Easy Cases Research Articles

FREQUENCY OF EASY AND DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY FOR CHOLELITHIASIS

The prevalence of gallstone disease is influenced by factors such as age, gender, and marital status. Ultrasonography is important for screening. Laparoscopic cholecystectomy (LC) is the standard treatment for symptomatic cholelithiasis, but some cases may require conversion to open surgery (OC). Preoperative ultrasound assessments, particularly the common bile duct (CBD) diameter, may help predict the difficulty of LC and prepare for potential complications. Objective: The objectives of this study are to assess the frequency of easy and difficult laparoscopic cholecystectomy in patients with cholelithiasis and to compare the mean diameter of the common bile duct between cases of easy and difficult laparoscopic cholecystectomy. Methods: This sctional study was conducted from February 10, 2023, to August 10, 2023, and included 170 patients (ages 18-60 years) undergoing laparoscopic cholecystectomy for cholelithiasis. Both genders were included. Variables such as age, gender, diabetes, hypertension, and cholecystectomy status were recorded. The mean and standard deviation (SD) were calculated for age and CBD diameter. An independent t-test was used to compare CBD diameters between easy and difficult LC cases. Chi-square tests were applied to control for effect modifiers. Results: The mean age of the patients was 52.32 ± 4.89 years. Other patient characteristics included an average height of 162.90 ± 9.25 cm, weight of 75.95 ± 12.32 kg, and BMI of 27.47 ± 4.72. The common bile duct diameter was 4.55 ± 1.42 mm. Gender distribution showed 54.7% male and 45.3% female patients. Of the 170 patients, 84 (49.4%) were classified as easy LC cases, while 86 (50.6%) were classified as difficult. The mean CBD diameter was significantly different between the two groups, measuring 3.54 ± 1.03 mm in easy cases and 5.52 ± 1.02 mm in difficult cases (p = 0.001). Conclusion: This study highlights the importance of preoperative assessment of common bile duct diameter in predicting the difficulty of laparoscopic cholecystectomy. Patients with a larger CBD diameter are more likely to experience a difficult LC, emphasizing the need for personalized surgical planning. These findings underscore the value of preoperative ultrasonography in optimizing patient outcomes and reducing the risk of conversion to open surgery.

Road marking defect detection based on CFG_SI_YOLO network

Existing road marking detection primarily focuses on the direction, position, and color of road markings. However, clear and accurate road markings directly impact issues such as directional guidance, lane selection, speed limits, and parking positions. Therefore, we introduce the CFG_SI_YOLO model for road marking defect detection. This model introduces a multi-channel CoordConv module, which enhances the network's focus on fine details based on the distribution characteristics of road markings defect. This helps prevent the loss of road marking information caused by model compression and pooling operations; Moreover, the model introduces the Focal-EIoU loss function to address the issue of imbalanced samples between easy and difficult cases. Additionally, the GELU activation function is incorporated to prevent gradient explosions, enhance the network's non-linear expressiveness, and improve the detection accuracy of the model. Finally, we add a similarity attention module to enhance the network's focus on the target, reduce interference from other objects, and mitigate false detection defects caused by inter-class similarity. Experiments conducted on a self-made dataset containing various types of road markings have shown that our approach achieved Precision, Recall, F1, IoU, and mAP of 85.7%, 85.8%, 85.7%, 75.1% and 82.8%, respectively. These results are significantly better than other methods, confirming the effectiveness and feasibility of our approach. Our code and results can be found on https://github.com/ly6660/Road_marking_line_code_data.

Comparison of Modified Mallampati Classification in Supine and Sitting Positions to Predict Difficult Tracheal Intubation in Diabetic Patients.

