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Background Opportunities for surgical skills practice using high-fidelity simulation in the workplace are limited due to cost, time and geographical constraints, and accessibility to junior trainees. An alternative is needed to practise laparoscopic skills at home. Our objective was to undertake a systematic review of low-cost laparoscopic simulators. Method A systematic review was undertaken according to PRISMA guidelines. MEDLINE/EMBASE was searched for articles between 1990 and 2014. We included articles describing portable and low-cost laparoscopic simulators that were ready-made or suitable for assembly; articles not in English, with inadequate descriptions of the simulator, and costs >£1500 were excluded. Validation, equipment needed, cost, and ease of assembly were examined. Results Seventy-three unique simulators were identified (60 non-commercial, 13 commercial); 55 % (33) of non-commercial trainers were subject to at least one type of validation compared with 92 % (12) of commercial trainers. Commercial simulators had better face validation compared with non-commercial. The cost ranged from £3 to £216 for non-commercial and £60 to £1007 for commercial simulators. Key components of simulator construction were identified as abdominal cavity and wall, port site, light source, visualisation, and camera monitor. Laptop computers were prerequisite where direct vision was not used. Non-commercial models commonly utilised retail off-the-shelf components, which allowed reduction in costs and greater ease of construction. Conclusion The models described provide simple and affordable options for self-assembly, although a significant proportion have not been subject to any validation. Portable simulators may be the most equitable solution to allow regular basic skills practice (e.g. suturing, knot-tying) for junior surgical trainees.

ObjectivesParkinson’s disease (PD) has become a public health concern with global ageing. With a focus on PD, this study sought to project its burden and trends at the national, regional and worldwide levels between 1990 and 2021.Study designPopulation-based study.MethodsThe Global Burden of Disease (GBD) 2021 provided the PD burden data. The GBD data are considered globally and regionally representative, as it integrates multiple data sources and employs standardised estimation methods. The age-standardised rate (ASR) and estimated annual percentage change (EAPC) were used to estimate trends in the incidence, prevalence, mortality and disability-adjusted life years (DALYs) of PD from 1990 to 2021. ASR was used to calculate the EAPCs using a linear regression model. A Bayesian age-period-cohort model was used to predict future trends up to 2046.ResultsGlobally, the overall ASR of PD incidence, prevalence, DALYs and mortality increased from 1990 to 2021. The EAPCs were 1.09 (95% CI: 1.07 to 1.11) for incidence, 1.52 (95% CI: 1.49 to 1.54) for prevalence, 0.32 (95% CI: 0.28 to 0.36) for DALYs and 0.18 (95% CI: 0.13 to 0.23) for mortality. The incidence, prevalence, mortality and DALYs of PD in 2021 were higher in men than in women. The age-standardized incidence rate (ASIR) was 18.52 per 100 000 in men and 12.92 per 100 000 in women (EAPC: 1.11, 95% CI: 1.09 to 1.13 vs 1.07, 95% CI: 1.05 to 1.09). The age-standardized prevalence rate (ASPR) was 157.42 per 100 000 in men and 121.84 per 100 000 in women (EAPC: 1.70, 95% CI: 1.67 to 1.73 vs 1.25, 95% CI: 1.22 to 1.27). The ASMR was 6.57 per 100 000 in men and 3.59 per 100 000 in women (EAPC: 0.21, 95% CI: 0.14 to 0.28 vs −0.01, 95% CI: −0.04 to 0.03). The ASDR was 97.12 per 100 000 in men and 81.23 per 100 000 in women (EAPC: 0.37, 95% CI: 0.33 to 0.42 vs 0.14, 95% CI: 0.10 to 0.18). From 1990 to 2021, the burden of PD remained consistently higher in men than in women, with the gender difference widening with age. The prevalence, incidence, DALYs and mortality rates of PD increased with age before declining, peaking in the 80–84 age group for prevalence and incidence, while peaking in the 90–94 age group for mortality. DALY rates peaked in the 85–89 age group. The ASR of incidence and prevalence increased significantly in Norway (EAPC=3.39, 95% CI: 3.15 to 3.64; EAPC=5.04, 95% CI: 4.65 to 5.43). Lesotho was the nation with the highest rise in age-standardised DALYs for PD (EAPC=1.67, 95% CI: 1.41 to 1.93). The United Arab Emirates had the fastest increase in age-standardised mortality for PD (EAPC=1.98, 95% CI: 1.24 to 2.71). The global ASPR of PD is projected to show a continuous upward trend.ConclusionsFrom 1990 to 2021, there were rising trends in the prevalence and burden of PD in most areas and nations worldwide. Our research indicates that the management and control of PD need significant improvement, particularly in light of the ageing population.

