Inspired by the impressive success of image-text foundation models, recent works have proposed to adapt these foundation models to video data, leading to efficient and effective video models for open-vocabulary action recognition. However, through a comprehensive evaluation, our work finds that state-of the-art open-vocabulary action recognition models still struggle with generalization to video domains that they have not en countered. To address this limitation, we introduce generalizable open-vocabulary action recognition, which aims to develop action recognition models capable of generalizing to both novel action categories and unseen video domains. Our work contributes a novel model named XOV-Action to overcome two critical challenges: (1) understanding novel action concepts of open-set categories, and (2) mitigating the scenario discrepancy between training and test datasets. Specifically, XOV-Action first proposes to capture diverse action-related concepts by learning diversified elaboration representations, which enables better generalization to open-set action categories. Second, XOV-Action learns scene agnostic video representations to overcome the scene bias, which improves the generalization in unseen video domains. Addition ally, to evaluate models in generalizable open-vocabulary action recognition, we contribute a new cross-domain action benchmark named XOVABench, which covers multiple video domains with varying degrees of gaps and consists of both closed-set and open-set action categories. Extensive quantitative and qualitative experiments demonstrate that our proposed XOV-Action can effectively improve the action recognition performance for both closed-set and open-set categories across video domains.
Feeding jejunostomy (FJ) provides critical enteral access for patients undergoing treatment for upper gastrointestinal (GI) pathology. This study aimed to evaluate the safety, complication profile, and operative context of laparoscopic versus open FJ using a standardised laparoscopic technique. A retrospective cohort study included 576 patients who underwent FJ between March 2018 and August 2024 (302 laparoscopic, 274 open). Patient demographics, operative context, and postoperative complications were analysed. Outcomes are reported as frequencies with relative effect estimates and corresponding 95% confidence intervals. Baseline characteristics were comparable between groups. Laparoscopic FJ was more frequently performed in the elective setting (286/302 vs. 225/274; OR 3.88, 95% CI 2.20-6.85) and during cancer staging procedures (102/302 vs. 50/274; OR 2.28, 95% CI 1.55-3.37). In contrast, laparoscopic FJ was less commonly undertaken during major resections (156/302 vs. 165/274; OR 0.71, 95% CI 0.51-0.98) and emergency surgery (16/302 vs. 49/274; OR 0.25, 95% CI 0.14-0.45). On unadjusted analysis, overall postoperative complications were more frequent following laparoscopic FJ (43/302, 14.2%) compared with open FJ (18/274, 6.5%); however, after adjustment for comorbidity burden, procedural urgency, and other clinically relevant covariates, surgical approach was not independently associated with postoperative morbidity (adjusted OR 1.25, 95% CI 0.75-2.05). Tube-related complications, including dislodgement, leakage, and small bowel obstruction, were infrequent. Lower body mass index and female sex were associated with increased odds of obstruction. Early infectious complications occurred exclusively following laparoscopic FJ (5/302, 1.7%), but this association did not persist after multivariable adjustment (adjusted OR 2.60, 95% CI 0.75-9.10). Laparoscopic FJ was a safe alternative to open insertion. Although unadjusted complication rates were higher following laparoscopic FJ, surgical approach was not independently associated with early morbidity after risk adjustment, supporting the use of minimally invasive techniques in appropriately selected patients.
