Search Results (6,468)

Background: EUS-guided gastroenterostomy (EUS-GE) is a novel and effective procedure for the management of malignant gastric outlet obstruction (GOO) with more durable results when compared to enteral stenting (ES). However, data comparing EUS-GE to ES in patients already treated with EUS-guided choledocoduodenostomy (EUS-CDS) for distal malignant biliary obstruction (DMBO) are lacking. We aimed to compare outcomes of EUS-GE and ES for the palliation of GOO in this specific population of patients. Methods: A multicenter, retrospective analysis of patients with DMBO treated by EUS-CDS and subsequent GOO treated by EUS-GE or ES from 2016 to 2021 was conducted. Primary outcomes were overall AEs rate and dysfunction of the EUS-CDS after GOO treatment. Secondary outcomes included clinical success, technical success, procedure duration, length of hospital stay and relapse of GOO symptoms. Results: A total of 77 consecutive patients were included in the study: 25 patients underwent EUS-GE and 52 underwent ES. AEs rate and patency outcomes of the EUS-CDS after GOO treatment were comparable between the two groups (12.5% vs. 17.3%; p = 0.74). No recurrence of GOO symptoms was registered in the EUS-GE group while 11.5% of ES patients had symptoms recurrence, even if not statistically significant (p = 0.16), after a mean follow-up period of 63.5 days. Conclusion: EUS-GE and ES are both effective and safe for the palliation of GOO in patients already treated by EUS-CDS for DMBO with no difference in the biliary stent dysfunction rate and overall AEs. EUS-GE is associated with less recurrence of GOO symptoms. Full article

Shiqu County, Sichuan Province, forms the eastern edge of the distribution area of the kiang (Equus kiang). It is important to assess the population and habitat status of peripheral populations, as these play a significant role in the development of conservation strategies for kiangs. Based on field transect data collected from July to August 2023, this study predicted the suitable habitat distribution of kiangs in Shiqu County using a MaxEnt model and estimated the population size and density using the ‘Distance’ package. Additionally, it analyzed the responses of the group size of kiangs to environmental factors in Shiqu County. The results showed that the area of suitable habitat for kiangs is 3402.45 km², accounting for 13.51% of the total area of Shiqu County. The estimated population was 1395.00 ± 272.20, with a population density of 0.41 ± 0.08/km². Additionally, the group size of kiangs was significantly positively correlated with the distance from the road and grazing site. The distance from the grazing site, elevation, and temperature annual range are the main environmental factors affecting the distribution of kiangs. This study initially revealed the peripheral population Status and suitable habitat of the kiang on the eastern Tibetan Plateau, and the potential threat of grazing interference and road obstruction. The research results can provide a scientific reference for the population and habitat protection of kiangs in this area. Full article

Background: Mullerian duct anomalies include a broad spectrum of genital tract defects that arise from developmental abnormalities of the genital tract. Herlyn–Werner–Wunderlich syndrome (HWWS) refers to the combination of uterus didelphys, blind hemivagina and ipsilateral renal agenesis. In the literature, the syndrome often appears as a few sporadic case reports. Case: We report a case of symptomatic Herlyn–Werner–Wunderlich syndrome diagnosed by transavaginal scan and MRI and successfully treated with a laparoscopic-assisted hysteroscopic vaginal septum resection. The postoperative course was without complications, and clinical symptoms completely resolved the surgery. Summary and Conclusion: Combination of laparoscopy and hysteroscopy was found to be an easy, safe, effective and appropriate approach for patients with HWWS. Full article

One important aspect to consider when buying a house or apartment is adequate solar exposure. The same applies to the evaluation of the shadowing effects of existing buildings on prospective construction sites and vice versa. In different climates and seasons, it is not always easy to assess if there will be an excess or lack of sunlight, and both can lead to discomfort and excessive energy consumption. The aim of our project is to design a method to quantify the availability of direct sunlight to answer these questions. We developed a tool in Octave to calculate representative parameters, such as sunlight hours per day over a year and the times of day for which sunlight is present, considering the surrounding objects. The apparent sun position over time is obtained from an existing algorithm and the surrounding objects are surveyed using a picture taken with a 360° camera from a window or other sunlight entry area. The sky regions in the picture are detected and all other regions correspond to obstructions to direct sunlight. The sky detection is not fully automatic, but the sky swap tool in the camera software could be adapted by the manufacturer for this purpose. We present the results for six representative test cases. Full article