Airway management of patients with long-standing diabetes poses a major challenge for anaesthesiologists due to stiff joint syndrome affecting the atlanto-occipital joint. In certain cases requiring immobilization, the Mallampati test must often be performed in the supine position for obvious reasons. Hence, we determined the diagnostic precision (sensitivity and specificity) of the modified Mallampati test in sitting and supine positions among the diabetic population in predicting difficult tracheal intubation. A single-center prospective observational study on adult diabetic patients undergoing general anesthesia and orotracheal intubation was carried out. An observer recorded the modified Mallampati in the sitting posture during the pre-anesthetic examination. The Mallampati in the supine position was determined while in the operating room, and the difficulty of intubation was noted, and diagnostic precision was calculated. The main objective was to predict a difficult airway by calculating the sensitivity, specificity, positive predictive value, and negative predictive value. Out of the 150 participants, Mallampati grading in a sitting position was correctly able to identify 42.5% of difficult intubation cases, whereas it was 97.5% with Mallampati in the supine position. Mallampati grading in the sitting position was able to correctly identify 89.1% of easy intubation cases, which was 63.6% with Mallampati in the supine position. The correlation of Mallampati in the supine position with CL grading was statistically significant (P < 0.001). Among diabetic patients, the modified Mallampati test in the supine position can be considered a more accurate and sensitive predictor of difficult intubation than the sitting posture.

A Unified Approach for Resilience and Causal Responsibility with Integer Linear Programming (ILP) and LP Relaxations

What is a minimal set of tuples to delete from a database in order to eliminate all query answers? This problem is called "the resilience of a query" and is one of the key algorithmic problems underlying various forms of reverse data management, such as view maintenance, deletion propagation and causal responsibility. A long-open question is determining the conjunctive queries (CQs) for which resilience can be solved in PTIME. We shed new light on this problem by proposing a unified Integer Linear Programming (ILP) formulation. It is unified in that it can solve both previously studied restrictions (e.g., self-join-free CQs under set semantics that allow a PTIME solution) and new cases (all CQs under set or bag semantics). It is also unified in that all queries and all database instances are treated with the same approach, yet the algorithm is guaranteed to terminate in PTIME for all known PTIME cases. In particular, we prove that for all known easy cases, the optimal solution to our ILP is identical to a simpler Linear Programming (LP) relaxation, which implies that standard ILP solvers return the optimal solution to the original ILP in PTIME. Our approach allows us to explore new variants and obtain new complexity results. 1) It works under bag semantics, for which we give the first dichotomy results in the problem space. 2) We extend our approach to the related problem of causal responsibility and give a more fine-grained analysis of its complexity. 3) We recover easy instances for generally hard queries, including instances with read-once provenance and instances that become easy because of Functional Dependencies in the data. 4) We solve an open conjecture about a unified hardness criterion from PODS 2020 and prove the hardness of several queries of previously unknown complexity. 5) Experiments confirm that our findings accurately predict the asymptotic running times, and that our universal ILP is at times even quicker than a previously proposed dedicated flow algorithm.

Detection of Authentication of Meat Products by Low Cost Closed-tube Molecular Methods

Nowadays adulteration of meat products, especially of ground meat products which form an easy case scenario for implementing adulteration practices due to their structure and texture, emerges a critical issue of raised concern threatening fair trade, food quality and consumers&amp;rsquo; health and protection. Food authentication testing is the tool to address this kind of fraud. There is several analytical methodologies applied for meat authentication targeting at different biomarkers and using a variety of analytical techniques. However, the applied methodologies should exhibit suitable performance characteristics such as reliability, sensitivity, reproducibility and availability in order to be fit for purpose. During the last 20 years, amplification tests have emerged as an important diagnostic tool, not only for clinical applications, but also for food quality and safety. It was urgent to develop molecular techniques fast and sensitive. The introduction of new DNA technologies has facilitated the ease and accuracy of of methods for fraud detection. The closed-tube methods of Loop-mediated isothermal amplification (LAMP) and Gold Nanoparticles linked with oligonucleotides used as molecular probes are well known for their robust and highly sensitive and specific amplification of target DNA. Moreover, these techniques are rapid, low-cost diagnostics and available on site. This review provides a comprehensive overview of the molecular methods developed that can be applied for investigating ground meat adul-teration and focuses on the advantages of the rapid closed tube methods that can yield color results interpreted with the naked eye. The application of such time- and cost-effective molecular tools in the food market is proposed to provide a first-level filter for meat adulterated products, serving as a complementary tool to the more in-depth -omics approach.