Pancreatoduodenectomy (PD) remains a technically demanding procedure with substantial postoperative morbidity. The robotic PD (R-PD) may offer advantages over open PD (O-PD), but its role is still under scrutiny. This study compared R-PD and O-PD within a mature, high-volume single-institution experience. From October 2008 to May 2024, 500 PDs were performed at our institution (388 O-PDs and 112 R-PDs since January 2018). The 112 R-PD cases were 1:1 case-matched with 112 O-PD cases to ensure comparability in terms of patient-related surgical risk (sex, age, BMI, ASA score), disease-related factors (histological diagnosis, and T stage) and surgeon-related expertise. Univariable and multivariable logistic regression analyses were performed to identify predictors of clinically relevant postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE). Mean operative time was comparable between groups (389 vs 399 min, p = 0.315), with no conversions to open surgery for R-PD. Clinically relevant POPF occurred in 5.4% of R-PD patients vs 14.3% of O-PD (p = 0.025), and clinically relevant DGE in 21.4% vs 37.5% (p = 0.008). Median length of stay was shorter after R-PD (11 [8-22.75] vs 19.5 [13-27.5] days, p < 0.001). Rates of major complications (Clavien-Dindo ≥ III) were similar (15.2% for R-PD vs 14.3% for O-PD, p = 0.850). Thirty-day mortality was comparable (0.9% vs 1.8%, p = 0.561), while ninety-day mortality was 2.7% in both groups. Regression analysis showed that the robotic approach was associated with a lower risk of clinically relevant POPF in univariable analysis and a reduced risk of clinically relevant DGE in multivariable analysis. When performed in centers with established robotic and pancreatic expertise, R-PD appears to be a safe alternative to open surgery, with an extremely low risk of conversion and potential advantages in perioperative recovery. These findings suggest that R-PD may be considered a first-line option in appropriately selected patients within experienced high-volume programs.
Although minimally invasive (MIS) liver resections are associated with improved outcomes, uptake remains slow. Using data from the Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample (NIS), adults who underwent elective liver resections (2016-2020) were identified. Approach was classified as MIS (laparoscopic or robotic-assisted) or open. Annual utilization was characterized by approach and association between approach and patient and hospital variables was estimated. Among 63,280 adult liver resections, 22.5% were MIS. MIS resections increased from 21.3% in 2016 to 22.5% in 2020. Laparoscopy alone decreased from 18.4 to 14.9%, while robotic-assistance increased from 2.9 to 7.6%. In multivariable analysis, patients were less likely to undergo MIS resection if they were in a county with < 250,000 people (vs. > 250,000, OR [95% CI], 0.82 [0.73-0.93]). Patients were more likely to undergo a MIS resection if they had a benign indication (vs. malignancy, OR [95% CI], 2.9 [2.49-3.38]), or were undergoing a partial hepatectomy (vs. lobectomy, OR, [95% CI], 2.62 [2.24-3.07]). MIS liver resection increased between 2016 and 2020, driven by an increase in robotic-assisted surgery and despite a reduction in laparoscopic surgery. Rurality, indication, and resection type were contributors to a MIS vs. open approach.
Agentic AI systems increasingly connect large language models (LLMs) to external scientific tools, yet whether and when tool access improves prediction accuracy remains uncharacterized. We present AGAPI (AtomGPT.org API), an open-access platform integrating eight open-source LLMs with 18 REST end points (28 agent tools, 50 web apps) spanning materials databases, force fields, tight-binding band structures, X-ray diffraction, and protein structure. A three-evaluation residual decomposition on JARVIS-Leaderboard electronic-structure test sets separates agent pipeline fidelity from inherited density functional theory (DFT) functional bias. For bulk modulus and bandgap the agent reproduces JARVIS-DFT entries to numerical precision, so the experimental-reference degradation is functional bias, not agentic malfunction. On memorization-resistant test sets (57 defective supercells, 60 hypothetical compositions), tool-augmented mean absolute error (MAE) is below 0.005 eV versus 1.25 to 1.86 eV tool-free, confirming tools are indispensable where parametric knowledge is unavailable. We further demonstrate autonomous multistep workflows including 10-operation defect-engineering pipelines. AGAPI is available at https://github.com/atomgptlab/agapi.
Segment Anything Model (SAM) has achieved impressive segmentation performance in an open-world setting. However, SAM relies heavily on high-quality input images and usually struggles in low-light conditions. This is mainly caused by the pre-training dataset, SA-1B, in which low-light samples constitute a relatively small fraction of the data. This lack of presence leads to a noticeable weakness when SAM is applied in real-world dark environments. With the motivation of improving SAM's performance under low-light conditions while retaining its strong zero-shot capability, this work proposes an alignment stage between the pre-training stage and testing stage. Unlike existing low-light studies that mainly focus on task-specific and close-set settings, our work further emphasizes pursuing the segmentation ability under low-light conditions for open-world models. To this end, we construct DarkSeg58K, a realistic and diverse dataset, which serves as the alignment dataset to support this stage. We further introduce Lighted-SAM as the lightweight repair strategy to fix SAM's performance in low-light conditions. Different from existing methods focusing on introducing spectral adapters into the model design and training this model end-to-end, Lighted-SAM introduces the Spectral Information Resonance (SIR) mechanism to harmoniously integrate the spectral enhancement module into SAM, which is usually kept frozen due to its large-scale parameters. Based on our lightweight repairing strategy, Lighted-SAM can improve SAM's ability in low-light conditions while preserving its zero-shot ability. Experiments on different benchmarks validate the superiority of our approach. Code will be released when this work is fully accepted.