Toceranib phosphate (toceranib) is approved for canine mast cell tumor treatment. However, no long-term response to toceranib in canine HSTCL has been reported. Here, we describe a case of a 10-year-old castrated mixed-breed dog that presented with a 3-month history of weight loss, polydipsia, and polyuria. The clinicopathological and imaging abnormalities included icterus, biliary obstruction, and splenomegaly with multiple diffuse splenic hypoechoic nodules. On day 21, a cholecystectomy was performed to remove the obstruction, followed by a liver biopsy and splenectomy. Cytology of the spleen and liver showed many small lymphocytes with intracytoplasmic granules (sGLs). Splenic and hepatic infiltration of neoplastic CD3/granzyme B-positive small cells and lymphocytic cholecystitis with granzyme B-negative small cells were noted. T-cell receptor gene clonal rearrangements were observed in the liver tissues. The dog was diagnosed with a hepatosplenic T-cell lymphoma (HSTCL) of sGLs concurrent with lymphocytic cholecystitis. The icterus resolved after surgery, but there was progressive elevation of liver enzyme levels. Toceranib was administered from day 39, resulting in decreased liver enzyme levels, and the dog remained in good condition. The dog stayed in remission after toceranib administration and survived for 460 days. Toceranib should be considered an effective treatment option for canine HSTCL. Full article

To encourage energy saving and emission reduction and improve traffic efficiency in the multiple signalized intersections area, an eco-driving strategy for connected and automated vehicles (CAVs) considering the effects of traffic flow is proposed for the mixed traffic environment. Firstly, the formation and dissipation process of signalized intersection queues are analyzed based on traffic wave theory, and a traffic flow situation estimation model is constructed, which can estimate intersection queue length and rear obstructed fleet length. Secondly, a feasible speed set calculation method for multiple signalized intersections is proposed to enable vehicles to pass through intersections without stopping and obstructing the following vehicles, adopting a trigonometric profile to generate smooth speed trajectory to ensure good riding comfort, and the speed trajectory is optimized with comprehensive consideration of fuel consumption, emissions, and traffic efficiency costs. Finally, the effectiveness of the strategy is verified. The results show that traffic performance and fuel consumption benefits increase as the penetration rate of CAVs increases. When all vehicles on the road are CAVs, the proposed strategy can increase the average speed by 9.5%, reduce the number of stops by 78.2%, reduce the stopped delay by 82.0%, and reduce the fuel consumption, NO_x, and HC emissions by 20.4%, 39.4%, and 46.6%, respectively. Full article

Emphysema in patients with chronic obstructive pulmonary disease (COPD) is characterized by progressive inflammation. Preclinical studies suggest that lung volume reduction surgery (LVRS) and mesenchymal stromal cell (MSC) treatment dampen inflammation. We investigated the effects of bone marrow-derived MSC (BM-MSC) and LVRS on circulating and pulmonary immune cell profiles in emphysema patients using mass cytometry. Blood and resected lung tissue were collected at the first LVRS (L1). Following 6–10 weeks of recovery, patients received a placebo or intravenous administration of 2 × 10⁶ cells/kg bodyweight BM-MSC (n = 5 and n = 9, resp.) in week 3 and 4 before the second LVRS (L2), where blood and lung tissue were collected. Irrespective of BM-MSC or placebo treatment, proportions of circulating lymphocytes including central memory CD4 regulatory, effector memory CD8 and γδ T cells were higher, whereas myeloid cell percentages were lower in L2 compared to L1. In resected lung tissue, proportions of Treg (p = 0.0067) and anti-inflammatory CD163⁻ macrophages (p = 0.0001) were increased in L2 compared to L1, while proportions of pro-inflammatory CD163⁺ macrophages were decreased (p = 0.0004). There were no effects of BM-MSC treatment on immune profiles in emphysema patients. However, we observed alterations in the circulating and pulmonary immune cells upon LVRS, suggesting the induction of anti-inflammatory responses potentially needed for repair processes. Full article

Recently, indoor positioning has been one of the hot topics in the field of navigation and positioning. Among different solutions on indoor positioning, positioning with acoustic signals has its promise due to its relatively high accuracy in the line of sight scenarios, low cost, and ease of being implemented in smartphones. In this work, a novel acoustic positioning method, called RATBILS, is proposed, in which encoded chirp acoustic signals are modulated and transmitted by different acoustic base stations. The smartphones receive the signals and perform the following three steps: (1) preprocessing; (2) time of arrival (TOA) estimation; and (3) time difference of arrival (TDOA) calculation and location estimation. In the preprocessing stage, we use band pass filters to filter out low-frequency noise from the environment. At the same time, we perform a signal decoding function in order to lock onto the positioning source. In the TOA estimation stage, we conduct both coarse and fine detection to enhance the accuracy and robustness of TOA estimation. The primary goal of coarse detection is to establish a noise range for fine detection. The main objective of fine detection is to emphasize the intensity of the first arrival diameter and resistance with multipath and non-line-of-sight (NLOS) caused by human body obstruction. In the TDOA calculation and location estimation stage, we estimate the TDOA based on the TOA estimation and then use the TDOA results for position estimation. In order to evaluate the performance of the proposed RATBILS system, two indoor field tests are carried out. The test results show that the RATBILS system achieves a positioning error of 0.23 m at 92% in region 1 of scene 1 and is superior to the traditional threshold method. The RATBILS system achieves a positioning error of 0.56 m at 92% in region 2 of scene 1 and is superior to the traditional threshold method. In scene 2, the maximum average positioning error was 1.26 m, which is better than the 3.33 m and 3.87 m of the two traditional threshold methods. Full article

