Objective While there is consensus regarding a positive effect of video gaming on dexterity,little is known regarding how much traditional laparoscopic practice can or should be substituted with video gaming.This stud...Objective While there is consensus regarding a positive effect of video gaming on dexterity,little is known regarding how much traditional laparoscopic practice can or should be substituted with video gaming.This study was designed to assess the effects of varying the amount of traditional practice in a lap box trainer and video gaming on performance in two fundamentals of laparoscopic surgery core tasks.Methods Undergraduate and medical students were recruited and randomized into one of four groups:a control group,a lap box group,a video game group,and a combined group with 50%of the time allocated to each modality.Performance in the peg transfer and precision cutting tasks was assessed both prior to and following the 6 training sessions.Results Peg transfer performance significantly improved in the lap box group(168.4±70.6 s vs.332.9±178.2 s,p<0.001),video game group(176.7±53.3 s vs.300.0±101.2 s,p<0.001)and combined group(214.2±86.9 s vs.406.8±239.5 s,p=0.002)after training.Similar improvements were also observed in precision cutting performance in the lap box group(413.1±138.4 s vs.614.3±211.4 s,p=0.002),video game group(434.1±150.8 s vs.609.2±233.2 s,p=0.007)and combined group(469.2±185.3 s vs.663.8±296.3 s,p=0.020).When analyzing improvements in performance across three different training groups compared with the control group,we found that both the lap box group(p<0.001)and the combined group(p<0.001)showed better improvement in both tasks,and the video game group had significantly better outcomes in the precision cutting task(p=0.003).Conclusion Traditional lap box training remains the most effective method for improving the performance of simulated laparoscopic surgery.Video games can be encouraged to enhance skills retention and supplement simulated practice outside of a formal training curriculum.展开更多
Objectives:One of the most notable challenges in endoscopic procedures is maintaining correct orientation.Mental rotation exercise(MRE)has been suggested as a potential aid for improving orientation.However,there is a...Objectives:One of the most notable challenges in endoscopic procedures is maintaining correct orientation.Mental rotation exercise(MRE)has been suggested as a potential aid for improving orientation.However,there is a lack of research on designing MREs with varying difficultylevels for training purposes.Furthermore,few studies provide solid evidence linking MRE difficultylevels with cognitive load measurements.This study aims to address this gap by investigating the correlation between the MRE difficultylevels and participants’cognitive load,as measured by pupil dilation.Method:We recruited 33 participants to perform MREs on a computer equipped with a screen-mounted eye-tracker.The test consisted of 15 MREs,with the first10 relatively easy(traditional cube)and the next 5 more complex(invented molecule).The participants’eye movements during MREs were recorded.The participants’MRE scores and pupil dilation were obtained and compared between two MRE difficultylevels.Results:The participants who performed traditional cube MREs achieved significantlybetter MRE scores(0.77±0.11 vs.0.58±0.03,p<0.001)and lower pupil dilation(0.27±0.04 pixels vs.0.47±0.09 pixels,p<0.001)than did those who performed the invented molecule MREs.Moreover,there were significant negative correlations(r=0.62,p=0.015)between pupil dilation and MRE scores.Conclusions:The results revealed a significantnegative correlation between MRE scores and pupil dilation.The more challenging MRE questions led to worse MRE scores but increased pupil dilation.The MRE difficultylevels can be evaluated not only by the degrees or dimensions with which the objects were rotated but also by the participants’MRE scores and pupil dilation.The results of this study provide a basis for training orientation skills in endoscopy using MREs.By incorporating MREs with varying difficultylevels,customized training programs can be developed to enhance camera navigation in endoscopic and laparoscopic procedures.展开更多
Unlike earlier innovations that focused on manipulation and task precision,the latest surgical advancements emphasize data visualization and the acceleration of surgeons’decision-making.Before entering the operating ...Unlike earlier innovations that focused on manipulation and task precision,the latest surgical advancements emphasize data visualization and the acceleration of surgeons’decision-making.Before entering the operating room,digital tools help surgeons develop patient-specific approaches,outline procedural steps,and prepare strategies for managing potential crises.During the operation,relevant data appear at the right moment to assist decision-making and guide performance in formats tailored to the surgeon’s physical and cognitive state,all without causing distractions.In the future operating room,performance data from surgeons will be gathered,integrated,and analyzed to interpret surgeons’behavior and confidence.Advanced techniques,including artificial intelligence,can be employed to automatically detect moments of performance difficulty or cognitive overload.As a result,digital surgery provides timely,context-specific assistance to surgeons in high-stakes situations.Key components of digital surgery are highlighted in this narrative review.展开更多
The cognitive load plays a key role in surgical education,influencingtask performance and skill acquisition.This review explores three primary approaches to assessing cognitive load in the surgical context—paper-base...The cognitive load plays a key role in surgical education,influencingtask performance and skill acquisition.This review explores three primary approaches to assessing cognitive load in the surgical context—paper-based measures,physiological measures,and performance-based measures—and highlights their relevance and applications in surgical education.Paper-based tools,such as the NASA Task Load Index and its surgical adaptation,the Surgery Task Load Index,offer simplicity but lack realtime insight.Physiological measures,including heart rate,eye tracking,and electrodermal activity,provide objective and timely data.Neuroimaging techniques,such as electroencephalography and functional near-infrared spectroscopy,provide direct evidence of brain activity but face challenges such as cost and complexity.Performance-based metrics,such as secondary tasks,infer cognitive load from working memory capacity.Accurate assessment of cognitive load can improve training outcomes by adapting demands to cognitive capacity.Future directions include the development of more accurate,multimodal,and user-friendly tools for dynamic,timely assessment,ultimately advancing personalized surgical training and improving patient care.展开更多
