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Measuring pain on digital devices using classic unidimensional pain scales such as the visual analog scale (VAS), numerical rating scale (NRS), and faces pain scale (FPS) has been proven to be reliable and valid. Emoji are pictographs designed in colorful form following the Unicode standard. It could be more beneficial to use emoji as faces of FPS on digital devices because emoji can easily fit on most devices and emoji are open-source so no approval would be needed before use. With a concise and user-friendly design, the emoji faces pain scale (Emoji-FPS) might be more generalizable to a wider population and more preferred by digital device users. This study was designed to develop an Emoji-FPS as well as to evaluate its reliability, validity, and preference on mobile devices in adult patients who underwent surgery. A modified Delphi technique with 2 rounds of web-based surveys was applied to obtain panelists' consensus on the sequence of emoji that can best represent 6 levels of pain. The initial candidate sequences of emoji for the Delphi process were constructed referring to 2 well-validated FPSs (Wong-Baker FACES pain rating scale [Wong-Baker FACES] and faces pain scale-revised [FPS-R]). Then, a prospective cohort of patients scheduled to receive perianal surgery was recruited and asked to complete a web-based questionnaire on a mobile device at 5 time points (before surgery [T1], wake up after surgery [T2], 4 hours after surgery [T3], the second day after surgery [T4], and 15 minutes after T4 [T5]). The 4 well-validated pain scales (NRS, VAS, Wong-Baker FACES, and FPS-R) were used as reference scales. After 2 rounds of surveys on 40 Delphi panelists, an Emoji-FPS was finally determined to represent 6 pain levels (0, 2, 4, 6, 8, and 10) from \"no hurt\" to \"hurts worst.\" For validation, 300 patients were recruited and 299 were analyzed, the mean age of whom was 38.5 (SD 10.5) years, and 106 (35.5%) were women. For concurrent validity, the Emoji-FPS was highly correlated with 4 reference scales with Spearman correlation coefficient ρ ranging from 0.91 to 0.95. Excellent agreements were observed between 4 versions of Emoji-FPS (iOS, Android, Microsoft, and OpenMoji), with weighted κ coefficients ranging from 0.96 to 0.97. For discriminant validity, patients' mean preoperative Emoji-FPS score (T1) was significantly higher than their postoperative Emoji-FPS score (T4) with a difference of 1.4 (95% CI 1.3-1.6; P<.001). For test-retest reliability, Emoji-FPS scores measured at T4 and T5 were highly correlated with a ρ of 0.91. The Emoji-FPS was mostly preferred, followed by the Wong-Baker FACES, FPS-R, NRS, and VAS. The Emoji-FPS is reliable and valid compared with traditional pain scales in adult surgery patients.

Postoperative nausea and vomiting are typical postsurgical complications. Drug therapy is only partially effective. The goal of our meta-analysis is to systematically evaluate the efficacy and safety of electrical acupoint stimulation for postoperative nausea and vomiting and to score the quality of evidence supporting this concept. PubMed, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from inception to March 19, 2020. Twenty-six studies (2064 patients) were included. Compared with control treatment, electrical acupoint stimulation reduced the incidence of postoperative nausea and vomiting (RR 0.49, 95% CI 0.41 to 0.57, P < 0.001), postoperative nausea (RR 0.55, 95% CI 0.47 to 0.64, P < 0.001) and postoperative vomiting (RR 0.56, 95% CI 0.45 to 0.70, P < 0.001). Electrical acupoint stimulation also reduced the number of patients requiring antiemetic rescue (RR 0.60, 95% CI 0.43 to 0.85, P = 0.004). No differences in adverse events were observed. Subgroup analysis showed that both electroacupuncture (RR 0.58, 95% CI 0.46 to 0.74, P < 0.001) and transcutaneous electrical acupoint stimulation (RR 0.44, 95% CI 0.34 to 0.58, P < 0.001) had significant effects. Electrical acupoint stimulation was effective whether administered preoperatively (RR 0.40, 95% CI 0.27 to 0.60, P < 0.001), postoperatively (RR 0.59, 95% CI 0.46 to 0.76, P < 0.001), or perioperatively (RR 0.50, 95% CI 0.37 to 0.67, P < 0.001). The quality of evidence was moderate to low. Electrical acupoint stimulation probably reduce the incidence of postoperative nausea and vomiting, postoperative nausea, postoperative vomiting, and reduce the number of patients requiring antiemetic rescue, with few adverse events.