Background/Objectives: Bladder outlet obstruction (BOO) resulting from benign prostate enlargement (BPE) is a common cause of lower urinary tract symptoms (LUTS) in men. Patients with central nervous system (CNS) diseases, such as spinal cord injury (SCI), Parkinson’s disease (PD), cerebrovascular accident (CVA) and multiple systemic atrophy (MSA), commonly experience lower urinary tract dysfunction. Men who suffer from CNS diseases may also experience symptoms related to BPE and BOO, which pose an additional burden to their overall clinical status and result in the need for catheter use and a deterioration in quality of life. The aim of this study was to identify if prostate surgery will benefit men with CNS diseases who have been diagnosed with BPE-related BOO. Methods: The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. EMBASE, MEDLINE, Cochrane systematic reviews, Cochrane Central Register of Controlled Trials, Google Scholar, and ClinicalTrials.gov were searched from 1946 up to July 2023 for peer-reviewed publications addressing the primary outcome (success rate) and the secondary outcomes (postoperative changes in incontinence episodes, urodynamic parameters, questionnaire scores, and quality of life). In addition, the perioperative outcomes (adverse events and the need for further medical or surgical therapy) were reported. Results: A total of 1572 abstracts were screened, and 13 studies involving 1144 patients were eligible for inclusion. Six studies assessed the effect of prostate surgery for BPE-related BOO in SCI, four studies in CVA, two studies in PD, and one study in the MSA population. All studies were considered to have a high risk of bias. Transurethral resection of the prostate (TURP) was the most common de-obstruction procedure, followed by prostatic artery embolism and open prostatectomy. The overall pooled success rate was calculated as 81.4% (65–100%) in SCI, 27.1% (9–70%) in PD, and 66.7% (50–79%) in CVA populations. The risk of de novo incontinence was 24.7–50% in SCI, 20% in PD, 21–50% in CVA, and 60% in MSA population. In patients with SCI with BPE-related BOO, prostate surgery improved mean bladder compliance and detrusor filling pressure and resolved detrusor overactivity in up to 50% of patients. Improvement of free flow rate, voided volume, and post-void residual was observed in all patients. Patients with CVA had an increased risk of perioperative mortality compared to non-CVA patients, and the risk of postoperative complications was inversely proportional to the timing of the CVA insult since surgery. Conclusions: This systematic review provides an overview of the available evidence on the outcome of prostate surgery in patients with neurologic diseases and BPE-related BOO. Identifying the optimal practice was challenging due to the limited availability of high-quality studies and the high variability of the reported outcomes. Properly selected patients with neurological diseases may benefit from prostate surgery, provided that preoperative investigations indicate BPE-related BOO. Full article

Background/Objective: Sensitization to specific IgE Staphylococcus aureus enterotoxins (SEs) is associated with an increased risk for severe asthma development. Limited data exist regarding the association of seropositivity for specific IgE SEs and the different aspects of severe asthma. We aimed to determine whether the presence of SEs is associated with asthma-related parameters such as inflammatory cells in the airways, features of airway remodeling, and other variables relating to asthma assessment and severity. Methods: Fifty patients with severe asthma were recruited in the study. Demographics, comorbidities, asthma duration, and asthma medication were recorded by treating physicians. Specific IgE SE measurement, lung function, atopic status, asthma control test (ACT), sputum induction, bronchoscopy with BAL, and indices of airway remodeling were also assessed. Results: Twelve patients were positive to enterotoxin sensitization. Patients seropositive to specific IgE SEs significantly differed in regard to FEV₁% pred and FEV₁/FVC ratio compared to seronegative ones. Analyzing the inflammatory variables obtained from induced sputum, BAL, and endobronchial biopsies, the only significant difference was that of smooth muscle area (SMA), which was greater in specific IgE SE seropositive patients. The multivariate linear regression analysis showed two significant associations of specific IgE SE seropositivity. We found a negative with FEV₁% pred with beta standardized coefficient 95%CI −0.054 (−0.083, −0.031), p < 0.001, and a positive with SMA with beta standardized coefficient 95%CI 0.054 (0.081, 0.037), p < 0.001. Conclusions: Seropositivity to specific IgE SEs in severe asthma is associated with more severe airflow limitation, obstruction, and upregulation in SMA, indicating a possible role in the remodeling process. Full article