Neoadjuvant therapy is recommended for hepatocellular carcinoma at advanced stages. It is unknown whether robotic liver resection (RLR) is superior to open liver resection (OLR) after neoadjuvant therapy. We analyzed consecutive RLR and OLR patients from December 2020 to December 2023. Patient variables, short- and long-term outcomes were compared. A respective 1:3 propensity score-matched (PSM) analysis was performed between RLR and OLR groups. The analysis included 32 RLR and 386 OLR cases. After PSM, 29 RLR cases matched to 78 OLR cases. RLR had similar operative time, fewer blood loss (123 mL vs. 230 mL, P = 0.032), and shorter postoperative hospital stay (7.2 days vs. 10.4 days, P = 0.014) compared to OLR. RLR had similar incidence and grades of complications compared to OLR. No significant difference was found in recurrence-free and overall survival. RLR after neoadjuvant therapy was as safe and feasible as OLR, and could improve postoperative recovery and produce equivalent long-term survival outcomes.
Soil heavy metals (HMs) pollution from mining activities poses a significant threat to environmental health and has attracted widespread attention. This study integrated eco-health risk assessment and identified driving factors for risks of HMs in soils at an open-pit lead-zinc mining area. Results indicated that Pb, As and Cu were the major contaminants, with 46.43%, 32.14% and 25.00% of soil samples exhibited moderate to severe pollution levels. Distinct from the pollution level, Cd total contents and effective available contents showed the highest ecological risk, with an average Er value of 180.06 (heavily polluted) and mean RAC value of 82.01(extreme pollution), respectively. Through the probabilistic health risk assessment, As was identified as the key pollutant posing health risks, contributing 98.6% and 97.8% of the Carcinogenic risks and 68.5% and 76.7% of the Non-carcinogenic risks for adults and children, respectively. Cd and As were identified as the primary pollutants posing potential ecological and human health risks. Redundancy and permutation feature importance analysis further demonstrated that electrical conductivity (EC) was a key predictor strongly associated with the ecological risk and health risk. This study distinguished the target priority pollutant between the ecological and health risks and identified the driving factors for risks, providing valuable insights into the pollution control and targeted soil management in mining areas.
暂无摘要（点击查看详情）
pT4 colon tumors are associated with worse oncologic prognosis. Although minimally invasive surgery (MIS) improves postoperative recovery, concerns remain regarding its long‑term oncologic safety. This is a secondary analysis of a retrospective, multicenter national cohort including patients with pT4 colon cancer treated with curative intent in 50 hospitals. We compared oncologic outcomes (local, peritoneal and systemic recurrence, disease‑free survival [DFS] and overall survival [OS]) between open surgery and MIS. Variables associated with surgical approach were incorporated into a propensity score (PS) to adjust outcomes. A total of 1850 patients were analyzed: 725 (39.2%) underwent MIS and 1125 (60.8%) open surgery. Patients selected for MIS more frequently had favorable clinical and tumor characteristics. After PS adjustment, MIS was associated with fewer postoperative complications, including fewer major complications (OR 2.4, p < 0.01). The mean number of resected lymph nodes and margin involvement were similar between groups. After a median follow‑up of 42.1 months, overall recurrence rates did not differ between MIS and open surgery, including peritoneal and systemic metastases. Although overall mortality was lower in the MIS group, cancer‑specific mortality was similar. MIS was associated with better DFS (HR 1.2, p = 0.018) and OS (HR 1.3, p = 0.024) after adjustment. MIS can be safely performed in well-selected patients with T4 colon cancer-specifically those with ASA I-II, screen-detected disease, right-sided tumors, elective surgery, tumors not adherent to adjacent structures, no need for extended resection, absence of tumor perforation, pT4a stage, and low-grade histology-reducing postoperative complications without compromising oncological outcomes.