The pursuit of safer energy storage systems is driving the development of advanced electrolytes for lithium-ion batteries.Traditional liquid electrolytes pose flammability risks,while solid-state alternatives often su...The pursuit of safer energy storage systems is driving the development of advanced electrolytes for lithium-ion batteries.Traditional liquid electrolytes pose flammability risks,while solid-state alternatives often suffer from low ionic conductivity.Gel polymer electrolytes(GPEs)emerge as a promising compromise,combining the safety of solids with the ionic conductivity of liquids.Cellulose,an abundant and eco-friendly polymer,presents an ideal base material for sustainable GPEs due to its biocompatibility and mechanical strength.This study systematically investigates how drying methods affect cellulose-based GPEs.Cellulose hydrogels were synthesized through dissolution-crosslinking and processed using vacuum drying(VD),supercritical drying(SCD),and freeze-drying(FD).VD and SCD produced dense membranes with excellent mechanical strength(7.2 MPa)but limited electrolyte uptake(30%–40%).In contrast,FD created a highly porous structure(21.13%porosity)with remarkable electrolyte absorption(638%),leading to superior ionic conductivity(1.22 mS⋅cm^(-1))and lithium-ion transference number(0.28).However,this came at the cost of increased interfacial impedance and poor rate capability,resulting in 81.24%capacity retention after 100 cycles.These findings illuminate the critical balance between electrochemical performance and mechanical properties in cellulose GPEs,providing valuable insights for designing sustainable electrolytes for flexible electronics and electric vehicles.展开更多
Objective:Interpersonal brain synchronization(IBS)has emerged as a significant concept in understanding collaborative team dynamics,with functional near-infrared spectroscopy(fNIRS)proving to be a vital tool in its as...Objective:Interpersonal brain synchronization(IBS)has emerged as a significant concept in understanding collaborative team dynamics,with functional near-infrared spectroscopy(fNIRS)proving to be a vital tool in its assessment.This review aims to collate and analyze the literature on the application of fNIRS in various team settings,emphasizing its potential utility in surgical environments.Methods:A thorough search and screening process across multiple databases resulted in 17 studies being reviewed,with a focus on the utilization of fNIRS to measure IBS in different collaborative tasks.This review examined the tasks employed,participant demographics,organizational structures of teams,methodologies for IBS measurement,and correlations between brain synchronization and behavioral measurements.Results:fNIRS emerged as a non-invasive,cost-effective,and portable tool,predominantly used to assess IBS in pair-based tasks with a variety of participant demographics.Wavelet transform coherence was the primary method used for measuring synchronization,particularly in the prefrontal brain region.A consistent correlation was found between increased brain synchronization and enhanced team performance,underscoring the potential of fNIRS in understanding and optimizing team dynamics.Conclusion:This review establishes fNIRS as a promising tool for investigating the neural mechanisms underlying team cooperation,providing invaluable insights for potential applications in surgical settings.While acknowledging the limitations in the current literature,the review highlights the need for further research with larger sample sizes and varied task complexities to solidify the understanding of IBS and its impact on team performance.The ultimate goal is to leverage fNIRS in assessing and improving surgical team dynamics,contributing to improved patient outcomes and safety.展开更多
Objective Reliable and objective methods for assessing surgical skill are essential for improving surgical skills and clinical outcomes.While conventional methods rely on subjective evaluations,motion analysis can off...Objective Reliable and objective methods for assessing surgical skill are essential for improving surgical skills and clinical outcomes.While conventional methods rely on subjective evaluations,motion analysis can offer a quantitative alternative.This study aims to use motion tracking data to analyze the motion smoothness and bimanual coordination of various surgical skill levels during laparoscopic surgery.Methods The participants were recruited and grouped into an expert group,an intermediate group,and a novice group on the basis of their experience with laparoscopic surgery.They completed peg transfer,bimanual peg transfer,and rubber band translocation tasks.Motion smoothness was assessed via logarithmic dimensionless tooltip motion jerk,and the dynamic time warping metric of tooltips velocities was employed to assess bimanual coordination.Results Seventeen participants,with four experts,five intermediates,and eight novices,were included.Compared with novices,the experts exhibited smoother motion in both the dominant hand(peg transfer:16.30 vs.18.05,p=0.004;bimanual peg transfer:15.21 vs.17.45,p=0.004;rubber band translocation:14.32 vs.15.87,p=0.004)and non-dominant hand(peg transfer:16.32 vs.18.22,p=0.004;bimanual peg transfer:15.32 vs.17.52,p=0.004;rubber band translocation:14.33 vs.15.77,p=0.004),and superior bimanual coordination(peg transfer:8.77 m/s vs.13.28 m/s,p=0.004;bimanual peg transfer:6.29 m/s vs.11.13 m/s,p=0.004;rubber band translocation:4.50 m/s vs.7.13 m/s,p=0.004)across all tasks.They also outperformed intermediates in motion smoothness in the non-dominant hand and bimanual coordination in the peg transfer(16.32 vs.17.35,p=0.016;8.77 m/s vs.11.89 m/s,p=0.016)and bimanual peg transfer(15.32 vs.16.22,p=0.016;6.29 m/s vs.8.63 m/s,p=0.032)tasks.Similarly,intermediates demonstrated smoother motion in the non-dominant hand(peg transfer:17.35 vs.18.22,p=0.002;bimanual peg transfer:16.22 vs.17.52,p=0.002)and dominant hand(bimanual peg transfer:16.06 vs.17.45,p=0.011),and better bimanual coordination(peg transfer:11.89 m/s vs.13.28 m/s,p=0.002;bimanual peg transfer:8.63 m/s vs.11.13 m/s,p=0.002)than novices did in these tasks.Conclusion This study revealed that motion smoothness and bimanual coordination are capable of facilitating surgical skill differentiation across various skill levels.These findings underscore the utility of motion metrics for objective surgical skill assessment,potentially reducing the subjectivity,bias,and associated costs of conventional assessment approaches.展开更多
Photothermal therapy(PTT)uses heat generated by photothermal agents to efficiently kill cancer cells in the least invasive manner.Inorganic nanoparticles,such as precious metals and carbon nanoparticles,have been exte...Photothermal therapy(PTT)uses heat generated by photothermal agents to efficiently kill cancer cells in the least invasive manner.Inorganic nanoparticles,such as precious metals and carbon nanoparticles,have been extensively studied for their ability to convert near-infrared(NIR)light(700-900 nm)into heat[1].However,these nanoparticles are easily captured by the reticuloendothelial system,which severely limits their clinical applications[2].Despite targeted and stealth modifications,these issues remain unresolved;therefore,researchers are seeking more effective methods.展开更多
