Objective. Transcranial magnetic stimulation-electroencephalogram (TMS-EEG) technology has played an increasingly important role in the field of neuroscience, and closed loop TMS has also been gradually concerned. However, the characteristics of closed-loop TMS-EEG were few discussed. To study the dependence of EEG reactivity on cortical oscillation phase under TMS stimulation, we explored in detail the TMS-EEG characteristics induced by closed-loop TMS contingent on occipital alpha phase.Approach.By collecting 30 healthy volunteers\' closed-loop TMS-EEG data, we verified the real-time accuracy of our closed-loop system and analyzed the inter-trial phase coherence (ITPC) value, the TMS-induced natural frequency, the N100 TMS-evoked potential and the spatial characteristics of TMS-EEG data.Main results.The ITPC value of closed-loop TMS-EEG was higher than that of open loop TMS-EEG, suggesting that our research improves the repeatability of TMS-EEG experiments; the alpha power induced by 0° TMS was higher than that induced by 180° stimulation in the central region and parietal/occipital lobe; the N100 amplitude of 90° (3.85μV) stimulation was significantly higher than that of 270° (1.87μV) stimulation, and the latency of the N100 of the 90° stimulation (mean 95.01 ms) was significantly less than that of the 270° stimulation (mean 113.94 ms); the topographical distributions of the N45-P70-N100 potential were significantly affected by the O1 alpha phase at the moment of TMS.Significance.Our experimental results provided support for the dependence of EEG reactivity on cortical oscillation phase under TMS stimulation.

Cancer patients benefit from early tumor detection since treatment outcomes are more favorable for less advanced cancers. Platelets are involved in cancer progression and are considered a promising biosource for cancer detection, as they alter their RNA content upon local and systemic cues. We show that tumor-educated platelet (TEP) RNA-based blood tests enable the detection of 18 cancer types. With 99% specificity in asymptomatic controls, thromboSeq correctly detected the presence of cancer in two-thirds of 1,096 blood samples from stage I-IV cancer patients and in half of 352 stage I-III tumors. Symptomatic controls, including inflammatory and cardiovascular diseases, and benign tumors had increased false-positive test results with an average specificity of 78%. Moreover, thromboSeq determined the tumor site of origin in five different tumor types correctly in over 80% of the cancer patients. These results highlight the potential properties of TEP-derived RNA panels to supplement current approaches for blood-based cancer screening.

Backgrounds: Nowadays, risks of Cognitive Impairment (CI) [highly suspected Alzheimer\'s disease (AD) in this study] threaten the quality of life for more older adults as the population ages. The emergence of Transcranial Magnetic Stimulation-Electroencephalogram (TMS-EEG) enables noninvasive neurophysiological investi-gation of the human cortex, which might be potentially used for CI detection. Objectives: The aim of this study is to explore whether the spatiotemporal features of TMS Evoked Potentials (TEPs) could classify CI from healthy controls (HC). Methods: Twenty-one patients with CI and 22 HC underwent a single-pulse TMS-EEG stimulus in which the pulses were delivered to the left dorsolateral prefrontal cortex (left DLPFC). After preprocessing, seven regions of interest (ROIs) and two most reliable TEPs\' components: N100 and P200 were selected. Next, seven simple and interpretable linear features of TEPs were extracted for each region, three common machine learning algorithms including Support Vector Machine (SVM), Random Forest (RF), and K-Nearest Neighbor (KNN) were used to detect CI. Meanwhile, data augmentation and voting strategy were used for a more robust model. Finally, the performance differences of features in classifiers and their contributions were investigated. Results: 1. In the time domain, the features of N100 had the best performance in the SVM classifier, with an accuracy of 88.37%. 2. In the aspect of spatiality, the features of the right frontal region and left parietal region had the best performance in the SVM classifier, with an accuracy of 83.72%. 3. The Local Mean Field Power (LMFP), Average Value (AVG), Latency and Amplitude contributed most in classification. Conclusions: The TEPs induced by TMS over the left DLPFC has significant differences spatially and temporally between CI and HC. Machine learning based on the spatiotemporal features of TEPs have the ability to separate the CI and HC which suggest that TEPs has potential as non-invasive biomarkers for CI diagnosis.

Despite the emerging insights into many snoRNAs (small nucleolar RNAs) which are detectable in body fluids and serve as noninvasive biomarkers, few studies have previously discussed the role of snoRNAs in tumor-educated platelets (TEPs). Herein, we systematically estimated dysregulation of snoRNAs in non-small cell lung cancer (NSCLC) and clarified the biomarker potential of SNORD55 in platelets.
We compared expression of snoRNAs between NSCLC and normal tissues using SNORic datasets. Platelets were isolated from plasma using low-speed centrifugation and subjected to quantitative polymerase chain reaction (qPCR) for SNORD55 detection.
SNORD55 was significantly decreased in TEPs from NSCLC patients especially in early-stage patients compared with healthy controls. Importantly, we validated that TEP SNORD55 was capable of acting as a promising biomarker for NSCLC. It exerted diagnostic performance for NSCLC diagnosis, possessing an AUC of 0.803, as well as for early NSCLC diagnosis, possessing an AUC of 0.784. Moreover, the combination of TEP SNORD55 and carcinoembryonic antigen (CEA) improved the diagnostic efficiency of cancer progression. In addition, TEP SNORD55 also potentially acts as a noninvasive early biomarker for lung adenocarcinoma (LUAD) and lung squamous cell carcinoma (LUSC) with favorable diagnostic efficiencies.
In summary, TEP SNORD55 could potentially serve as a noninvasive biomarker for NSCLC diagnosis and early diagnosis.
SNORD55 was significantly decreased in TEPs from NSCLC patients compared to healthy controls and acted as a novel biomarker for early NSCLC.