Isorhamnetin (ISO) is an active flavonoid compound mainly isolated from the fruits of Hippophae rhamnoides L. and the leaves of Ginkgo biloba L. Previous studies have revealed the antifibrotic action of ISO in the liver and lungs, although its potential protective effects against renal fibrosis and the underlying mechanisms are still poorly understood. Given that many actions of ISO could be similarly attained by hydrogen sulfide (H₂S), we speculated that ISO may work through the induction of endogenous H₂S. To test the hypothesis, we established the unilateral ureteral obstruction (UUO) renal fibrosis rat model and transforming growth factor-β1(TGF-β1)-induced fibrosis in cultured renal tubular cells. ISO treatment inhibited epithelial–mesenchymal transition (EMT) formation, decreased extracellular matrix (ECM) deposition, and relieved renal fibrosis. Further analysis revealed that ISO stimulated the expression of the H₂S-synthesizing enzyme cystathionine lyase (CSE) and cystathionine beta-synthase (CBS), and promoted H₂S production in vivo and in vitro. The elevated H₂S attenuated oxidative stress and elevated the thiol level. It induced Keap1 sulfhydration, disrupted Keap1-Nrf2 interaction, and promoted the entry of Nrf2 into the nucleus. Finally, we found that circulating H₂S mainly derived from the liver, and not the kidney. Collectively, our study revealed that ISO alleviated renal fibrosis by inducing endogenous H₂S and regulating Keap1-Nrf2 interaction through sulfhydration of Keap1. Endogenous H₂S could be an important mediator underlying the pharmacological actions of ISO. Due to the multifunctional properties of H₂S, the H₂S-inducing nature of ISO could be exploited to treat various diseases. Full article

Global Navigation Satellite Systems (GNSSs) frequently encounter challenges in providing reliable navigation and positioning within urban canyons due to signal obstruction. Micro-Electro-Mechanical System (MEMS) Inertial Measurement Units (IMUs) offers an alternative for autonomous navigation, but they are susceptible to accumulating errors. To mitigate these influences, a LiDAR-based Simultaneous Localization and Mapping (SLAM) system is often employed. However, these systems face challenges in drift and error accumulation over time. This paper presents a novel approach to loop closure detection within LiDAR-based SLAM, focusing on the identification of previously visited locations to correct time-accumulated errors. Specifically, the proposed method leverages the vehicular drivable area and IMU trajectory to identify significant environmental changes in keyframe selection. This approach differs from conventional methods that only rely on distance or time intervals. Furthermore, the proposed method extends the SCAN CONTEXT algorithm. This technique incorporates the overall distribution of point clouds within a region rather than solely relying on maximum height to establish more robust loop closure constraints. Finally, the effectiveness of the proposed method is validated through experiments conducted on the KITTI dataset with an enhanced accuracy of 6%, and the local scenarios exhibit a remarkable improvement in accuracy of 17%, demonstrating improved robustness in loop closure detection for LiDAR-based SLAM. Full article