The primary energy demand increases, but a large amount of waste heat resources w</span><span style="font-family:Verdana;">ere </span><span style="font-family:Verdana;">...The primary energy demand increases, but a large amount of waste heat resources w</span><span style="font-family:Verdana;">ere </span><span style="font-family:Verdana;">not effectively used. To explore the influence of particle stacking structure on waste heat recovery process, CFD method was used to simulate. An unsteady heat transfer model of two particles was established, effect of particle stacking angle on heat transfer characteristics of the particles close to the wall under different initial temperature conditions was studied. Results show that: higher initial temperature, resulting in increased heat transfer time, the larger particle stacking angle causes the shortening of heat transfer time. When initial temperature is 1073</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">K, the average wall heat flux shows a trend of rapid decline first and then a slow one. At the same moment, the larger stacking angle causes smaller particle average temperature. The change of particle stacking angle shows a greater impact on the temperature of the particles close to adiabatic wall. The increase in the stacking angle resulting in better heat transfer characteristics between particles.展开更多
目的探讨动态增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)在评价和预测乳腺癌新辅助化疗疗效方面的价值。方法回顾性分析57例行术前新辅助化疗,且化疗前、后2周期行MRI检查的乳腺癌恶性患者,对其按...目的探讨动态增强磁共振成像(dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI)在评价和预测乳腺癌新辅助化疗疗效方面的价值。方法回顾性分析57例行术前新辅助化疗,且化疗前、后2周期行MRI检查的乳腺癌恶性患者,对其按病理学反应分为化疗有效组和无效组。提取患者的乳腺MRI病灶和背景特征进行统计分析。结果化疗前MRI不对称特征、正常侧动态增强特征与化疗结果显著相关(单变量逻辑回归P<0.05)。在多变量回归分析中,病灶表面积和正常侧动态增强特征与乳腺癌新辅助化疗结果显著相关(P<0.05)。结论 DCE-MRI中正常侧背景区域动态增强特征与乳腺癌新辅助化疗疗效结果显著相关,在新辅助化疗疗效的预测与治疗中有重要的参考价值。展开更多
Background and Objective: Transthoracic and transabdominal approaches are commonly used for the surgical treatment of adenocarcinoma of the cardia. Which approach is better has been controversial for quite a long time...Background and Objective: Transthoracic and transabdominal approaches are commonly used for the surgical treatment of adenocarcinoma of the cardia. Which approach is better has been controversial for quite a long time. Our study aimed to compare the surgical trauma, range of lymph node dissection, and the prognosis of the transthoracic and transabdominal approaches for the treatment of adenocarcinoma of the cardia. Methods: The medical records of 331 patients with adenocarcinoma of the cardia treated in our hospital between 1994 and 2003 were analyzed. Of the 331 patients, 284 underwent operation via transthoracic approach and 47 via transabdominal approach. Surgery-related status, postoperative complications, range of removed lymph nodes and prognosis of the two groups were compared. Results: There was no significant difference in surgery-related status and postoperative complications between the two groups (P >0.05). The mean number of removed lymph nodes from the thoracic cavity was much higher in transthoracic group than in transabdominal group (P < 0.001), while that from the abdominal cavity was similar in both groups (P = 0.404). The thoracic lymph node metastasis rate was 18.8% in transthoracic group and 13.3% in transabdominal group. The median survival time was 29 months in transthoracic group and 28 months in transabdominal group, and the 5-year survival rates were 34.9% and 40.1% (P= 0.599). Conclusions: For the surgical treatment of adenocarcinoma of the cardia, the surgical trauma of the transthoracic approach is similar with that of transabdominal approach. The transthoracic approach has the advantage in thoracic lymph node dissection. The two approaches have no obvious effect on the prognosis.展开更多
An efficient and low-cost supported Pt catalyst for hydrogenation of niroarenes was prepared with colloid Pt precursors andα-Fe2O3 as a support.The catalyst with Pt content as low as 0.2 wt%exhibits high activities,c...An efficient and low-cost supported Pt catalyst for hydrogenation of niroarenes was prepared with colloid Pt precursors andα-Fe2O3 as a support.The catalyst with Pt content as low as 0.2 wt%exhibits high activities,chemoselectivities and stability in the hydrogenation of nitrobenzene and a variety of niroarenes.The conversion of nitrobenzene can reach 3170 molconv h^–1 molPt^–1 under mild conditions(30°C,5 bar),which is much higher than that of commercial Pt/C catalyst and many reported catalysts under similar reaction conditions.The spatial separation of the active sites for H2 dissociation and hydrogenation should be responsible for the high chemoselectivity,which decreases the contact possibility between the reducible groups of nitroarenes and Pt nanoparticles.The unique surface properties ofα-Fe2O3 play an important role in the reaction process.It provides active sites for hydrogen spillover and reactant adsorption,and ultimately completes the hydrogenation of the nitro group on the catalyst surface.展开更多
BACKGROUND Lymphovascular invasion(LVI)and perineural invasion(PNI)are important prognostic factors for gastric cancer(GC)that indicate an increased risk of metastasis and poor outcomes.Accurate preoperative predictio...BACKGROUND Lymphovascular invasion(LVI)and perineural invasion(PNI)are important prognostic factors for gastric cancer(GC)that indicate an increased risk of metastasis and poor outcomes.Accurate preoperative prediction of LVI/PNI status could help clinicians identify high-risk patients and guide treatment deci-sions.However,prior models using conventional computed tomography(CT)images to predict LVI or PNI separately have had limited accuracy.Spectral CT provides quantitative enhancement parameters that may better capture tumor invasion.We hypothesized that a predictive model combining clinical and spectral CT parameters would accurately preoperatively predict LVI/PNI status in GC patients.AIM To develop and test a machine learning model that fuses spectral CT parameters and clinical indicators to predict LVI/PNI status accurately.METHODS This study used a retrospective dataset involving 257 GC patients(training cohort,n=172;validation cohort,n=85).First,several clinical indicators,including serum tumor markers,CT-TN stages and CT-detected extramural vein invasion(CT-EMVI),were extracted,as were quantitative spectral CT parameters from the delineated tumor regions.Next,a two-step feature selection approach using correlation-based methods and information gain ranking inside a 10-fold cross-validation loop was utilized to select informative clinical and spectral CT parameters.A logistic regression(LR)-based nomogram model was subsequently constructed to predict LVI/PNI status,and its performance was evaluated using the area under the receiver operating characteristic curve(AUC).RESULTS In both the training and validation cohorts,CT T3-4 stage,CT-N positive status,and CT-EMVI positive status are more prevalent in the LVI/PNI-positive group and these differences are statistically significant(P<0.05).LR analysis of the training group showed preoperative CT-T stage,CT-EMVI,single-energy CT values of 70 keV of venous phase(VP-70 keV),and the ratio of standardized iodine concentration of equilibrium phase(EP-NIC)were independent influencing factors.The AUCs of VP-70 keV and EP-NIC were 0.888 and 0.824,respectively,which were slightly greater than those of CT-T and CT-EMVI(AUC=0.793,0.762).The nomogram combining CT-T stage,CT-EMVI,VP-70 keV and EP-NIC yielded AUCs of 0.918(0.866-0.954)and 0.874(0.784-0.936)in the training and validation cohorts,which are significantly higher than using each of single independent factors(P<0.05).CONCLUSION The study found that using portal venous and EP spectral CT parameters allows effective preoperative detection of LVI/PNI in GC,with accuracy boosted by integrating clinical markers.展开更多
