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This study aimed to compare the efficacy between decompression and drainage seton (DADS) and cutting seton (CS) in the treatment of high complex anal fistula. Patients were randomly assigned 1:1 to DADS or CS group. The primary outcome was the rate of wound healing. Second outcomes included time taken to return to work, postoperative pain, the severity of fecal incontinence and other complications. A total of 120 patients with a mean age of 39 years were included. There was no significant difference in the rate of complete wound healing at 1 year. The mean time taken to return to work was 5 ± 2 days in DADS group, shorter than CS group (10 ± 3, p  < 0.001). Mean vaizey incontinence score and the post-operation pain in DADS group was significantly lower than CS group. No significant difference was found between two groups in the incidence of complications. DADS is as effective as Cutting seton for the treatment of high complex anal fistula but is associated with less postoperative pain and better sphincter function preserving.

Background Despite significant advancements in neonatal care, mid to late preterm infants (32–36 weeks’ gestation) remain at high risk for recurrent respiratory tract infections (RRTIs). Current prevention strategies are limited by the absence of individualized risk assessment tools. This study aimed to identify critical perinatal risk factors and to develop a robust, clinically applicable prediction model for RRTI in this vulnerable population. Methods A retrospective cohort study was conducted at a tertiary care hospital, enrolling 288 preterm infants born between April 2023 and April 2024. Comprehensive maternal, perinatal, and postnatal data were extracted from electronic medical records and supplemented by structured caregiver interviews. A multivariable logistic regression analysis using a stepwise selection method (entry criterion: P  < 0.05; exit criterion: P  > 0.10) was performed to determine independent predictors of RRTI. The derived model was externally validated in a temporally distinct cohort ( n  = 100) from the same center. Model performance was assessed by the area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. Results Seven independent predictors were retained in the final model: small-for-gestational-age (OR = 3.53, 95% CI: 1.41–11.61), intrauterine infection (OR = 4.22, 95% CI: 1.81–9.83), mechanical ventilation > 72 h (OR = 3.00, 95% CI: 1.27–7.14), prolonged antibiotic use (> 30 days/year; OR = 2.23, 95% CI: 1.01–5.05), maternal passive smoking (OR = 2.91, 95% CI: 1.19–7.14), history of RSV infection (OR = 5.61, 95% CI: 2.24–14.08), and vaginal delivery as a protective factor (OR = 0.24, 95% CI: 0.08–0.71). The prediction model demonstrated excellent discriminatory performance with an AUC of 0.935 in the training cohort and 0.927 in the validation cohort. Overall accuracy was 75.3% for the training set and 82.0% for the validation set. Conclusions This study presents a novel risk stratification tool that effectively identifies high-risk moderate-to-late preterm infants and facilitates targeted interventions, such as RSV prophylaxis and enhanced immune monitoring. This advancement enables tailored RSV immunoprophylaxis planning in low-resource Asian NICUs. Nonetheless, further multi-center validation studies are warranted to confirm the model’s generalizability and to refine its predictive accuracy for broader clinical application.

Background Hemorrhoids are common. Hemorrhoidectomy should typically be offered to patients whose symptoms result from external hemorrhoids or combined internal and external hemorrhoids with prolapse (grades III/IV). However, none of the currently used surgical methods could be considered an ideal surgical option that is effective, safe, and painless. We hypothesized that a combination of Ruiyun procedure for hemorrhoids (RPH) and simplified Milligan–Morgan hemorrhoidectomy (sMMH) will increase the safety and effectiveness of surgical treatment hemorrhoids. This study aimed to evaluate the efficacy of Ruiyun procedure for hemorrhoids combined simplified Milligan–Morgan hemorrhoidectomy with dentate line-sparing (RPH + sMMH) to treat grade III/IV hemorrhoid. Methods Total 452 patients with hemorrhoids of grade III/IV were retrospectively reviewed in China-Japan Friendship Hospital, 244 cases were assigned to RPH + sMMH group, and 208 cases in MMH group. The primary efficacy outcome was rate of curative at 3 month after operation, and the recurrence rate within 12 months post operation. Secondary efficacy outcomes included wound healing time, time required to resume normal work, constipation symptom, quality of life, and pain post operation was also evaluated. The safety outcome included postoperative complications. Results There were no differences between the two groups in demographic characteristics. There was no statistically significant difference between the two groups in the curative rate. The recurrence rate after 12 months post operation in the RPH + sMMH (3.0%) was significantly lower than the sMMH group (7.8%) (P = 0.032). The wound healing time was significantly shorter in RPH + sMMH group than that in MMH group (P < 0.001). The time required to resume normal work in the RPH + sMMH group was significantly shorter than MMH group (P < 0.001). Compared with the MMH group, the RPH + sMMH therapy preserve better life quality and lower constipation symptom (all P < 0.05). Patients who underwent RPH + sMMH had significantly less postoperative pain than MMH therapy. The total rate of patients with postoperative complications in the RPH + sMMH group (8.6%) was significant lower than the MMH group (16.3%) (P = 0.012). Conclusion RPH + sMMH may more effective in treating patients with III/IV hemorrhoids, which indicated lower recurrence rate, lower postoperative complications and pain, shorter recovery and return to normal life.