In colorectal surgery, a higher body mass index (BMI) is associated with increased technical difficulty, reduced use of minimally invasive surgery (MIS), and higher rates of conversion to open. While these associations are well established, less is known about how they vary across systems and providers. The study presents a methodological framework that evaluates the impact of obesity on operative approach and conversion risk in colorectal surgery and compares these associations between a provincial Canadian cohort (Nova Scotia (NS)) and National-Surgical-Quality-Improvement-Program (NSQIP), accounting for procedure-, surgeon-, and hospital-level variations. A retrospective cohort analysis was performed using NS (n = 3373) and NSQIP (n = 243,221) data between 2018 and 2022. Adult patients undergoing elective colectomy or proctectomy were included. Operative approach (open vs. laparoscopic) and conversion to open were the primary and secondary outcomes, respectively, and were compared between cohorts across BMI categories. Multivariate logistic regression identified independent predictors of conversion, with further stratification by procedure, surgeon, and hospital. Data analysis was performed using RStudio. Laparoscopic utilization was lower in NS than NSQIP (36.4% vs. 49.3%, p < 0.0001), while conversion rates were higher (23.1% vs. 19.3%, p = 0.02). BMI was a significant independent predictor of conversion in both cohorts (NS 2.54, CI 1.23-5.50; NSQIP 1.61, CI 1.27-2.03), with a stronger effect in NS. A clear volume-outcome relationship emerged of surgeons with higher laparoscopic utilization had lower conversion rates, particularly in right hemicolectomies and anterior resections. Institutional factors were not independently associated with conversion. Obesity markedly increases the risk of conversion in minimally invasive colorectal surgery, with greater impact in NS compared to NSQIP. Surgeon-level variation, rather than hospital factors, primarily drives differences in conversion. This study presents foundational evidence for perioperative decision-making and offers an opportunity for incorporating remote proctoring by higher-volume laparoscopic providers.
Adult intestinal malrotation is rare, and data comparing minimally invasive surgery (MIS) to open Ladd's procedures in this population are limited. This study evaluates perioperative outcomes and MIS utilization in adults. A retrospective cohort study using the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) 2022-2023 datasets identified adults undergoing Ladd's procedure. The primary outcome was total hospital length of stay (tLOS); secondary outcomes included postoperative LOS (pLOS), 30-day morbidity, and mortality. Multivariable linear and logistic regression identified independent predictors of LOS and MIS utilization. Of 142 Ladd's procedures identified in adult patients (109 open, 33 MIS), MIS patients were younger (mean age 47.0 vs. 58.2 years, p = 0.005), more often female (78.8% vs. 53.2%, p = 0.014), and more likely undergoing elective surgery (51.6% vs. 24.8%, p = 0.005). Total LOS (3.12 vs. 7.89 days, p < 0.001) and pLOS (2.45 vs. 6.81 days, p < 0.001) were significantly shorter in the MIS cohort. 30-day morbidity and mortality were similar. Multivariable linear regression showed MIS approach (B = - 0.871, 95% CI - 1.137, - 0.604, p < 0.001), higher ASA class (B = 0.347, 95% CI 0.068, 0.627, p = 0.015), and days from admission to surgery (B = 0.180, 95% CI 0.119, 0.240, p < 0.001) independently predicted tLOS. These represent a 58.1% reduction in tLOS for MIS approach, 41.5% increase for higher ASA class, and 19.6% increase per day of surgical delay. MIS approach (B = - 0.893, p < 0.001) and higher ASA class (B = 0.395, p = 0.012) independently predicted pLOS, representing 59.1% reduction and 48% increase, respectively. Younger age (OR 0.97, p = 0.040) and elective surgery (OR 0.33, p = 0.024) independently predicted MIS utilization. MIS Ladd's procedures in adults were associated with significantly shorter hospital stays without an associated increase in 30-day morbidity or mortality. For those undergoing elective Ladds procedure for malrotation without volvulus, MIS Ladd's appears to be a viable surgical approach to consider.