AIM： To evaluate the safety and efficacy of intravitreal conbercept（IVC） injections as pretreatment for pars plana vitrectomy（PPV） in severe proliferative diabetic retinopathy（PDR）. METHODS： This was a retrosp...AIM： To evaluate the safety and efficacy of intravitreal conbercept（IVC） injections as pretreatment for pars plana vitrectomy（PPV） in severe proliferative diabetic retinopathy（PDR）. METHODS： This was a retrospective chart review of all patients who underwent PPV for PDR from January 2014 to October 2016. Patients who underwent IVC injection before PPV were assigned to the IVC group; the others were assigned to the control group. The IVC was performed 3-7 d before surgery in the IVC group. All the eyes in the two groups were operated by the same doctor to complete the vitrectomy. Intraoperative complications and the changes in best-corrected visual acuity（BCVA） before and after surgery were compared between the two groups. RESULTS： A total of 68 eyes of 63 patients（22 eyes in the IVC group and 46 eyes in the control group） were examined. The risk of intraoperative bleeding was lower in the IVC group（2/22） than in the control group（25/46, P=0.000）. Furthermore, the use of endodiathermy was significantly lower in the IVC group（1/22） than in the control group（12/46, P=0.047）. The surgical time in the IVC group（112.64±34.52 min） was significantly shorter than in the control group（132.85±40.04 min, P〈0.05）. Compared to the BCVA before surgery, the mean BCVA was significantly improved after surgery for both groups（P〈0.05）. CONCLUSION： PPV is an effective treatment and can improve vision in patients with PDR. Preoperative intravitreal injection of conbercept could reduce the chances of intraoperative bleeding and the use of endodiathermy and shorten the operative time, which are beneficial in the management of PDR.展开更多
Objective:Cervical disease,a type of chronic pain,can greatly impact quality of life.Traditional Chinese tuina,a form of therapeutic massage and manipulation,has been shown to be effective in relieving pain and other ...Objective:Cervical disease,a type of chronic pain,can greatly impact quality of life.Traditional Chinese tuina,a form of therapeutic massage and manipulation,has been shown to be effective in relieving pain and other symptoms in patients with chronic neck pain.This study applied functional magnetic resonance imaging (fMRI) to explore the features of the resting state network of patients with chronic neck pain caused by cervical radiculopathy,and how tuina affects the causality between intrinsic brain networks.Methods:Using Granger causality analysis,effective connectivity of brain networks of 10 patients with chronic neck pain was compared with 10 healthy control subjects.Resting state fMRI data were using magnetic resonance scanning.Cervical spondylosis symptom scores were evaluated before and after 4 weeks of tuina therapy.Independent component analysis was applied to extract the specific networks related to sensation,execution,and cognition,including sensorimotor network (SMN),visual network (VN),auditory network (AN),anterior and posterior default mode network (aDMN,pDMN),left frontoparietal network and right frontoparietal network.Results:Compared with the control group,data from the treatment group revealed two major findings:before tuina therapy,SMN had a profound influence on aDMN and AN greatly affected pDMN;however,after 4 weeks of tuina therapy,aDMN and SMN showed reversed causality.Conclusion:Chronic neck pain caused by cervical radiculopathy may influence the DMN,which plays an important role in emotion,cognition,and memory,by stimulating the sensory afferent network.Tuina not only significantly relieves pain and discomfort,but also reverses the causality between aDMN and SMN.展开更多
Ca3Co409/polyaniline bulk composites have been successfully fabricated by ball-milling and hot-pressing method. Our results indicate that the Seebeck coefficient can be increased nearly by 400% with adding 15 wt% 0a3C...Ca3Co409/polyaniline bulk composites have been successfully fabricated by ball-milling and hot-pressing method. Our results indicate that the Seebeck coefficient can be increased nearly by 400% with adding 15 wt% 0a3Co409 to the polyaniline. The thermal conductivity changes slightly with increasing filler content. The highest figure of merit, ZT can reach 5× 10-4 at 329 K for these bulk composites, which is almost 50 times larger than that of pure polyaniline, suggesting that the polymer-thermoelectric oxide composites are promising candidates for light-weight, low-cost and non-toxic thermoelectric applications.展开更多
BACKGROUND Since December 2019,there have been many new cases of coronavirus pneumonia in Wuhan,Hubei Province,which has gradually spread throughout the country.AIM To explore our hospital’s innovative management sys...BACKGROUND Since December 2019,there have been many new cases of coronavirus pneumonia in Wuhan,Hubei Province,which has gradually spread throughout the country.AIM To explore our hospital’s innovative management system to ensure the efficient operation of fever clinics during the epidemic,since controlling the spread of disease is an important way to prevent and control the epidemic.METHODS In total,200 outpatients with fever at our hospital between November 2019 and July 2020 were selected and allocated into two groups.RESULTS The fever clinic in our hospital operated smoothly,and infection with the novel coronavirus disease(COVID-19)has not been reported in our hospital.Additionally,we did not have any cases of missed diagnosis.The awareness regarding COVID-19 infection sources,transmission routes,early symptoms,and preventive measures was significantly higher in our fever clinic than in those of the pre-management group.CONCLUSION"An integrated system,three separate responsibilities"ensured the efficient functioning of our fever outpatient clinic and early screening of COVID-19 cases,which effectively curbed the transmission of COVID-19 and hence prevented COVID-19 pneumonia epidemic in our hospital,ultimately achieving the maximum effect of epidemic prevention and control.展开更多
基金the financial support from the China Scholarship Council(Grant No.202106370009)and Alberta Innovate Graduate Student Scholarship.