ChatGPT performance in laryngology and head and neck surgery: a clinical case-series.

To study the performance of ChatGPT in the management of laryngology and head and neck (LHN) cases. History and clinical examination of patients consulting at the Otolaryngology-Head and Neck Surgery department were presented to ChatGPT, which was interrogated for differential diagnosis, management, and treatment. The ChatGPT performance was assessed by two blinded board-certified otolaryngologists using the following items of a composite score and the Ottawa Clinic Assessment Tool: differential diagnosis; additional examination; and treatment options. The complexity of clinical cases was evaluated with the Amsterdam Clinical Challenge Scale test. Forty clinical cases were submitted to ChatGPT, accounting for 14 (35%), 12 (30%), and 14 (35%) easy, moderate and difficult cases, respectively. ChatGPT indicated a significant higher number of additional examinations compared to practitioners (p = 0.001). There was a significant agreement between practitioners and ChatGPT for the indication of some common examinations (audiometry, ultrasonography, biopsy, gastrointestinal endoscopy or videofluoroscopy). ChatGPT never indicated some important additional examinations (PET-CT, voice quality assessment, or impedance-pH monitoring). ChatGPT reported highest performance in the proposition of the primary (90%) or the most plausible differential diagnoses (65%), and the therapeutic options (60-68%). The ChatGPT performance in the indication of additional examinations was lowest. ChatGPT is a promising adjunctive tool in LHN practice, providing extensive documentation about disease-related additional examinations, differential diagnoses, and treatments. The ChatGPT is more efficient in diagnosis and treatment, rather than in the selection of the most adequate additional examination.

Design an IoT Based Pratima Monitoring System

Pratima is usually kept in temples or kept in sacred rooms. Lack of care and supervision causes easy cases of theft and damage due to fire. An Internet of Things-based pratima monitoring system is needed to avoid some of the threats that occur. Devices that are made connected to the internet for monitoring, and controlling monitoring devices so that Pratima remains safe. The Internet of Things-based pratima monitoring system is expected to be an early prevention system for acts of theft and damage due to fire. The results obtained are all the features successfully run. The measurement values of the ultrasonic sensor are 11CM and 16CM, while the ruler measurements are 10.5CM and 16CM. The temperature on the DHT22 is 70.50°C, and the flame sensor value is 123. The microwave sensor detects movement, and the image capture is stored on firebase and SD Card.

Malocclusion Complexity in Patients with Disc Displacement Disorders: A Case-Control Study.

This study aimed to determine the possible association between disc displacement (DD) disorders and malocclusion complexity. This cross-sectional study was carried out using a case-control design. The Research Diagnosis Criteria for Temporomandibular Disorders were used to identify cases and controls. The Index of Complexity, Outcome, and Need (ICON) was used to quantify malocclusion complexity as easy, mild, moderate, difficult, or very difficult. A total of 310 subjects were included: 130 cases and 180 controls. A binary logistic regression (p < 0.05) was used to identify associations. The odds ratio (OR) was also calculated. DD was associated with sex, age, and malocclusion complexity (p < 0.05). The malocclusion complexity comparison showed that 89.3% of the controls fell within the easy-moderate levels of the ICON, whereas 85.4% of the cases were in the moderate-very difficult levels (p ≤ 0.001). Difficult and very difficult malocclusions had high ORs (9.801 and 9.689, respectively) compared to the easy cases. In conclusion, patients with malocclusion complexity levels classified as difficult or very difficult have greater odds of presenting DD.

To be (disadvantaged) or not to be? An egalitarian guide for creating new people

Derek Parfit held that in evaluating the future, we should ignore the difference between necessary persons and merely possible persons. In this article, I look at one of the most prominent alternatives to Parfit's view, namely Michael Otsuka and Larry Temkin ‘shortfall complaints’ view. In that view, we aggregate future persons’ well-being and deduct intrapersonal shortfall complaints, giving extra weight to the complaints of necessary persons. I offer here a third view. I reject Parfit's no difference view in that I register a difference between necessary and possible persons. But I also reject the Shortfall View and replace its intra-personal complaints with an inter-personal complaints mechanism. I argue that the value of a population is its aggregate prioritarian value minus the egalitarian complaints that necessary persons hold. I show that the egalitarian view has all the explanatory power of the Shortfall view in easy cases, while significantly improving on it in three sorts of tough cases.