Objective To evaluate the total societal costs of postoperative antibiotic use compared to non-use in patients undergoing surgery for high horseshoe anal fistula (HHAF), based on a randomized controlled trial. Methods We conducted a single-blinded randomized controlled trial in 90 patients with HHAF treated using a standardized loose combined cutting seton (LCCS) procedure at the Department of Colorectal Surgery, China-Japan Friendship Hospital, between January and October 2023. Participants were randomly assigned to either a postoperative Antibiotic group or a No Antibiotic groups. The primary outcome was total societal cost. Clinical outcomes, including wound healing time and early recurrence, were assessed as secondary measures A societal cost-minimization analysis (CMA) was performed, encompassing direct medical costs, outpatient visit costs, and indirect costs due to lost productivity. Patient follow-up was completed by December 2024. Results Ninety patients were randomized equally (45 per group) with comparable baseline data. The Antibiotic group showed significantly higher hospitalization costs (¥13,202 ± 3,054 vs. ¥9,322 ± 1,205; p  < 0.001) and longer stays (12.5 ± 5.8 vs. 7.9 ± 2.4 days; p  < 0.001), without differences in wound healing ( p  = 0.490). Regression confirmed that both incision number (β = 1735.18, p  = 0.020) and antibiotic use (β = 3287.06, p  < 0.001) independently increased cost, with a significant interaction (β = 3641.00, p  = 0.010). Antibiotic use also led to more outpatient visits (5.25 vs. 2.75; p  = 0.013) and higher total societal costs (¥9,802 vs. ¥7,931; p  = 0.014). Sensitivity analyses under multiple scenarios consistently confirmed higher overall costs in the Antibiotic group. Conclusion Routine postoperative antibiotics showed no significant additional clinical benefit in terms of wound healing or recurrence in HHAF patients treated with LCCS, yet significantly increase societal costs and postoperative burdens. A selective, evidence-based approach to antibiotic use should be adopted in the surgical management of complex anal fistulas. Trial registration This study was retrospectively registered in the Chinese Clinical Trial Registry (ChiCTR2400093477) on December 5, 2024, after the enrollment of participants began in January 2023. The retrospective registration is in accordance with the journal’s editorial policy for studies involving healthcare interventions in human participants.

Leaf functional traits have attracted the attention of ecologists for several decades, but few studies have systematically assessed leaf morphological traits (termed “economic traits”), stomatal (termed “hydraulic”), and anatomical traits of entire forest communities, thus it is unclear whether their relationships are consistent among trees, shrubs, and herbs, and which anatomical traits should be assigned to economical or hydraulic traits. In this study, we collected leaf samples of 106 plant species in temperate forests and 164 plant species in subtropical forests and determined nine key functional traits. We found that functional traits differed between temperate and subtropical forests. Leaf traits also differed between different plant functional groups, irrespective of forest type; dry matter content, stomatal density, and cell tense ratio followed the order trees > shrubs > herbs, whereas specific leaf area and sponginess ratio showed the opposite pattern. The correlations of leaf traits were not consistent among trees, shrubs, and herbs, which may reflect different adaptive strategies. Principal component analysis indicated that leaf economics and hydraulic traits were uncoupled in temperate and subtropical forests, and correlations of anatomical traits and economic and hydraulic traits were weak, indicating anatomical traits should be emphasized in future studies.