文摘Objective While there is consensus regarding a positive effect of video gaming on dexterity,little is known regarding how much traditional laparoscopic practice can or should be substituted with video gaming.This study was designed to assess the effects of varying the amount of traditional practice in a lap box trainer and video gaming on performance in two fundamentals of laparoscopic surgery core tasks.Methods Undergraduate and medical students were recruited and randomized into one of four groups:a control group,a lap box group,a video game group,and a combined group with 50%of the time allocated to each modality.Performance in the peg transfer and precision cutting tasks was assessed both prior to and following the 6 training sessions.Results Peg transfer performance significantly improved in the lap box group(168.4±70.6 s vs.332.9±178.2 s,p<0.001),video game group(176.7±53.3 s vs.300.0±101.2 s,p<0.001)and combined group(214.2±86.9 s vs.406.8±239.5 s,p=0.002)after training.Similar improvements were also observed in precision cutting performance in the lap box group(413.1±138.4 s vs.614.3±211.4 s,p=0.002),video game group(434.1±150.8 s vs.609.2±233.2 s,p=0.007)and combined group(469.2±185.3 s vs.663.8±296.3 s,p=0.020).When analyzing improvements in performance across three different training groups compared with the control group,we found that both the lap box group(p<0.001)and the combined group(p<0.001)showed better improvement in both tasks,and the video game group had significantly better outcomes in the precision cutting task(p=0.003).Conclusion Traditional lap box training remains the most effective method for improving the performance of simulated laparoscopic surgery.Video games can be encouraged to enhance skills retention and supplement simulated practice outside of a formal training curriculum.
文摘Objectives:One of the most notable challenges in endoscopic procedures is maintaining correct orientation.Mental rotation exercise(MRE)has been suggested as a potential aid for improving orientation.However,there is a lack of research on designing MREs with varying difficultylevels for training purposes.Furthermore,few studies provide solid evidence linking MRE difficultylevels with cognitive load measurements.This study aims to address this gap by investigating the correlation between the MRE difficultylevels and participants’cognitive load,as measured by pupil dilation.Method:We recruited 33 participants to perform MREs on a computer equipped with a screen-mounted eye-tracker.The test consisted of 15 MREs,with the first10 relatively easy(traditional cube)and the next 5 more complex(invented molecule).The participants’eye movements during MREs were recorded.The participants’MRE scores and pupil dilation were obtained and compared between two MRE difficultylevels.Results:The participants who performed traditional cube MREs achieved significantlybetter MRE scores(0.77±0.11 vs.0.58±0.03,p<0.001)and lower pupil dilation(0.27±0.04 pixels vs.0.47±0.09 pixels,p<0.001)than did those who performed the invented molecule MREs.Moreover,there were significant negative correlations(r=0.62,p=0.015)between pupil dilation and MRE scores.Conclusions:The results revealed a significantnegative correlation between MRE scores and pupil dilation.The more challenging MRE questions led to worse MRE scores but increased pupil dilation.The MRE difficultylevels can be evaluated not only by the degrees or dimensions with which the objects were rotated but also by the participants’MRE scores and pupil dilation.The results of this study provide a basis for training orientation skills in endoscopy using MREs.By incorporating MREs with varying difficultylevels,customized training programs can be developed to enhance camera navigation in endoscopic and laparoscopic procedures.
文摘Unlike earlier innovations that focused on manipulation and task precision,the latest surgical advancements emphasize data visualization and the acceleration of surgeons’decision-making.Before entering the operating room,digital tools help surgeons develop patient-specific approaches,outline procedural steps,and prepare strategies for managing potential crises.During the operation,relevant data appear at the right moment to assist decision-making and guide performance in formats tailored to the surgeon’s physical and cognitive state,all without causing distractions.In the future operating room,performance data from surgeons will be gathered,integrated,and analyzed to interpret surgeons’behavior and confidence.Advanced techniques,including artificial intelligence,can be employed to automatically detect moments of performance difficulty or cognitive overload.As a result,digital surgery provides timely,context-specific assistance to surgeons in high-stakes situations.Key components of digital surgery are highlighted in this narrative review.
基金the financialsupport from the China Scholarship Council(Grant No.202106370009)Alberta Innovate Graduate Student Scholarship.
文摘The cognitive load plays a key role in surgical education,influencingtask performance and skill acquisition.This review explores three primary approaches to assessing cognitive load in the surgical context—paper-based measures,physiological measures,and performance-based measures—and highlights their relevance and applications in surgical education.Paper-based tools,such as the NASA Task Load Index and its surgical adaptation,the Surgery Task Load Index,offer simplicity but lack realtime insight.Physiological measures,including heart rate,eye tracking,and electrodermal activity,provide objective and timely data.Neuroimaging techniques,such as electroencephalography and functional near-infrared spectroscopy,provide direct evidence of brain activity but face challenges such as cost and complexity.Performance-based metrics,such as secondary tasks,infer cognitive load from working memory capacity.Accurate assessment of cognitive load can improve training outcomes by adapting demands to cognitive capacity.Future directions include the development of more accurate,multimodal,and user-friendly tools for dynamic,timely assessment,ultimately advancing personalized surgical training and improving patient care.