This prospective randomized study compared the efficacy of articulated ArtiSential® instruments with that of conventional straight laparoscopic instruments in minimally invasive left-sided colorectal resections. The primary endpoint was conversion to open laparotomy. Secondary endpoints included intraoperative and postoperative complications, estimated blood loss, operating time, lymph node yield, and length of hospital stay. 78 patients (37 males) were randomized to conventional straight instruments (n = 40) or ArtiSential® instruments (n = 38). Categorical variables were analyzed using Chi-square or Fisher's exact tests; continuous variables were analyzed using the 2-sample t-test or Mann-Whitney U test, depending on distribution. Subgroup analysis was performed for rectal resections (n = 22; standard: n = 8, ArtiSential®: n = 14). In the overall cohort, no significant difference was observed in conversion to open surgery (7.5% vs. 0%; p = 0.241) or secondary endpoints: operating time (median 180.0 vs. 178.0 min; p = 1.000), estimated blood loss (25.0 vs. 20.0 mL; p = 0.096), intraoperative complications (7.5% vs. 2.6%; p = 0.616), postoperative complications (22.5% vs. 23.7%; p = 0.901), hospital stay (5.0 vs. 6.0 days; p = 0.695), and lymph node yield (17.0 vs. 14.0; p = 0.145). In the rectal resection subgroup, ArtiSential® instruments were associated with significantly lower conversion (37.5% vs. 0%; p = 0.036) and reduced blood loss (35.0 vs. 10.0 mL; p = 0.017), with no other significant differences observed. While no benefit was observed in the overall cohort, articulated ArtiSential® instruments may provide advantages in rectal resections, including lower conversion rates and reduced blood loss, suggesting particular utility in technically challenging minimally invasive procedures.
Appendectomy is a common emergency general surgery procedure and is now performed predominantly using minimally invasive techniques. While robotic platforms have diffused in elective general surgery, their role in appendectomy remains limited. Surgeon-level cost variation in emergency general surgery is not well defined. We performed a retrospective cohort study of adult patients undergoing appendectomy across a large integrated healthcare system from 2017 to 2025. Operative approach was categorized as open, laparoscopic, or robotic. The primary outcome was total direct procedural cost. Secondary outcomes included operating room (OR) time, postoperative length of stay (LOS), and 30-day reintervention. Hierarchical mixed-effects regression models with surgeons nested within hospitals were used to evaluate associations between operative approach, provider-level effects, cost, and outcomes. The cohort included 11,153 patients treated by 286 surgeons across 26 hospitals. Laparoscopic appendectomy accounted for 95.3% of cases, robotic for 2.4%, and open for 2.3%. Substantial procedural cost variation persisted after adjustment. Surgeon-level effects accounted for approximately 28% of residual cost variation, compared with 11% attributable to hospitals, with an interdecile range of adjusted surgeon-specific cost effects exceeding $400 per case. Robotic appendectomy was independently associated with higher procedural cost but remained infrequently utilized. Higher operative cost was associated with longer OR time and longer LOS, without improvement in short-term outcomes. Thirty-day reintervention was uncommon (0.84%) and was independently associated with operative approach and patient acuity, but not with higher spending or provider-level effects. In appendectomy, surgeon practice patterns are a dominant driver of procedural cost variation, while higher spending does not confer improvements in efficiency or short-term clinical outcomes. These findings demonstrate a disconnect between cost and value in emergency general surgery and identify surgeon-focused cost transparency and selective standardization as practical, actionable strategies to improve value without compromising patient safety.