During cortical gliogenesis, tri-potential intermediate progenitor cells (Tri-IPCs) differentiate into oligodendrocyte precursor cells (OPCs) or olfactory bulb interneuron intermediate progenitors (OBIN-IPCs) - a developmental program frequently co-opted in glioblastoma (GBM) to drive tumorigenesis. Here, we show that the transcription factors Olig1/2 coordinately regulate Tri-IPC fate specification through dual transcriptional mechanisms: they activate OPC specification while simultaneously repressing OBIN-IPC generation by directly suppressing Gsx2 expression. Genetic ablation of Olig1/2 redirects Tri-IPCs from producing proliferative OPCs to generating non-proliferative OBIN-IPCs, concomitant with Gsx2 upregulation. Mechanistically, Olig1/2 bind and silence multiple conserved enhancer elements of Gsx2 . Remarkably, in proneural GBM models, Olig1/2 deletion reprograms glioma stem cells toward OBIN-IPC-like cells, potently inhibiting tumor growth and improving survival. Integrative multi-omics and immunohistochemical staining analyses further identify cortical Tri-IPCs as the likely cellular origin of human H3.3G34R/V gliomas. These findings establish Olig1/2 as master regulators linking normal gliogenesis to gliomagenesis, and reveal therapeutic opportunities through fate reprogramming of glioma cells. Developmental programs are frequently co-opted in glioblastoma. Here, the authors show the role of transcription factors Olig1/2 in fate specification of tri-potential intermediate progenitor cells and their connection with gliomagenesis in mouse models; they also show that Olig1/2 deletion can reprogram such stem cell differentiation and inhibit tumour growth.

The emergence of myelinating oligodendrocytes represents a pivotal developmental milestone in vertebrates, given their capacity to ensheath axons and facilitate the swift conduction of action potentials. It is widely accepted that cortical oligodendrocyte progenitor cells (OPCs) arise from medial ganglionic eminence (MGE), lateral/caudal ganglionic eminence (LGE/CGE), and cortical radial glial cells (RGCs). Here, we used two different fate mapping strategies to challenge the established notion that the LGE generates cortical OPCs. Furthermore, we used a Cre/loxP-dependent exclusion strategy to reveal that the LGE/CGE does not give rise to cortical OPCs. Additionally, we showed that specifically eliminating MGE-derived OPCs leads to a significant reduction of cortical OPCs. Together, our findings indicate that the LGE does not generate cortical OPCs, contrary to previous beliefs. These findings provide a new view of the developmental origins of cortical OPCs and a valuable foundation for future research on both normal development and oligodendrocyte-related disease.

Right atrial thrombus is rare yet potentially life-threatening, carrying a substantial risk of pulmonary embolism and death. Management generally includes anticoagulation, thrombolysis, surgical thrombectomy, or catheter-based removal, whereas prognosis is poor when the thrombus remains untreated. We describe the intraoperative formation and spontaneous dissolution of a large, mobile right atrial thrombus that ultimately led to a favorable clinical outcome. During da Vinci robotic-assisted surgery, the patient experienced sudden cardiac arrest and was resuscitated with intraoperative cardiopulmonary resuscitation. Trans-esophageal echocardiography revealed a massive, free-floating thrombus in the right atrium, which subsequently resolved without the need for pharmacological or mechanical intervention.