ComparePD: Improving protein-DNA complex model comparison with hydrogen bond energy-based metrics.

Computational modeling of protein-DNA complex structures has important implications in biomedical applications such as structure-based, computer aided drug design. A key step in developing methods for accurate modeling of protein-DNA complexes is similarity assessment between models and their reference complex structures. Existing methods primarily rely on distance-based metrics and generally do not consider important functional features of the complexes, such as interface hydrogen bonds that are critical to specific protein-DNA interactions. Here, we present a new scoring function, ComparePD, which takes interface hydrogen bond energy and strength into account besides the distance-based metrics for accurate similarity measure of protein-DNA complexes. ComparePD was tested on two datasets of computational models of protein-DNA complexes generated using docking (classified as easy, intermediate, and difficult cases) and homology modeling methods. The results were compared with PDDockQ, a modified version of DockQ tailored for protein-DNA complexes, as well as the metrics employed by the community-wide experiment CAPRI (Critical Assessment of PRedicted Interactions). We demonstrated that ComparePD provides an improved similarity measure over PDDockQ and the CAPRI classification method by considering both conformational similarity and functional importance of the complex interface. ComparePD identified more meaningful models as compared to PDDockQ for all the cases having different top models between ComparePD and PDDockQ except for one intermediate docking case.

Deformations and moduli of irregular canonical covers with K2=4pg-8\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$K^2=4p_g-8$$\\end{document}

In this article, we study the moduli of irregular surfaces of general type with at worst canonical singularities satisfying K2=4pg-8\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$K^2 = 4p_g-8$$\\end{document}, for any even integer pg≥4\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$p_g\\ge 4$$\\end{document}. These surfaces also have unbounded irregularity q. We carry out our study by investigating the deformations of the canonical morphism φ:X→PN\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varphi :X\\rightarrow {\\mathbb {P}}^N$$\\end{document}, where φ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varphi $$\\end{document} is a quadruple Galois cover of a smooth surface of minimal degree. These canonical covers are classified in Gallego and Purnaprajna (Trans Am Math Soc 360(10):5489-5507, 2008) into four distinct families, one of which is the easy case of a product of curves. The main objective of this article is to study the deformations of the other three, non trivial, unbounded families. We show that any deformation of φ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varphi $$\\end{document} factors through a double cover of a ruled surface and, hence, is never birational. More interestingly, we prove that, with two exceptions, a general deformation of φ\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\varphi $$\\end{document} is two-to-one onto its image, whose normalization is a ruled surface of appropriate irregularity. We also show that, with the exception of one family, the deformations of X are unobstructed even though H2(TX)\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$H^2(T_X)$$\\end{document} does not vanish. Consequently, X belongs to a unique irreducible component of the Gieseker moduli space. These irreducible components are uniruled. As a result of all this, we show the existence of infinitely many moduli spaces, satisfying the strict Beauville inequality pg>2q-4\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$p_g > 2q-4$$\\end{document}, with an irreducible component that has a proper "quadruple" sublocus where the degree of the canonical morphism jumps up. These components are above the Castelnuovo line, but nonetheless parametrize surfaces with non birational canonical morphisms. The existence of jumping subloci is a contrast with the moduli of surfaces with K2=2pg-4\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$K^2 = 2p_g- 4$$\\end{document}, studied by Horikawa. Irreducible moduli components with a jumping sublocus also present a similarity and a difference to the moduli of curves of genus g≥3\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$g\\ge 3$$\\end{document}, for, like in the case of curves, the degree of the canonical morphism goes down outside a closed sublocus but, unlike in the case of curves, it is never birational. Finally, our study shows that there are infinitely many moduli spaces with an irreducible component whose general elements have non birational canonical morphism and another irreducible component whose general elements have birational canonical map.