AgSbTe 2 is a promising p-type thermoelectric material operating in the mid-temperature regime. To further enhance its thermoelectric performance, previous research has mainly focused on reducing lattice thermal conductivity by forming ordered nanoscale domains for instance. However, the relatively low power factor is the main limitation affecting the power density of AgSbTe 2 -based thermoelectric devices. In this work, we demonstrate that hole-doped AgSbTe 2 with Sn induces the formation of a new impurity band just above the valence band maximum. This approach significantly improves the electrical transport properties, contrary to previous strategies that focused on reducing lattice thermal conductivity. As a result, we achieve a record-high power factor of 27 μWcm −1 K −2 and a peak thermoelectric figure of merit zT of 2.5 at 673 K. This exceptional performance is attributed to an increased hole concentration resulting from the formation of the impurity band and a lower formation energy of the defect complexes ( V A g 1 −  +  S n S b 1 − ). Besides, the doped materials exhibit a significantly improved Seebeck coefficient by inhibiting bipolar conductivity and preventing the formation of n-type Ag 2 Te. Additionally, the optimized AgSbTe 2 is used to fabricate a unicouple thermoelectric device that achieves energy conversion efficiencies of up to 12.1% and a high power density of 1.13 Wcm −2 . This study provides critical insights and guidance for optimizing the performance of p-type AgSbTe 2 in thermoelectric applications. Sn doping enables a breakthrough in p-type AgSbTe 2 for thermoelectric applications, achieving a zT of 2.5 and 12.1% device efficiency. The authors reveal an impurity band mechanism, offering a strategy for AgSbTe 2 optimization.

The wireless energy-carrying communication method for the Internet of Things (IoT) presents several difficulties for information security such as eavesdropping or data loss. To solve these issues, this paper presents a new secure transmission method for IoT wireless energy-carrying communication systems. In this method, first the secret message is turned into a word, delivered to the intended recipient and unlawful listener, respectively, and the received message is characterized as an entropy function. The message is iteratively solved using the block coordinate descent technique, and for each iteration, a digital baseband signal containing the receiver’s secret message symbol and the matching beamforming vector is delivered. By concurrently optimizing the transmit beamforming vector, the noise covariance matrix, and the receiver power allocation factor based on a design that complies with the security rate and energy acquisition limitations for each receiver, the overall system transmit power is reduced. The Lagrangian method is used to solve the secure transmission problem of the communication system based on an iterative block coordinate descent algorithm, as well as to change the nonconvex problem into a convex problem and precisely derive the upper and lower bounds of the original transmission problem. In comparison to the conventional policy transmission scheme, the experimental results demonstrate that the DIPS (Digital Image Processing System) scheme can increase the STP (Signaling Transfer Point) by approximately 34.16 percent in the eavesdropper independent eavesdropping and joint eavesdropping scenarios. The usefulness of the secure transmission strategy for wireless energy-carrying communication systems is confirmed by this investigation.

White blood cell (WBC) segmentation, which is important for cytometry, is a challenging issue because of the morphological diversity of WBCs and the complex and uncertain background of blood smear images. This paper proposes a novel method for the nucleus and cytoplasm segmentation of WBCs for cytometry. A color adjustment step was also introduced before segmentation. Color space decomposition and k-means clustering were combined for segmentation. A database including 300 microscopic blood smear images were used to evaluate the performance of our method. The proposed segmentation method achieves 95.7% and 91.3% overall accuracy for nucleus segmentation and cytoplasm segmentation, respectively. Experimental results demonstrate that the proposed method can segment WBCs effectively with high accuracy.

Bin Han and colleagues report de novo assembly of the genome of a wild progenitor ( Setaria viridis ) of foxtail millet and low-pass resequencing of 916 diverse foxtail millet varieties. They identify 0.8 million common SNPs, construct a haplotype map of foxtail millet and perform genome-wide association studies on 47 agronomic traits. Foxtail millet ( Setaria italica ) is an important grain crop that is grown in arid regions. Here we sequenced 916 diverse foxtail millet varieties, identified 2.58 million SNPs and used 0.8 million common SNPs to construct a haplotype map of the foxtail millet genome. We classified the foxtail millet varieties into two divergent groups that are strongly correlated with early and late flowering times. We phenotyped the 916 varieties under five different environments and identified 512 loci associated with 47 agronomic traits by genome-wide association studies. We performed a de novo assembly of deeply sequenced genomes of a Setaria viridis accession (the wild progenitor of S. italica ) and an S. italica variety and identified complex interspecies and intraspecies variants. We also identified 36 selective sweeps that seem to have occurred during modern breeding. This study provides fundamental resources for genetics research and genetic improvement in foxtail millet.