基金supported by the Natural Science Foundation of China(52063005)Guizhou Province Science and Technology Achievement Transformation Project[2025]general 020Central Guiding Local Science and Technology Development Funds[2024]020 and[2025]013,ZZSG[2024]015,KXJZ[2025]037.
文摘The pursuit of safer energy storage systems is driving the development of advanced electrolytes for lithium-ion batteries.Traditional liquid electrolytes pose flammability risks,while solid-state alternatives often suffer from low ionic conductivity.Gel polymer electrolytes(GPEs)emerge as a promising compromise,combining the safety of solids with the ionic conductivity of liquids.Cellulose,an abundant and eco-friendly polymer,presents an ideal base material for sustainable GPEs due to its biocompatibility and mechanical strength.This study systematically investigates how drying methods affect cellulose-based GPEs.Cellulose hydrogels were synthesized through dissolution-crosslinking and processed using vacuum drying(VD),supercritical drying(SCD),and freeze-drying(FD).VD and SCD produced dense membranes with excellent mechanical strength(7.2 MPa)but limited electrolyte uptake(30%–40%).In contrast,FD created a highly porous structure(21.13%porosity)with remarkable electrolyte absorption(638%),leading to superior ionic conductivity(1.22 mS⋅cm^(-1))and lithium-ion transference number(0.28).However,this came at the cost of increased interfacial impedance and poor rate capability,resulting in 81.24%capacity retention after 100 cycles.These findings illuminate the critical balance between electrochemical performance and mechanical properties in cellulose GPEs,providing valuable insights for designing sustainable electrolytes for flexible electronics and electric vehicles.
文摘Objective:Interpersonal brain synchronization(IBS)has emerged as a significant concept in understanding collaborative team dynamics,with functional near-infrared spectroscopy(fNIRS)proving to be a vital tool in its assessment.This review aims to collate and analyze the literature on the application of fNIRS in various team settings,emphasizing its potential utility in surgical environments.Methods:A thorough search and screening process across multiple databases resulted in 17 studies being reviewed,with a focus on the utilization of fNIRS to measure IBS in different collaborative tasks.This review examined the tasks employed,participant demographics,organizational structures of teams,methodologies for IBS measurement,and correlations between brain synchronization and behavioral measurements.Results:fNIRS emerged as a non-invasive,cost-effective,and portable tool,predominantly used to assess IBS in pair-based tasks with a variety of participant demographics.Wavelet transform coherence was the primary method used for measuring synchronization,particularly in the prefrontal brain region.A consistent correlation was found between increased brain synchronization and enhanced team performance,underscoring the potential of fNIRS in understanding and optimizing team dynamics.Conclusion:This review establishes fNIRS as a promising tool for investigating the neural mechanisms underlying team cooperation,providing invaluable insights for potential applications in surgical settings.While acknowledging the limitations in the current literature,the review highlights the need for further research with larger sample sizes and varied task complexities to solidify the understanding of IBS and its impact on team performance.The ultimate goal is to leverage fNIRS in assessing and improving surgical team dynamics,contributing to improved patient outcomes and safety.
文摘Objective Reliable and objective methods for assessing surgical skill are essential for improving surgical skills and clinical outcomes.While conventional methods rely on subjective evaluations,motion analysis can offer a quantitative alternative.This study aims to use motion tracking data to analyze the motion smoothness and bimanual coordination of various surgical skill levels during laparoscopic surgery.Methods The participants were recruited and grouped into an expert group,an intermediate group,and a novice group on the basis of their experience with laparoscopic surgery.They completed peg transfer,bimanual peg transfer,and rubber band translocation tasks.Motion smoothness was assessed via logarithmic dimensionless tooltip motion jerk,and the dynamic time warping metric of tooltips velocities was employed to assess bimanual coordination.Results Seventeen participants,with four experts,five intermediates,and eight novices,were included.Compared with novices,the experts exhibited smoother motion in both the dominant hand(peg transfer:16.30 vs.18.05,p=0.004;bimanual peg transfer:15.21 vs.17.45,p=0.004;rubber band translocation:14.32 vs.15.87,p=0.004)and non-dominant hand(peg transfer:16.32 vs.18.22,p=0.004;bimanual peg transfer:15.32 vs.17.52,p=0.004;rubber band translocation:14.33 vs.15.77,p=0.004),and superior bimanual coordination(peg transfer:8.77 m/s vs.13.28 m/s,p=0.004;bimanual peg transfer:6.29 m/s vs.11.13 m/s,p=0.004;rubber band translocation:4.50 m/s vs.7.13 m/s,p=0.004)across all tasks.They also outperformed intermediates in motion smoothness in the non-dominant hand and bimanual coordination in the peg transfer(16.32 vs.17.35,p=0.016;8.77 m/s vs.11.89 m/s,p=0.016)and bimanual peg transfer(15.32 vs.16.22,p=0.016;6.29 m/s vs.8.63 m/s,p=0.032)tasks.Similarly,intermediates demonstrated smoother motion in the non-dominant hand(peg transfer:17.35 vs.18.22,p=0.002;bimanual peg transfer:16.22 vs.17.52,p=0.002)and dominant hand(bimanual peg transfer:16.06 vs.17.45,p=0.011),and better bimanual coordination(peg transfer:11.89 m/s vs.13.28 m/s,p=0.002;bimanual peg transfer:8.63 m/s vs.11.13 m/s,p=0.002)than novices did in these tasks.Conclusion This study revealed that motion smoothness and bimanual coordination are capable of facilitating surgical skill differentiation across various skill levels.These findings underscore the utility of motion metrics for objective surgical skill assessment,potentially reducing the subjectivity,bias,and associated costs of conventional assessment approaches.