Intraoperative Scoring System to Assess the Difficult Laparoscopic Cholecystectomy: A Prospective Study From a Tertiary Care Centre.

Background In comparison to a traditional cholecystectomy (open), the laparoscopic cholecystectomy approach provides a number of benefits and has been demonstrated in some studies to have a greater complication rate. The conversion rate from laparoscopic to open surgery ranged between 2% and 15%. A preoperative scoring or grading system (based on age, sex, history, clinical examination, laboratory, and sonographic results)was developed byNassar et al., to anticipate the challenge of laparoscopic cholecystectomy. So, we conducted this study to assess the degree of difficulty in faced during laparoscopic cholecystectomy using an intraoperative scoring system and validate the same using the preoperative scoring system. Methods We conducted this study in the department of General Surgery among 105 patients who underwent laparoscopic cholecystectomy during the defined study period of one year. We performed the preoperative workup for all patients. A preoperative scoring or grading system developed by Nassar et al., in 2020was used. In our study, laparoscopic cholecystectomy was performed by surgeons having a minimum of eight years of hands-on experience in laparoscopic surgeries. An intraoperative scoring or grading system for the degree of difficulty during laparoscopic cholecystectomy, developed by Sugrue et al., in 2015 was used. The Chi-square test was applied to assess the association between preoperative variables and the intraoperative score grading. We have also performed the receiver operating characteristic (ROC) curve analysis to validate the preoperative score in predicting the intraoperative findings. All tests were considered statically significant if the p-value was < 0.05. Results In our study, a total of 105 patients were included in the study and the mean age of patients was 57.6±16.4 years. The male patients were 58.1% and the remaining 41.9% were females. The primary diagnosis was cholecystitis among 44.8% of patients and 2.9% of patients were diagnosed with pancreatitis. Among enrolled patients, laparoscopic cholecystectomy was done on an emergency basis among 2.9% of subjects. During the laparoscopic cholecystectomy, among 21.0% and 30.5% of patients, there was a severe and extreme degree of difficulty respectively. In our study, the conversion rate from laparoscopic to open cholecystectomy was 8.6%. In our study, we found that at a preoperative score of 6, the sensitivity and specificity for predicting easy cases were 88.2% and 73.8%, respectively, and had an accuracy of 88.6% for easy cases and 68.5% for difficult cases. Conclusion When grading the difficulties of doing a laparoscopic cholecystectomy and determining the severity of cholecystitis, this intraoperative scoring system is effective and accurate. Additionally, it signifies the need for conversion from laparoscopic to open cholecystectomyin cases of severe cholecystitis.

High-Level Spinal Cord Injury and the Failure of US Acute Rehabilitation: An Analysis and Commentary.

Acute and long-term morbidity and mortality rates have not changed in the United States for people with high-level spinal cord injury in 40 yrs, neither has the conventional invasive respiratory management for these patients. This is despite a 2006 challenge to institutions for a paradigm shift to avoid or decannulate patients of tracheostomy tubes. Centers in Portugal, Japan, Mexico, and South Korea decannulate high-level patients to up to continuous noninvasive ventilatory support and use mechanical insufflation exsufflation, as we have done and reported since 1990, but there has been no such paradigm shift in US rehabilitation institutions. The quality of life and financial consequences of this are discussed. An example of decannulation of a relatively easy case, after failure to do so during 3 mos of acute rehabilitation, is presented to encourage institutions to begin to learn and apply noninvasive management before decannulating more severe patients with little to no ventilator free breathing ability.

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Making Law Possible

Predictors of the difficulty of transcervical subcarinal lymph node dissection for esophageal cancer