This book is the first edited volume to compile up-to-date scholarship that discusses frontier knowledge on second language (L2) collaborative writing (CW) and highlights technology-mediated solutions to CW.

Despite the well-established association between the apolipoprotein B/apolipoprotein A1 (apoB/apoA1) ratio and ischemic stroke, its specific relationship with the underlying vascular pathologies contributing to stroke remains poorly understood. This study aims to investigate the association between the apoB/apoA1 ratio and intracranial or extracranial atherosclerosis. We enrolled 408 patients with acute ischemic stroke who had never been treated with statins or fibrates. Based on the images from computed tomography angiography (CTA), the patients were categorized into four groups: intracranial atherosclerosis stenosis (ICAS, n  = 136), extracranial carotid atherosclerosis stenosis (ECAS, n  = 45), combined intracranial and extracranial atherosclerosis stenosis (COAS, n  = 73), and non-cerebral atherosclerosis stenosis (NCAS, n  = 154). Demographic characteristics, clinical factors, and serum lipid levels were collected and then compared across groups. The apoB/apoA1 ratio was significantly higher in patients with ICAS, ECAS and COAS compared to those in the NCAS group. Multivariable logistic regression analysis demonstrated that the ApoB/ApoA1 ratio was independently associated with ICAS, but not with ECAS. ROC curve analysis showed that the ApoB/ApoA1 ratio had a good diagnostic ability for ICAS, with an area under the curve (AUC) of 0.764, an optimal cut-off value of 0.8122, a sensitivity of 81.3%, and a specificity of 59.8%. An higher apoB/apoA1 ratio is associated with ICAS in ischemic stroke patients.

Background Abies beshanzuensis , an endemic fir native to the subtropical high mountains of eastern China, is classified as a first-class nationally protected wild plant and is listed as Critically Endangered (CR) by the International Union for Conservation of Nature (IUCN). Taxonomic controversies have long persisted among A. beshanzuensis , A. ziyuanensis , and A. dayuanensis , yet studies focusing on their mitochondrial DNA remain limited. Results In this study, the complete mitochondrial genome of A. beshanzuensis was assembled using a combination of Oxford Nanopore long-read sequencing and Illumina short-read sequencing technologies. The mitochondrial genome is 1.06 Mb in size with a GC content of 45.97%, and consists of nine linear chromosomes and one circular chromosome. Comprehensive analyses, including genome annotation, structural comparisons, RNA editing site prediction, and phylogenetic reconstruction, were subsequently conducted. Conclusion The results provide important insights into the mitochondrial genome architecture of A. beshanzuensis , offering a valuable resource for clarifying its controversial taxonomic status and advancing the understanding of evolutionary relationships within the genus Abies .