Access to elective ventral hernia repair is often limited for patients with obesity due to presumed higher risks of recurrence and complications. We hypothesize that higher BMI alone does not increase the risk of recurrence, and that delayed access may lead to worse outcomes. A retrospective cohort of 11,979 index ventral hernia repairs performed by 200 surgeons across 30 facilities (2017-2025) within a single system. The primary endpoint was reoperation for recurrence; secondary patient-centered outcomes included urgent presentation, length of stay (LOS), and 30-day readmission. Mixed-effects multivariable survival models were used to estimate hazard ratios (HRs). Compared to BMI 20-25 kg/m2, BMI > 25 kg/m2 was associated with a higher reoperation hazard (HR 2.50, p < 0.001); however, incremental risk hazard attenuated beyond BMI 25 kg/m2. Median follow-up was 3.6 years, with 546 reoperations occurring (50% within 417 days). For index procedures, surgical approaches were 63% open, 19% laparoscopic, and 17% robotic, with conversion-to-open rates of 11.3% (laparoscopic) and 5.0% (robotic) (p < 0.001). Independent predictors of a higher reoperation hazard included emergency admission (HR 2.03, p = 0.04), elective inpatient procedures (HR 2.18, p < 0.001), inpatient procedures (HR 1.75, p = 0.03) versus outpatient procedures, and bowel resection (HR 1.80, p = 0.017). Protective factors included umbilical hernia (HR 0.63, p < 0.001) and mesh use (HR 0.70, p = 0.027). There was no difference in recurrence between robotic and laparoscopic approaches. BMI ≥ 35 kg/m2 predicted urgent presentation (OR 1.45 ± 0.11, p < 0.001) but was not associated with longer LOS or increased readmission. Beyond a BMI of 25 kg/m2, increasing BMI was not associated with progressively higher recurrence risk. Adverse outcomes in patients with obesity appear more strongly related to delayed access and unplanned presentation than to BMI alone.
The rapid growth of urbanisation and the increasing intensity of extreme rainfall events have heightened the risk of overloading stormwater drainage systems worldwide. This study presents new experimental insights into the hydraulic performance of bar grate sump inlets operating in unsubmerged orifice flow mode under extreme clogging conditions. Four grate configurations were tested, with clogging levels reducing the effective open area by 92.5-96.8%. A notable trend was observed across all configurations: orifice discharge coefficient (Co) increased with higher clogging ratios. This relationship was expressed through a two-parameter exponential function linking Co to the total open-area ratio. The findings highlight the importance of context-specific assessment of inlet performance, especially for non-standard or heavily clogged urban drainage structures. By extending the experimental range beyond typical clogging levels considered in previous studies, this research contributes to a better understanding of inlet hydraulics and provides a practical reference for improving the resilience of urban drainage systems facing extreme events.
Lung transplantation (LTx) is a life-saving intervention for end-stage lung disease, yet long-term outcomes remain inferior compared to other solid organ transplants. No evidence-based national or international guidelines for post-transplant follow-up care existed prior to this work. This guideline aims to provide treating physicians with structured, evidence-based recommendations for follow-up care after LTx in adult patients. The guideline was developed with a multidisciplinary guideline group according to the guidance of the Association of the Scientific Medical Societies in Germany manual for evidence- and consensus-based guidelines. A systematic literature search was conducted across MEDLINE, Cochrane, Epistemonikos, and CINAHL databases through September 2024, focusing on randomized controlled trials and systematic reviews. Evidence quality was assessed using the GRADE framework and the Oxford Centre for Evidence-Based Medicine (CEBM) 2011 criteria. Consensus was established through structured consensus conferences, with recommendation strength classified as strong ("We recommend"), conditional ("We suggest"), or open ("may or may not"). Twelve evidence-based recommendations were developed, spanning five clinical domains: immunosuppression, infections, chronic lung allograft dysfunction (CLAD), and bone health. Tacrolimus was recommended over ciclosporin as the preferred calcineurin inhibitor, based on moderate-quality evidence demonstrating a significantly lower incidence of CLAD across four randomized controlled trials. Trimethoprim-sulfamethoxazole prophylaxis against Pneumocystis jirovecii and extended valganciclovir prophylaxis for CMV-seropositive recipients were recommended. For CLAD, azithromycin was strongly recommended as a therapeutic trial to assess reversibility of graft dysfunction. Regarding bone health, daily calcium and vitamin D supplementation were strongly recommended for all recipients, with bisphosphonates, denosumab, or teriparatide indicated in those with osteopenia or manifest osteoporosis. This guideline provides the first structured, evidence-based framework for follow-up care after LTx in German-speaking countries. Tacrolimus-based triple immunosuppression, targeted infection prophylaxis, CLAD prevention, and systematic bone protection represent the cornerstones of post-transplant care. The guideline will remain valid until July 2030.