The discovery of hypertrophic cardiomyopathy (HCM) dates back to 1958, when the pathologist Donald Teare of the St. George’s Hospital in London performed autopsies in eight cases with asymmetric hypertrophy of the ventricular septum and bizarre disorganization (disarray) at histology, first interpreted as hamartoma. Seven had died suddenly. The cardiac specimens were cut along the long axis, similar to the 2D echo. In the same year, at the National Institute of Health U.S.A., Eugene Braunwald, a hemodynamist, and Andrew Glenn Morrow, a cardiac surgeon, clinically faced a patient with an apparently similar morbid entity, with a systolic murmur and subaortic valve gradient. “Discrete” subaortic stenosis was postulated. However, at surgery, Dr. Morrow observed only hypertrophy and performed myectomy to relieve the obstruction. This first Braunwald–Morrow patient underwent a successful cardiac transplant later at the disease end stage. The same Dr. Morrow was found to be affected by the familial HCM and died suddenly in 1992. The term “functional subaortic stenosis” was used in 1959 and “idiopathic hypertrophic subaortic stenosis” in 1960. Years before, in 1957, Lord Brock, a cardiac surgeon at the Guy’s Hospital in London, during alleged aortic valve surgery in extracorporeal circulation, did not find any valvular or discrete subaortic stenoses. In 1980, John F. Goodwin of the Westminster Hospital in London, the head of an international WHO committee, put forward the first classification of heart muscle diseases, introducing the term cardiomyopathy (dilated, hypertrophic, and endomyocardial restrictive). In 1995, the WHO classification was revisited, with the addition of two new entities, namely arrhythmogenic and purely myocardial restrictive, the latter a paradox of a small heart accounting for severe congestive heart failure by ventricular diastolic impairment. A familial occurrence was noticed earlier in HCM and published by Teare and Goodwin in 1960. In 1989–1990, the same family underwent molecular genetics investigation by the Seidman team in Boston, and a missense mutation of the β-cardiac myosin heavy chain in chromosome 14 was found. Thus, 21 years elapsed from HCM gross discovery to molecular discoveries. The same original family was the source of both the gross and genetic explanations of HCM, which is now named sarcomere disease. Restrictive cardiomyopathy, characterized grossly without hypertrophy and histologically by myocardial disarray, was found to also have a sarcomeric genetic mutation, labeled “HCM without hypertrophy”. Sarcomere missense mutations have also been reported in dilated cardiomyopathy (DCM) and non-compaction cardiomyopathy. Moreover, sarcomeric gene defects have been detected in some DNA non-coding regions of HCM patients. The same mutation in the family may express different phenotypes (HCM, DCM, and RCM). Large ischemic scars have been reported by pathologists and are nowadays easily detectable in vivo by cardiac magnetic resonance with gadolinium. The ischemic arrhythmic substrate enhances the risk of sudden death. Full article

Background/Objectives: Obstructive hydrocephalus associated with vestibular schwannoma (VS) is the most common in giant VS. Despite tumor removal, some patients may require ongoing ventriculo-peritoneal (VP) surgery. This investigation explores the factors contributing to the requirement for VP surgery following VS surgery in instances of persistent hydrocephalus (HCP). Methods: Volumetric MRI analyses of pre- and postoperative tumor volumes, cerebellum, cerebrum, ventricle system, fourth ventricle, brainstem, and peritumoral edema were conducted using Brainlab Smartbrush and 3D Slicer. The total brain volume was defined as the sum of the cerebrum, cerebellum, and brainstem. ROC analyses were performed to identify the optimum cut-off values of the volumetric data. Results: Permanent cerebrospinal fluid (CSF) diversion after surgery was indicated in 12 patients (12/71; 16.9%). The ratio of baseline volume fraction of brain ventricles to total brain ventricle volume (VTB ratio) was found to predict postoperative VP shunt dependency. The AUC was 0.71 (95% CI: 0.51–0.91), and the optimum threshold value (</≥0.449) yielded a sensitivity and specificity of 67% and 81%, respectively. Multivariable logistic regression analyses of imaging data (pre- and postoperative VS volume, VTB ratio, and extent of resection (%) (EoR)) and patient-specific factors revealed that an increased VTB ratio (≥0.049, OR: 6.2, 95% CI: 1.0–38.0, p = 0.047) and an EoR < 96.4% (OR: 9.1, 95% CI: 1.2–69.3, p = 0.032) were independently associated with postoperative VP shunt dependency. Conclusions: Primary tumor removal remains the best treatment to reduce the risk of postoperative persistent hydrocephalus. However, patients with an increased preoperative VTB ratio are prone to needing postoperative VP shunt surgery and may benefit from perioperative EVD placement. Full article

With the rapid pace of urbanization, a significant number of rural laborers are migrating to cities, leading to a severe shortage of agricultural labor. Consequently, the modernization of agriculture has become a priority. Autonomous picking robots represent a crucial component of agricultural technological innovation, and their development drives progress across the entire agricultural sector. This paper reviews the current state of research on fruit- and vegetable-picking robots, focusing on key aspects such as the vision system sensors, target detection, localization, and the design of end-effectors. Commonly used target recognition algorithms, including image segmentation and deep learning-based neural networks, are introduced. The challenges of target recognition and localization in complex environments, such as those caused by branch and leaf obstruction, fruit overlap, and oscillation in natural settings, are analyzed. Additionally, the characteristics of the three main types of end-effectors—clamping, suction, and cutting—are discussed, along with an analysis of the advantages and disadvantages of each design. The limitations of current agricultural picking robots are summarized, taking into account the complexity of operation, research and development costs, as well as the efficiency and speed of picking. Finally, the paper offers a perspective on the future of picking robots, addressing aspects such as environmental adaptability, functional diversity, innovation and technological convergence, as well as policy and farm management. Full article