IntroductionColonoscopy is currently the most commonly used and effective method for early detection, diagnosis and treatment of tumours of the colon and rectum. However, similar to other invasive procedures, it is associated with adverse reactions such as pain and abdominal distension. Electroacupuncture (EA) has been proposed as a potential treatment for relieving this discomfort; however, there is limited evidence supporting its efficacy. Therefore, the aim of this study is to investigate the effectiveness of EA when used prior to colonoscopy.Methods and analysisThis multicentre, randomised, controlled, patient–assessor-blinded trial will be conducted at three hospitals in China. A total of 500 participants will be randomly assigned to either the EA group or sham EA (SEA) group, in a 1:1 ratio. EA will be administered for 30 min before the colonoscopy. Participants will be asked to complete detailed questionnaires within 10 min after the procedure and 24 hours after the procedure to record their symptoms. The primary outcome will be assessed using discomfort numeric rating scale (NRS) scores. Secondary outcomes will include participants’ tolerance levels, including standard NRS scores for abdominal pain, bloating and anal discomfort reported by the participants, as well as heart rate(HR), blood pressure(BP), surgical pleth index, participant satisfaction, nurses’ and endoscopists’ evaluations, incidence of adverse events and salivary cortisol levels collected before EA and after colonoscopy.Ethics and disseminationEthics approval was obtained from the Ethics Committee of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (number 2023-1327-94-01), Ethics Committee of Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine (number 2023LCSY059) and Ethics Committee of Wuxi Hospital Affiliated to Nanjing University of Traditional Chinese Medicine (number 2023-062-01). The results of this study will be disseminated in peer-reviewed publications. All potential participants will be provided informed consent before participating in the study.Trial registration numberChiCTR2300073485.

Gasdermin D (GSDMD)‐mediated pyroptosis in macrophages plays a clear role in promoting inflammation and mortality in sepsis. The liver is a commonly damaged organ during sepsis and also an important organ for releasing acute response proteins. However, whether pyroptosis occurs and the function of GSDMD in hepatocytes remains unclear. It is surprising to find that hepatocyte‐specific GSDMD knockout (GSDMDhep‐/‐) mice have significantly reduced survival rates, markedly elevated systemic inflammation, and increased inflammation in the peritoneal cavity and lungs, suggesting that the absence of GSDMD in hepatocytes promotes systemic inflammatory responses. Serum proteomic analysis shows that anti‐inflammatory factors such as VEGF‐B and Gremlin‐1 are significantly reduced in GSDMDhep‐/‐ mice. Through in vitro and in vivo experiments combined with a constructed full‐length GSDMD and a mutant GSDMD plasmid (GSDMD‐c.D276A) that cannot be cleaved, VEGF‐B and Gremlin‐1 are verified to be released from hepatocytes through the pore‐forming activity of GSDMD, thus inhibiting the production of inflammatory factors by macrophages. More importantly, hepatocyte‐specific replenishment of full‐length GSDMD can reverse the exacerbated inflammatory response in GSDMDhep‐/‐ mice. These findings together establish that hepatic GSDMD plays a key protective role in sepsis by promoting the release of anti‐inflammatory factors through pore formation in hepatocytes. This study proposes for the first time that hepatic GSDMD plays a key protective role in sepsis. Hepatic GSDMD may release inflammatory inhibitory factors including VEGF‐B and Gremlin‐1 through pore‐forming activity to inhibit the production of inflammatory factors from macrophages, thereby alleviating the inflammatory response of septic mice.

Lack of liver regenerative capacity is the primary cause of hepatic failure and even mortality in patients undergoing hepatectomy, with no effective intervention strategies currently available. Therefore, identifying efficacious interventions to enhance liver regeneration is pivotal for optimizing clinical outcomes. Recent studies have demonstrated that vagotomy exerts an inhibitory effect on liver regeneration following partial hepatectomy, thereby substantiating the pivotal role played by the vagus nerve in the process of liver regeneration. In recent years, electroacupuncture (EA) has emerged as a non‐invasive technique for stimulating the vagus nerve. However, EA on hepatic regeneration remains uncertain. In this study, a 70% partial hepatectomy (PH) mouse model is utilized to investigate the effects of EA on acute liver regeneration and elucidate its underlying molecular mechanisms. It is observed that EA at ST36 acutely activated cholinergic neurons in the dorsal motor nucleus of the vagus nerve (DMV), resulting in increased release of acetylcholine from hepatic vagal nerve endings and subsequent activation of IL‐6 signaling in liver macrophages. Ultimately, these events promoted hepatocyte proliferation and facilitated liver regeneration. These findings provide insights into the fundamental brain‐liver axis mechanism through which EA promotes liver regeneration, offering a novel therapeutic approach for post‐hepatectomy liver regeneration disorders. Electroacupuncture (EA) at ST36 activates cholinergic neurons in the dorsal motor nucleus of the vagus nerve (DMV) of the brain, leading to the release of acetylcholine from hepatic vagus nerve terminals which subsequently activates IL‐6 signaling in liver macrophages and promotes liver regeneration.