基金supported by the National Key Research and Development Program of China(2021YFC2600503)National Natural Science Foundation of China(32271400)Elderly Health&Happiness Major Program of the China Ageing Development Foundation(EHH20211002 and EHH20211001)。
文摘Photothermal therapy(PTT)uses heat generated by photothermal agents to efficiently kill cancer cells in the least invasive manner.Inorganic nanoparticles,such as precious metals and carbon nanoparticles,have been extensively studied for their ability to convert near-infrared(NIR)light(700-900 nm)into heat[1].However,these nanoparticles are easily captured by the reticuloendothelial system,which severely limits their clinical applications[2].Despite targeted and stealth modifications,these issues remain unresolved;therefore,researchers are seeking more effective methods.
文摘The primary energy demand increases, but a large amount of waste heat resources w</span><span style="font-family:Verdana;">ere </span><span style="font-family:Verdana;">not effectively used. To explore the influence of particle stacking structure on waste heat recovery process, CFD method was used to simulate. An unsteady heat transfer model of two particles was established, effect of particle stacking angle on heat transfer characteristics of the particles close to the wall under different initial temperature conditions was studied. Results show that: higher initial temperature, resulting in increased heat transfer time, the larger particle stacking angle causes the shortening of heat transfer time. When initial temperature is 1073</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">K, the average wall heat flux shows a trend of rapid decline first and then a slow one. At the same moment, the larger stacking angle causes smaller particle average temperature. The change of particle stacking angle shows a greater impact on the temperature of the particles close to adiabatic wall. The increase in the stacking angle resulting in better heat transfer characteristics between particles.
文摘Background and Objective: Transthoracic and transabdominal approaches are commonly used for the surgical treatment of adenocarcinoma of the cardia. Which approach is better has been controversial for quite a long time. Our study aimed to compare the surgical trauma, range of lymph node dissection, and the prognosis of the transthoracic and transabdominal approaches for the treatment of adenocarcinoma of the cardia. Methods: The medical records of 331 patients with adenocarcinoma of the cardia treated in our hospital between 1994 and 2003 were analyzed. Of the 331 patients, 284 underwent operation via transthoracic approach and 47 via transabdominal approach. Surgery-related status, postoperative complications, range of removed lymph nodes and prognosis of the two groups were compared. Results: There was no significant difference in surgery-related status and postoperative complications between the two groups (P >0.05). The mean number of removed lymph nodes from the thoracic cavity was much higher in transthoracic group than in transabdominal group (P < 0.001), while that from the abdominal cavity was similar in both groups (P = 0.404). The thoracic lymph node metastasis rate was 18.8% in transthoracic group and 13.3% in transabdominal group. The median survival time was 29 months in transthoracic group and 28 months in transabdominal group, and the 5-year survival rates were 34.9% and 40.1% (P= 0.599). Conclusions: For the surgical treatment of adenocarcinoma of the cardia, the surgical trauma of the transthoracic approach is similar with that of transabdominal approach. The transthoracic approach has the advantage in thoracic lymph node dissection. The two approaches have no obvious effect on the prognosis.
基金supported by the National Natural Science Foundation of China(21473073,21473074)‘‘13th Five-Year’’ Science and Technology Research of the Education Department of Jilin Province(2016403)+1 种基金the Development Project of Science and Technology of Jilin Province(20170101171JC,20180201068SF)the Open Project of State Key Laboratory of Inorganic Synthesis and Preparative Chemistry(201703)~~
文摘An efficient and low-cost supported Pt catalyst for hydrogenation of niroarenes was prepared with colloid Pt precursors andα-Fe2O3 as a support.The catalyst with Pt content as low as 0.2 wt%exhibits high activities,chemoselectivities and stability in the hydrogenation of nitrobenzene and a variety of niroarenes.The conversion of nitrobenzene can reach 3170 molconv h^–1 molPt^–1 under mild conditions(30°C,5 bar),which is much higher than that of commercial Pt/C catalyst and many reported catalysts under similar reaction conditions.The spatial separation of the active sites for H2 dissociation and hydrogenation should be responsible for the high chemoselectivity,which decreases the contact possibility between the reducible groups of nitroarenes and Pt nanoparticles.The unique surface properties ofα-Fe2O3 play an important role in the reaction process.It provides active sites for hydrogen spillover and reactant adsorption,and ultimately completes the hydrogenation of the nitro group on the catalyst surface.
基金Supported by Science and Technology Project of Fujian Province,No.2022Y0025.
文摘BACKGROUND Lymphovascular invasion(LVI)and perineural invasion(PNI)are important prognostic factors for gastric cancer(GC)that indicate an increased risk of metastasis and poor outcomes.Accurate preoperative prediction of LVI/PNI status could help clinicians identify high-risk patients and guide treatment deci-sions.However,prior models using conventional computed tomography(CT)images to predict LVI or PNI separately have had limited accuracy.Spectral CT provides quantitative enhancement parameters that may better capture tumor invasion.We hypothesized that a predictive model combining clinical and spectral CT parameters would accurately preoperatively predict LVI/PNI status in GC patients.AIM To develop and test a machine learning model that fuses spectral CT parameters and clinical indicators to predict LVI/PNI status accurately.METHODS This study used a retrospective dataset involving 257 GC patients(training cohort,n=172;validation cohort,n=85).First,several clinical indicators,including serum tumor markers,CT-TN stages and CT-detected extramural vein invasion(CT-EMVI),were extracted,as were quantitative spectral CT parameters from the delineated tumor regions.Next,a two-step feature selection approach using correlation-based methods and information gain ranking inside a 10-fold cross-validation loop was utilized to select informative clinical and spectral CT parameters.A logistic regression(LR)-based nomogram model was subsequently constructed to predict LVI/PNI status,and its performance was evaluated using the area under the receiver operating characteristic curve(AUC).RESULTS In both the training and validation cohorts,CT T3-4 stage,CT-N positive status,and CT-EMVI positive status are more prevalent in the LVI/PNI-positive group and these differences are statistically significant(P<0.05).LR analysis of the training group showed preoperative CT-T stage,CT-EMVI,single-energy CT values of 70 keV of venous phase(VP-70 keV),and the ratio of standardized iodine concentration of equilibrium phase(EP-NIC)were independent influencing factors.The AUCs of VP-70 keV and EP-NIC were 0.888 and 0.824,respectively,which were slightly greater than those of CT-T and CT-EMVI(AUC=0.793,0.762).The nomogram combining CT-T stage,CT-EMVI,VP-70 keV and EP-NIC yielded AUCs of 0.918(0.866-0.954)and 0.874(0.784-0.936)in the training and validation cohorts,which are significantly higher than using each of single independent factors(P<0.05).CONCLUSION The study found that using portal venous and EP spectral CT parameters allows effective preoperative detection of LVI/PNI in GC,with accuracy boosted by integrating clinical markers.