Background To determine the correlation between intracranial atherosclerotic stenosis and high-sensitivity C-reactive protein (hs-CRP) levels in elderly patients with cerebral infarction. Methods We performed a retrospective assessment of acute minor ischemic stroke patients aged over 60 at our institution from January 2021 to May 2023. A thorough computed tomography angiography (CTA) assessment was conducted for each participant. The patients were classified into four categories according to the site of stenosis in the cerebral arteries: (1) intracranial atherosclerotic stenosis (ICAS), (2) extracranial atherosclerotic stenosis (ECAS), (3) combined intracranial and extracranial atherosclerotic stenosis (IEAS), and (4) non-arterial stenosis (NOAS). Multivariate logistic regression analysis was utilized to evaluate the relationship between intracranial atherosclerotic stenosis and hs-CRP levels. The predictive efficacy of hs-CRP for intracranial arterial stenosis was assessed utilizing the Receiver Operating Characteristic (ROC) curve. Results The research comprised 203 participants in total. Among these, 73 individuals (34.96%) were categorized as having Intracranial Stenosis Atherosclerosis (ICAS). The hs-CRP levels in the ICAS group were markedly elevated ( P  = 0.011), while no significant difference in hs-CRP levels was observed between the ECAS and NOAS groups ( P  = 0.080). Hs-CRP levels were found to be independently correlated with intracranial arterial stenosis (OR 1.136, 95% CI 1.038–1.242, P  = 0.006) following multivariable analysis, as shown in Table 2. The upper quartile of hs-CRP was determined to be a statistically significant independent risk factor for intracranial stenosis (OR 3.779, 95% CI 1.519–9.402, P  = 0.004). The area under the curve (AUC) for hs-CRP was calculated to be 0.632 following the analysis of the ROC curve. The ideal cutoff value for hs-CRP was established at 3.96 mg/L, accompanied by a 95% confidence interval ranging from 0.555 to 0.710 ( P  = 0.001). The sensitivity and specificity were 0.500 and 0.735, respectively. Conclusions In elderly patients with acute minor ischemic stroke, elevated hs-CRP levels are significantly correlated with intracranial atherosclerosis stenosis, rather than extracranial atherosclerotic stenosis.

Malania oleifera is a nationally Category II protected wild plant in China and a Vulnerable species on the IUCN Red List, specifically distributed in the karst forest, playing a crucial role in maintaining biodiversity and ecological balance in karst fragile ecosystems. In this study, the potential suitable habitats for M. oleifera were simulated by the MaxEnt model using 126 distribution records and 19 environment variables. The key environmental variables influencing its distribution were identified: topsoil USDA texture classification (t_usda_tex), precipitation of warmest quarter (Bio18), isothermality (Bio03), precipitation of driest quarter (Bio17), precipitation seasonality (Bio15), and temperature annual range (Bio07), which are clay soil, 606–882 mm, 33.1–43.5, 40.7–67.2 mm, 76.9–86.7%, and 20.6–23.1 °C, respectively. Under the future climate scenarios, the total area of suitable habitats for M. oleifera is expected to decrease, with a more significant reduction under the SSP585 scenario compared to the SSP126 and SSP245 scenarios. Compared to the current centroid of the suitable habitat, the future centroid is projected to shift southeastward. This study identifies stable habitats of M. oleifera in the Guangxi-Yunnan-Guizhou border region, recommending prioritized in situ conservation and breeding base development. Environmentally sensitive zones require continuous monitoring and adaptive protection strategies. Climate-adaptive cultivation trials are proposed for expansion areas like Guangdong. These findings offer scientific and practical guidance for sustainable management of this vulnerable species under climate change.

Background Application of mesenchymal stem cell-derived exosomes (MSC-EXO) has emerged as a novel therapeutic strategy for myocardial infarction (MI). Our previous study showed that pretreatment with hemin, a potent heme oxygenase-1 (HO-1) inducer, enhanced the cardioprotective effects of MSCs in a mouse model of MI. This study aimed to investigate the therapeutic effects of EXO derived from hemin-pretreated MSCs (Hemin-MSC-EXO) in MI and explore the potential mechanisms. Methods MSC-EXO and Hemin-MSC-EXO were collected and characterized. MSC-EXO and Hemin-MSC-EXO were intramuscularly injected into the peri-infarct region in a mouse model of MI. Heart function of mice was assessed by echocardiography. The mitochondrial morphology of neonatal mice cardiomyocytes (NMCMs) under serum deprivation and hypoxic (SD/H) conditions was examined by Mitotracker staining. The cellular senescence of NMCMs was determined by senescence-associated-β-galactosidase assay. A loss-of-function approach was adopted to determine the role of Hemin-MSC-exosomal-miR-183-5p in the regulation of cardiomyocyte senescence Results EXO were successfully isolated from the supernatant of MSCs and Hemin-pretreated MSCs. Compared with MSC-EXO, injection of Hemin-MSC-EXO significantly improved cardiac function and reduced fibrosis. Both MSC-EXO and Hemin-MSC-EXO ameliorated cardiomyocyte senescence and mitochondrial fission in vitro and in vivo, and the latter exhibited better protective effects. MicroRNA sequencing revealed a higher level of miR-183-5p in Hemin-MSC-EXO than in MSC-EXO. MiR-183-5p knockdown partially abrogated the protective effects of Hemin-MSC-EXO in attenuating mitochondrial fission and cellular senescence of cardiomyocytes induced by SD/H. High mobility group box-1 (HMGB1) abundance was lower in Hemin-MSC-EXO-treated than MSC-EXO-treated mouse hearts, and HMGB1 was identified as one of the potential target genes of miR-183-5p. Mechanistically, Hemin-MSC-EXO inhibited SD/H-induced cardiomyocyte senescence partially by delivering miR-183-5p into recipient cardiomyocytes via regulation of the HMGB1/ERK pathway. Furthermore, knockdown of miR-183-5p reduced the Hemin-MSC-EXO-mediated cardioprotective effects in a mouse model of MI. Conclusion Our results reveal that Hemin-MSC-EXO are superior to MSC-EXO in treating MI. Exosomal miR-183-5p mediates, at least partially, the cardioprotective effects of Hemin-MSC-EXO by inhibiting cardiomyocyte senescence via regulation of the HMGB1/ERK pathway. This study highlights that MSC-EXO have high translational value in repairing cardiac dysfunction following infarction. Graphic abstract

