and risk of reversal failure before making a decision of diverting ileostomy. Reducing anastomotic complications is helpful to the successful return of preventive ileostomy.

Objective:To examine the prognosis factors for non-reversal of defunctioning ileostomy in rectal cancer surgery.Methods:The data of 234 patients with rectal cancer undergoing radical resection and defunctioning ileostomy in the Department of General Surgery, Beijing Friendship Hospital, Capital Medical University from January 2013 to June 2020 was analyzed retrospectively. There were 166 males and 68 females, aging ( M(IQR)) 62(12) years (range: 33 to 89 years). Telephone following-up was conducted intensively in July 2021 to investigate whether stoma was reversed, causes of reversal failure, and tumor recurrence or metastasis after surgery. The non-reversal stoma was defined as stoma not being reversed during the follow-up period (more than 12 months). The χ 2 test or Fisher′s exact test was used to conduct a univariate analysis of clinical data related to reversal failure, and the factors with P<0.05 were selected into Logistic regression for multivariate analysis. Results:A total of 165 patients received stoma reversal postoperatively with an interval time of (6.5±2.4) months (range: 0.9 to 17.8 months), but 69 patients failed to closure of stoma. Univariate analysis showed that age, concomitant diseases, surgical methods, preoperative hemoglobin, preoperative carcinoembryonic antigen, tumor maximum diameter, depth of invasion, lymph node metastasis, TNM stage, anastomotic-related complications, postoperative tumor local recurrence or distant metastasis were associated with non-reversal of diverting ileostomy in rectal cancer surgery (all P<0.05). Multivariate analysis showed that age ( OR=2.270, 95% CI: 1.150 to 4.479, P=0.018), open surgery ( OR=7.249, 95% CI: 1.977 to 26.587, P=0.003), preoperative hemoglobin<120 g/L ( OR=3.092, 95% CI: 1.566 to 6.105, P<0.01), anastomotic-related complications ( OR=4.375, 95% CI: 1.686 to 11.349, P=0.002), postoperative local recurrence or distant metastasis ( OR=7.065, 95% CI: 2.591 to 19.264, P<0.01) were independent prognosis factors for reversal failure of defunctioning stoma in rectal cancer surgery. Conclusions:There is a high risk of reversal failure of defunctioning ileostomy among rectal cancer patients with age>65 years, open surgery, preoperative hemoglobin<120 g/L, anastomotic-related complications, postoperative local recurrence or distant metastasis. Colorectal surgeons should fully evaluate the outcome and risk of reversal failure before making a decision of diverting ileostomy. Reducing anastomotic complications is helpful to the successful return of preventive ileostomy.

Post-stroke cognitive impairment (PSCI) is a series of syndromes caused by stroke, involving impairment of one or more cognitive functions, such as attention, language function, executive function, visuospatial cognition, episodic memory and working memory, etc. The traditional treatment methods of PSCI include drug therapy and cognitive training. The treatment modalities are limited and the maintenance effect is not good. Therefore, an auxiliary treatment method is urgently needed to improve its therapeutic effect. Transcranial direct current stimulation (tDCS) is a safe and mature non-invasive brain stimulation technique, which generates weak direct current (1-2 mA) through electrodes placed on the scalp to change the resting membrane potential of neurons, regulate the excitability of the cerebral cortex, so as to achieve the purpose of treatment. This article reviews the effect of tDCS on PSCI, and hopes to provide reference and guidance for its rehabilitation treatment.