基金Supported by the National Science and Technology Major Project of the Ministry of Science and Technology of China(No.2014ZX09303301)the Science and Technology Department of Major Scientific and Technological Projects of Major Social Development Projects of Zhejiang Province(No.2013C03048-3)+1 种基金the Medical and Health Platform Project of Zhejiang Province(No.2016RCB012)the Medical Key Subject of Zhejiang Province(No.2016CXXK2)
文摘AIM： To evaluate the safety and efficacy of intravitreal conbercept（IVC） injections as pretreatment for pars plana vitrectomy（PPV） in severe proliferative diabetic retinopathy（PDR）. METHODS： This was a retrospective chart review of all patients who underwent PPV for PDR from January 2014 to October 2016. Patients who underwent IVC injection before PPV were assigned to the IVC group; the others were assigned to the control group. The IVC was performed 3-7 d before surgery in the IVC group. All the eyes in the two groups were operated by the same doctor to complete the vitrectomy. Intraoperative complications and the changes in best-corrected visual acuity（BCVA） before and after surgery were compared between the two groups. RESULTS： A total of 68 eyes of 63 patients（22 eyes in the IVC group and 46 eyes in the control group） were examined. The risk of intraoperative bleeding was lower in the IVC group（2/22） than in the control group（25/46, P=0.000）. Furthermore, the use of endodiathermy was significantly lower in the IVC group（1/22） than in the control group（12/46, P=0.047）. The surgical time in the IVC group（112.64±34.52 min） was significantly shorter than in the control group（132.85±40.04 min, P〈0.05）. Compared to the BCVA before surgery, the mean BCVA was significantly improved after surgery for both groups（P〈0.05）. CONCLUSION： PPV is an effective treatment and can improve vision in patients with PDR. Preoperative intravitreal injection of conbercept could reduce the chances of intraoperative bleeding and the use of endodiathermy and shorten the operative time, which are beneficial in the management of PDR.
基金This research was supported by the Young Teachers Foundation of Beijing University of Chinese Medicine,No.2013-JYBZZ-JS-047The funders had no role in study design,data collection and analysis,decision to publish,or preparation of the manuscript.
文摘Objective:Cervical disease,a type of chronic pain,can greatly impact quality of life.Traditional Chinese tuina,a form of therapeutic massage and manipulation,has been shown to be effective in relieving pain and other symptoms in patients with chronic neck pain.This study applied functional magnetic resonance imaging (fMRI) to explore the features of the resting state network of patients with chronic neck pain caused by cervical radiculopathy,and how tuina affects the causality between intrinsic brain networks.Methods:Using Granger causality analysis,effective connectivity of brain networks of 10 patients with chronic neck pain was compared with 10 healthy control subjects.Resting state fMRI data were using magnetic resonance scanning.Cervical spondylosis symptom scores were evaluated before and after 4 weeks of tuina therapy.Independent component analysis was applied to extract the specific networks related to sensation,execution,and cognition,including sensorimotor network (SMN),visual network (VN),auditory network (AN),anterior and posterior default mode network (aDMN,pDMN),left frontoparietal network and right frontoparietal network.Results:Compared with the control group,data from the treatment group revealed two major findings:before tuina therapy,SMN had a profound influence on aDMN and AN greatly affected pDMN;however,after 4 weeks of tuina therapy,aDMN and SMN showed reversed causality.Conclusion:Chronic neck pain caused by cervical radiculopathy may influence the DMN,which plays an important role in emotion,cognition,and memory,by stimulating the sensory afferent network.Tuina not only significantly relieves pain and discomfort,but also reverses the causality between aDMN and SMN.
基金supported by the National Basic Research Program of China("973 Program",No.2013CB632506)the National Natural Science Foundation of China(No.51025205)the Specialized Research Fund for the Doctoral Program of Higher Education(No.20120002110006)
文摘Ca3Co409/polyaniline bulk composites have been successfully fabricated by ball-milling and hot-pressing method. Our results indicate that the Seebeck coefficient can be increased nearly by 400% with adding 15 wt% 0a3Co409 to the polyaniline. The thermal conductivity changes slightly with increasing filler content. The highest figure of merit, ZT can reach 5× 10-4 at 329 K for these bulk composites, which is almost 50 times larger than that of pure polyaniline, suggesting that the polymer-thermoelectric oxide composites are promising candidates for light-weight, low-cost and non-toxic thermoelectric applications.
基金Supported by the Zhejiang Natural Science Foundation of China,No.LGF18H030009.
文摘BACKGROUND Since December 2019,there have been many new cases of coronavirus pneumonia in Wuhan,Hubei Province,which has gradually spread throughout the country.AIM To explore our hospital’s innovative management system to ensure the efficient operation of fever clinics during the epidemic,since controlling the spread of disease is an important way to prevent and control the epidemic.METHODS In total,200 outpatients with fever at our hospital between November 2019 and July 2020 were selected and allocated into two groups.RESULTS The fever clinic in our hospital operated smoothly,and infection with the novel coronavirus disease(COVID-19)has not been reported in our hospital.Additionally,we did not have any cases of missed diagnosis.The awareness regarding COVID-19 infection sources,transmission routes,early symptoms,and preventive measures was significantly higher in our fever clinic than in those of the pre-management group.CONCLUSION"An integrated system,three separate responsibilities"ensured the efficient functioning of our fever outpatient clinic and early screening of COVID-19 cases,which effectively curbed the transmission of COVID-19 and hence prevented COVID-19 pneumonia epidemic in our hospital,ultimately achieving the maximum effect of epidemic prevention and control.