BackgroundTransmediastinal radical esophagectomy (TME) is a new minimally invasive approach without thoracotomy. However, the transcervical dissection of subcarinal lymph nodes (SCLN) is challenging. The shape or narrowness of the mediastinal space, particularly around the aortic arch to the tracheal bifurcation, may increase the difficulty of this procedure. The present study aimed to clarify predictors of the difficulty of transcervical SCLN dissection.MethodsPatients who underwent TME between 2016 and 2019 were included (n = 126). Four indicators, the cervical angle, carina distance, aorta distance, and sternum distance, were defined as indicators of mediastinal narrowness by 3D-CT. The relationships between the difficulty of transcervical SCLN dissection and clinicopathological features, including the above indicators, were investigated.ResultsIn a univariate analysis, the cervical angle (p = 0.023), aorta distance (p = 0.002), and middle thoracic tumor (p = 0.040) correlated with difficulty. The median cervical angle and aorta distance were 15° and 33 mm in difficult cases and 19° and 43 mm in easy cases, respectively. In a multivariate analysis, the short aorta distance (odds ratio: 7.96, p = 0.002) and middle thoracic tumor (odds ratio: 3.35, p = 0.042) were independent predictive factors.ConclusionsThe cervical angle, aorta distance, and middle thoracic tumor may predict the difficulty of transcervical SCLN dissection. In difficult cases, a transhiatal approach should be combined for complete SCLN dissection.

Evaluation of Preoperative Scoring System for Predicting Difficult Laparoscopic Cholecystectomy.

Laparoscopic cholecystectomy (LC) is established as the gold standard for benign gallbladder disease. This study was done for the evaluation of preoperative scoring system given by Randhawa and Pujahari considering various preoperative parameters to predict difficulty in LC. Preoperative prediction of difficult LC using a scoring system considering various preoperative factors in elective/interval LC to predict difficult gallbladder. A prospective study of 120 patients admitted for LC from January 2020 to June 2021 was analyzed. All the patients were evaluated on the basis of Randhawa and Pujahari scoring system with the following variables: age >50 years, male sex, body mass index 25.1-27.5 and >27.5 kg/m2, previous abdominal surgery, prior hospitalization for gallstone disease, palpable gallbladder, gallbladder wall thickening, impacted stone, and pericholecystic collection. Each variable had given a score. Based on these findings, the surgical procedure was defined as easy, difficult, and very difficult. One hundred and twenty cases satisfying the inclusion criteria were studied comparing different variables and assigned preoperative scoring. A score >5 was considered significant and compared with intraoperative findings. Out of 53 patients having preoperative scores >5, 40 were difficult gallbladders and 13 were easy to operate. Prediction came true in 93.0% of difficult cases and 83.1% of easy cases. From this study, we can conclude that the preoperative scoring system is statistically reliable to predict difficulty in LC in the majority of the cases (area under receiver operator characteristics = 0.935).

Enabling 3-D Object Detection With a Low-Resolution LiDAR

Light detection and ranging (LiDAR) has been widely used in autonomous vehicles for perception and localization. However, the cost of a high-resolution LiDAR is still prohibitively expensive, while its low-resolution counterpart is much more affordable. Therefore, using low-resolution LiDAR for autonomous driving is an economically viable solution, but the point cloud sparsity makes it extremely challenging. In this letter, we propose a two-stage neural network framework that enables 3-D object detection using a low-resolution LiDAR. Taking input from a low-resolution LiDAR point cloud and a monocular camera image, a depth completion network is employed to produce dense point cloud that is subsequently processed by a voxel-based network for 3-D object detection. Evaluated with KITTI dataset for 3-D object detection in bird-eye view (BEV), the experimental result shows that the proposed approach performs significantly better than directly applying the 16-line LiDAR point cloud for object detection. For both easy and moderate cases, our 3-D vehicle detection results are close to those using 64-line high-resolution LiDARs.

Macrocycle-based supramolecular assembly: An alternative strategy for visualizing the mechanism of piezochromic luminescence

Though clarifying the relationship between packing and emission is very important and highly desirable for understanding the mechanism behind responsive luminescent materials, it is not an easy case for piezochromic luminescent materials, due to the difficulties of in situ tracking the interactions change during pressurization. Herein, a smart supramolecular assembly strategy based on two macrocyclic hosts with tailored guests’ packing has been proposed for illustrating the mechanism of piezochromic luminescence. The elusive changes of molecular packing associated with variable luminescence behavior under mechanical forces, such as grinding and high pressure, can be expressed intuitively by cryptand (CP) or cucurbit [7]urils (CB [7])-based host-guest complex in a visualized way. Specifically, the enhanced π-π stacking interactions induced by CP corresponds well to the dim and red-shifted emission under isotropic compression, while the isolated chromophore in non-aromatic CB [7] with reduced intermolecular π-π interactions perfectly explains the brightened and blue-shifted emission after grinding. This controllable self-assembly strategy provides a reliable and smart strategy for visualizing the mechanism of piezochromic luminescence.