The olfactory bulb (OB) is one of the earliest brain regions affected in neurodegenerative diseases such as Parkinson's disease (PD). Its high metabolic rate, dopaminergic modulation, and connectivity with the cortical and limbic regions make it particularly vulnerable to early neuroinflammatory and oxidative processes. This study aimed to investigate whether the administration of 6-hydroxydopamine (6-OHDA) into the OB induces behavioral, redox, and inflammatory alterations associated with early cortical disturbances. Male Wistar rats were randomly assigned to the sham or 6-OHDA groups and underwent stereotaxic injection of the vehicle or 6-OHDA into the left OB. Behavioral performance was assessed in the open-field test 12 days after surgery, and cortical tissue was collected for biochemical and molecular analyses. Cytokines (IL-1β, IL-6, TNF-α, IL-10, IFN-γ, and MCP-1) were quantified by Luminex, redox parameters (CAT, GPx, MDA, and protein carbonyls) by spectrophotometry, and neuronal signaling proteins (c-FOS, CREB, and BDNF) by qPCR. Animals with 6-OHDA lesions exhibited decreased latency and increased time spent in the central zone of the open field, indicating altered exploratory behavior. IL-6 levels were significantly elevated, whereas IFN-γ was reduced in the cortex, while IL-1β, TNF-α, MCP-1, and IL-10 remained unchanged. The oxidative stress markers MDA and protein carbonyls were increased, while catalase and glutathione peroxidase activities showed no change. The expression of c-FOS, CREB, and BDNF was not significantly modified. These findings indicate that localized 6-OHDA administration in the OB is sufficient to elicit behavioral, inflammatory, and oxidative alterations in connected cortical regions, which may resemble early non-motor features associated with olfactory dysfunction, without representing a neurodegenerative disease-specific process.
Operative management is the definitive treatment for congenital duodenal obstruction (CDO). Currently, there is a paucity of large-scale comparative studies on laparoscopic procedure (LP) versus open procedure (OP). This study aims to present a 10-year, single-center experience in the management of CDO in neonates from a National Children's Hospital in China. A single-center, retrospective cohort study with a comparative design was conducted. Neonates who underwent surgical intervention for CDO between January 2016 and July 2025 were included. To adequately adjust for baseline imbalances in gestational age and birth weight, a 1:1 propensity score matching (PSM) analysis was utilized. Differences between LP and OP in operative time, postoperative recovery, nutritional management, complication rates, and total costs were primarily compared. A total of 152 patients were enrolled and stratified into LP (n = 73) and OP (n = 79) groups. Baseline characteristics were similar except for significantly lower birth and admission weights in the OP group. After 1:1 PSM (yielding 60 pairs), operative time remained significantly longer in the LP group (median 110 min, 95% CI 105-120 vs. 75 min, 95% CI 69-80; P < 0.001). Crucially, the matched LP cohort maintained significant advantages in accelerating gastrointestinal recovery and shortening postoperative parenteral nutrition (PN) duration. However, the difference in postoperative length of stay (LOS) was no longer statistically significant. Total costs showed no significant difference between the matched groups (median 25,121 RMB, 95% CI 23647-29,577 vs. 24,178 RMB, 95% CI 22385-26,268; P = 0.071). The overall postoperative complication rate was 5.92% with no significant intergroup difference. This large-scale cohort study demonstrates that LP yields comparable overall outcomes to OP, with distinct early recovery benefits characterized by accelerated gastrointestinal recovery and a shorter PN duration. These results were achieved alongside a comparable postoperative LOS, without significantly increasing total costs or postoperative complication rates.
Major laparoscopic hepatectomy along the major hepatic veins requires accurate orientation to the transection plane and safe management of the hepatic venous branches. We developed an extracorporeal ventral traction (EVT) method combined with a 3-step dorsal approach (3SDA) to standardize laparoscopic hemihepatectomy. In EVT, a traction suture secured on the caudal edge of the transection line is brought out through the epigastrium and pulled extracorporeally, elevating the liver parenchyma ventrally and allowing dorsal access under the caudal laparoscopic view. In 3SDA, the transection plane containing the major hepatic vein is divided into three areas: Area A, caudal to the hilum; Area B, dorsal to the hepatic vein; and Area C, ventral to the hepatic vein. These areas are approached sequentially to open the caudal view, maintain anatomical landmarks, and reduce venous injury. EVT and 3SDA provide a reproducible framework for laparoscopic hemihepatectomy.