Objective The repair of great toe donor site defect after wrap‐around flap transfer is still controversial. The bilobed superficial circumflex iliac artery perforator (SCIP) flap can improve the aesthetics of the great toe while maintaining its function. Thus, this study aimed to report our experience in the reconstruction of big toe donor site defects with the bilobed SCIP flap and describe the clinical outcomes. Methods This study was a retrospective trial. From May 2017 to May 2020, 13 patients with the great toe donor site defect after wrap‐around flap transfer were included in this study. The average age of the patients was 44 years (range, 23–60 years). All patients received free bilobed SCIP flaps to reconstruct the donor site defect of the great toe. Relevant clinical features were recorded preoperatively. The thickness and design of the SCIP flap and the harvesting layer of the flap were measured during the operation. The survival rate of flaps and skin grafts and the incidence of infection were recorded after operation. At follow‐up, donor site complications and postoperative outcomes were evaluated. Results In all cases, the SCIP flap covering the donor site of the great toe survived. All patients were followed up for 24–40 months (mean, 30.5 months). The average thickness of the SCIP flap was 0.38cm. All SCIP flaps were harvested from the superficial fascial layer except for three obese patients. The thin SCIP flap had a bilobed design with no further defatting procedures. Postoperatively, the great toe‐nail flap donor site regained its original appearance without bloating or flap necrosis. There was a hidden linear scar in the groin donor site, which did not affect hip joint movement. All patients were satisfied with the aesthetics of the surgical site. Conclusion The SCIP flap with bilobed design for repairing the donor defect of the great toe after wrap‐around flap transfer is a kind of surgical method with excellent contour, meeting the requirements of function and aesthetics. Schematic diagram illustrating the SCIP flap with bilobed design to cover the nail area and the base of the great toe.

IntroductionPostoperative ileus (POI), a common complication after surgery, severely affects postoperative recovery. It is unclear whether pretreatment with transcutaneous electrical acupoint stimulation (TEAS) can improve recovery from POI. This trial will evaluate the effects of pretreatment with TEAS on POI.Methods and analysisThis will be a prospective, randomised controlled trial. American Society of Anesthesiologists (ASA) physical status classification I–III level patients, aged 18–75 years and scheduled for laparoscopic colon surgery, will be included in the study. It is planned that 146 subjects will be randomised to the TEAS and sham TEAS (STEAS) groups. The groups will undergo two sessions of TEAS/STEAS daily for 3 days before surgery, with a final TEAS/STEAS treatment 30 min before anaesthesia. The primary endpoint of the study will be time to first defaecation. Secondary endpoints will include time to first flatus, time to tolerance of oral diet, GI-2 (composite outcome of time to first defaecation and time to tolerance of oral diet), time to independent walking, length of hospital stay, postoperative pain Visual Analogue Scale score on the first 3 days after surgery, analgesic requirements, complications and plasma concentrations of interferon-β (IFN-β), IFN-γ, interleukin-6 (IL-6) and IL-1β. Multiple linear regression will be used to identify independent predictors of outcome measures.Ethics and disseminationThis study has been approved by the Chinese Registered Clinical Trial Ethics Review Committee (No. ChiECRCT-20170084). The results of the trial will be published in an international peer-reviewed journal.Trial registration numberThis study has been registered with the Chinese Clinical Trial Registry (No. ChiCTR-INR-17013184).Trial statusThe study was in the recruitment phase at the time of manuscript submission.