Comparison of efficiency and safety between dual-clip and rubber band-assisted ESD and conventional ESD for colonic lateral spreading tumors (LSTs) with different levels of technical difficulty: a retrospective case–control study

BackgroundDual-clip and rubber band-assisted endoscopic submucosal dissection (DCRB-ESD) is a useful technique in the management of lateral spreading tumors (LSTs) of the colon and is suggested by researchers compared with conventional ESD (C-ESD). The aim of this retrospective study is to further analyze the efficiency and safety of DCRB-ESD in a setting with varying technical difficulties.MethodsPatients who underwent endoscopic treatment (DCRB-ESD or C-ESD) due to LSTs between Jan 1st, 2019 and Jan 1st, 2022, were retrospectively collected. Patients were classified into the following two groups: the DCRB-ESD group (n = 46) and the C-ESD group (n = 81). Baselines were compared and propensity score matching (PSM) was employed to manage the heterogeneity. The technical difficulty and outcomes of the two groups were evaluated based on a semiquantitative model (CS-CRESD) previously described.ResultsThe baseline characteristics of the two groups were balanced except sex and LST classification before PSM and were corrected after PSM. The median ESD operation time of DCRB-ESD was shorter than that of C-ESD (32 vs 41 and 30 vs 44 before and after PSM respectively, P < 0.05). The operation durations of cases with different CS-CRESD scores were different (P < 0.05). In the subgroup with a score of 0, DCRB-ESD showed no advantage than C-ESD in terms of operation duration before and after PSM. In subgroups with a score of 1–3, DCRB-ESD was faster than C-ESD. In subgroups with a score of 4–5, the between-group operation duration was not significantly different due to the limited number of cases, although the median time of DCRB-ESD was shorter. The R0 resection rates, curative resection, complications, and additional surgery in both groups were not significantly different. No adverse events, such as a clip falling off or rubber band rupturing occurred during this study.ConclusionDCRB-ESD was an efficient and safe procedure in the management of colonic LSTs. With DCRB-ESD, the operation duration of difficult cases can be shortened without sacrificing complication risk. However, not all cases would benefit from DCRB-ESD. For easy cases (CS-CRESD score = 0), DCRB-ESD may not be prior to C-ESD by experienced endoscopists. A pre-ESD technical difficulty evaluation was recommended to decide whether to perform DCRB-ESD or not.

Efficacy of transperineal minimally invasive surgery with laparoscopic abdominoperineal excision for lower rectal cancer.

In abdominoperineal excision (APE), the advantages of the "down-to-up" approach are expected to be more obvious when performed as a two-team approach, including transperineal minimally invasive surgery (TpMIS). We investigated the efficacy of TpMIS with laparoscopic APE for lower rectal cancer. Patients who underwent laparoscopic APE with (n = 20) or without (n = 30) TpMIS between December 2013 and April 2020 were retrospectively reviewed. Patient and tumor characteristics, intraoperative outcome, short-term outcome, and pathological findings were compared. Additional subgroup analyses were performed in technically challenging cases, including male patients, obese patients, and patients with tumors located at the anterior wall. There was no marked difference in the patient or tumor characteristics or short-term outcomes, including morbidity and mortality between the two groups. Pathological results were comparable, and the circumferential resection margin (CRM) positive rate was 10% in both groups. TpMIS achieved a significant reduction in operative time (p = 0.02). In a subgroup analysis, the amount of blood loss was also smaller in males (p = 0.02) and patients with a high BMI (> 25) (p = 0.005) than in others. Simultaneously performing TpMIS and laparoscopic APE is feasible owing to the favorable complication and CRM-positive rates. In terms of operative time and blood loss, TpMIS is expected to be advantageous in both easy and challenging cases.