Changnienia amoena is a terrestrial orchid endemic to China and holds significant ornamental and medicinal value. Understanding the current and future potential geographic distribution patterns of C. amoena under climate change is crucial for its effective conservation and sustainable development. This study uses 48 distribution records and 19 environmental variables to simulate and predict the potential distribution and spatial pattern changes of C. amoena under different future gas emission scenarios (SSP1-2.6, SSP2-4.5, and SSP5-8.5) for both the 2050s and 2090s. The dominant environmental variables influencing its distribution were also identified. The MaxEnt model yielded an AUC of 0.990 and CBI of 0.959, indicating extremely high predictive accuracy. The key environmental variables influencing the distribution of C. amoena include the minimum temperature of coldest month (Bio06), annual precipitation (Bio12), isothermality (Bio03), land use classification, slope, topsoil USDA texture classification, elevation, and topsoil calcium carbonate. Among these, temperature and precipitation have relatively significant impacts on the distribution of C. amoena . Under the SSP1-2.6 scenario, the suitable habitat for C. amoena shows a slight contraction, while under the SSP2-4.5 and SSP5-8.5 scenarios, the suitable habitat shifts and expands significantly towards the northwest, higher latitude and altitude areas. This research has important scientific significance and practical guidance value for the in-situ conservation, ex-situ cultivation, and sustainable utilization of C. amoena .

Background The ratio between erythrocyte distribution width and serum albumin (RAR) has gained recognition as a novel composite biomarker for inflammatory processes, though its clinical significance in Parkinson's disease (PD) pathology requires further exploration. The purpose of this cross-sectional study was to investigate the relationship between RAR and PD. Methods This epidemiologic investigation utilized data from participants enrolled in the National Health and Nutrition Examination Survey (NHANES) spanning 2003–2018. Study cohorts comprised PD-diagnosed individuals and matched controls. To elucidate the RAR–PD connection, we implemented three analytical strategies: multivariable-adjusted logistic regression models incorporating sample weights, restricted cubic spline (RCS) modeling for nonlinear relationships, and stratified analyses across demographic subgroups. Comparative assessment of inflammatory biomarkers' discriminative performance was performed through ROC curve analysis, contrasting RAR against platelet–albumin ratio (PAR) and neutrophil–albumin ratio (NAR). Results The analysis encompassed 31,848 adults (297 PD cases; 31,551 controls) from the NHANES database. Quantitative analysis revealed elevated RAR measurements in PD subjects compared to controls [3.28 (0.04) vs. 3.09 (0.01), P  < 0.001]. Following covariate adjustment in weighted regression models, multivariable-adjusted analyses identified RAR as an independent predictor (adjusted OR = 1.40, 95% CI 1.06–1.85, P  = 0.018). RCS modeling revealed nonlinear RAR–PD associations, peaking at 3.48 (inverted U-shape). Comparative ROC analysis confirmed RAR's discriminative superiority over PAR and NAR in PD detection ( P  < 0.05). Conclusions As demonstrated by the research findings, RAR is strongly and independently associated with PD. RAR may serve as an indicator or screening tool for an increased risk of PD. Graphical abstract