Background: Laparoscopic repair has been recommended as the method-of-choice of groin hernia repair among women. Whether the round ligament of uterus should be divided to facilitate mesh placement remains controversial. This study aims to review the outcomes of laparoscopic total extraperitoneal (TEP) groin hernia repair in women and to evaluate the impact of division of round ligament. Methods: Consecutive female patients with inguinal or femoral hernias who underwent elective laparoscopic TEP repair at a single institution from 2006 to 2017 were included for retrospective analysis. Primary outcomes were postoperative pain, genital prolapse, and recurrence. Outcomes of patients who had the round ligament divided were further compared with those with round ligament preserved and multivariable adjusted analysis was performed. Results: Sixty-eight patients with a total of 77 TEP repairs were included in the 12-year study period. The mean age was 45 ± 16 years old. Incidental femoral hernia was identified in 4 patients (5.9%). There was 1 (1.3%) recurrence upon mean follow-up of 42.9 ± 37.3 months. The round ligament was divided in 67.5% of patients, and upon multivariable adjusted analysis, there were no statistically significant differences in outcomes in terms of chronic pain (odds ratio [OR] = 2.210, P = .357), paresthesia (OR = 0.241, P = .149), and genital prolapse (OR = 0.327, P = .415) when compared with patients with preserved round ligament. Conclusion: Laparoscopic groin hernia repair in women is associated with low recurrence. Division of round ligament intraoperatively facilitates mesh placement and has minimal impact on clinical outcomes.

Introduction: The self-adhesive mesh has become increasingly popular since its launch and has been proven to be reliable in laparoscopic hernia reparation. However, self-adhesive mesh may encounter unexpected adhesions during operation because one side of the mesh was covered with microgrips. Objective: Performing a modified technique of self-adhesive mesh implantation to avoid unexpected adhesions to the mesh itself and to the surrounding tissues in the operation space. Methods: We carried out a modified self-adhesive mesh implantation during May 2017 and March 2018. The modification was using a plastic membrane to cover the microgrips side of the mesh, and then rolling up the mesh to a cigarette shape. The mesh was inserted into the groin through a 10 mm trocar, and it was opened up with the membrane being removed meanwhile. Results: A total of 21 cases of laparoscopic total extraperitoneal inguinal hernia repair were successfully performed. The mesh could be conveniently put on the right place with no unexpected adhesions and the operation time was greatly shortened by using this modified technique. Conclusion: Putting a plastic membrane on the microgrips side of the self-adhesive mesh could avoid the mesh adhering itself when rolling up and could be easy to spread up the mesh in the operative field without unexpected adhesions, which simplified the surgical process and shortened the surgical duration.

In totally extraperitoneal (TEP) operation, when trocars are arranged with midline configuration, operative instruments can easily interfere with each other because of the small operative angle. The triangle trocar configuration, which creates a large operative angle, may minimize interference. Therefore, we evaluated the use of triangle trocar configuration in TEP inguinal hernia repair.
A prospective randomized controlled study was conducted in 113 patients of laparoscopic TEP inguinal hernia repair in the Department of Hernia and Abdominal Wall Surgery, Shanghai East Hospital, between July 2016 and June 2017. Patients were randomly assigned to TEP laparoscopic inguinal hernioplasty with triangle trocar configuration (study group, n = 59) or midline trocar configuration (control group, n = 54). Perioperative outcomes (operative time, operative complications, postoperative pain, hospital stay, and costs), early postoperative complications (seroma/hematoma and uroschesis), and mid-term outcomes (late postoperative complications and recurrence) were observed and compared.
After a mean follow-up of 10.21 ± 2.32 mo, there was no significant difference in operative time, operative complications, postoperative pain, postoperative hospital stay, costs, postoperative complications, and recurrence rate between the two groups. The indirect hernia sac dissection time was shorter in the study group than in the control group.
Triangle trocar configuration in TEP laparoscopic hernia repair is safe and reliable and is an option for hernia surgeons. The technique creates a large operative angle and avoids interference between endo-instruments, which facilitates TEP and decreases the indirect hernia sac dissection time.

The use of the self-gripping mesh (Progrip™) during laparoscopic inguinal hernia has been proved to be effective and eliminates the need of additional fixation. However, the deployment of the self-gripping mesh is challenging due to its adhesive property. The purpose of this study was to introduce and describe an easy self-gripping mesh deployment method in laparoscopic inguinal hernia repair.
The self-gripping mesh was folded bilaterally towards the center of the mesh and placed vertically to align with the inferior epigastric artery, centered on the internal defect, then unfolded in a horizontal-bilateral unfolding method, first laterally, then medially.
A total of 63 inguinal hernias were repaired laparoscopicly: 40 patients by TAPP or TEP technique with self-gripping mesh, and there were no perioperative complications. The average time of mesh placement was 186 s (45-250 s). The patients only feel minimal pain (less than VAS 3) the second postoperative morning, and most of the patients were discharged the next day postoperatively; the average postoperative hospital duration was 1 day (1-2 days).
The present \"horizontal-bilateral unfolding\" mesh deployment method is a relative easy method to implant the self-gripping mesh during laparoscopic inguinal hernia repair.