Purpose: Surgical templates produced by digital simulation and CAD/CAM allow for three-dimensional control of implant placement. However, due to clinical limitations, there are complications during the use of the temp...Purpose: Surgical templates produced by digital simulation and CAD/CAM allow for three-dimensional control of implant placement. However, due to clinical limitations, there are complications during the use of the template. The purpose of this study was to summarize the complications associated with the use of surgical templates for static computer-aided implant surgery. Methods: Complications were collected during the observation period, and then their implant sites were reanalyzed with simulation software. Results: There were 104 cases during the observation period, 5 cases had complications. Mechanical complications were observed in four cases, including three cases in which the frame of the template fractured during implant placement surgery and one case in which the sleeve fell off the surgical template. In one case, there was an error in the planned position. All cases were mandibular molar cases, and all cases of frame fracture were at the free end defect site. All cases had a Hounsfield unit of more than 700 at the implant site, and some of them had a significantly small jaw opening. Conclusion: Although the spread of CAD/CAM surgical templates has made it possible to avoid problems caused by the position of the implant, it has been difficult to avoid fractures in cases of mandibular free end defects with high Hounsfield unit.展开更多
BACKGROUND Computer-aided diagnosis(CAD)may assist endoscopists in identifying and classifying polyps during colonoscopy for detecting colorectal cancer.AIM To build a system using CAD to detect and classify polyps ba...BACKGROUND Computer-aided diagnosis(CAD)may assist endoscopists in identifying and classifying polyps during colonoscopy for detecting colorectal cancer.AIM To build a system using CAD to detect and classify polyps based on the Yamada classification.METHODS A total of 24045 polyp and 72367 nonpolyp images were obtained.We established a computer-aided detection and Yamada classification model based on the YOLOv7 neural network algorithm.Frame-based and image-based evaluation metrics were employed to assess the performance.RESULTS Computer-aided detection and Yamada classification screened polyps with a precision of 96.7%,a recall of 95.8%,and an F1-score of 96.2%,outperforming those of all groups of endoscopists.In regard to the Yamada classification of polyps,the CAD system displayed a precision of 82.3%,a recall of 78.5%,and an F1-score of 80.2%,outper-forming all levels of endoscopists.In addition,according to the image-based method,the CAD had an accuracy of 99.2%,a specificity of 99.5%,a sensitivity of 98.5%,a positive predictive value of 99.0%,a negative predictive value of 99.2%for polyp detection and an accuracy of 97.2%,a specificity of 98.4%,a sensitivity of 79.2%,a positive predictive value of 83.0%,and a negative predictive value of 98.4%for poly Yamada classification.CONCLUSION We developed a novel CAD system based on a deep neural network for polyp detection,and the Yamada classi-fication outperformed that of nonexpert endoscopists.This CAD system could help community-based hospitals enhance their effectiveness in polyp detection and classification.展开更多
Jaundice,common condition in newborns,is characterized by yellowing of the skin and eyes due to elevated levels of bilirubin in the blood.Timely detection and management of jaundice are crucial to prevent potential co...Jaundice,common condition in newborns,is characterized by yellowing of the skin and eyes due to elevated levels of bilirubin in the blood.Timely detection and management of jaundice are crucial to prevent potential complications.Traditional jaundice assessment methods rely on visual inspection or invasive blood tests that are subjective and painful for infants,respectively.Although several automated methods for jaundice detection have been developed during the past few years,a limited number of reviews consolidating these developments have been presented till date,making it essential to systematically evaluate and present the existing advancements.This paper fills this gap by providing a thorough survey of automated methods for jaundice detection in neonates.The primary focus of the survey is to review the existing methodologies,techniques,and technologies used for neonatal jaundice detection.The key findings from the review indicate that image-based bilirubinometers and transcutaneous bilirubinometers are promising non-invasive alternatives,and provide a good trade-off between accuracy and ease of use.However,their effectiveness varies with factors like skin pigmentation,gestational age,and measurement site.Spectroscopic and biosensor-based techniques show high sensitivity but need further clinical validation.Despite advancements,several challenges including device calibration,large-scale validation,and regulatory barriers still haunt the researchers.Standardization,regulatory compliances,and seamless integration into healthcare workflows are the key hurdles to be addressed.By consolidating the current knowledge and discussing the challenges and opportunities in this field,this survey aims to contribute to the advancement of automatic jaundice detection and ultimately improve neonatal care.展开更多
With the development of artificial intelligence technology,AI computer-aided diagnosis has found certain applications in the field of dermatology.However,due to the vast variety and complex manifestations of skin dise...With the development of artificial intelligence technology,AI computer-aided diagnosis has found certain applications in the field of dermatology.However,due to the vast variety and complex manifestations of skin diseases,the specific mechanisms underlying AI computer-aided diagnosis in this context still require further exploration.Therefore,this paper,based on the imaging characteristics of skin diseases,elucidates the technical principles of AI computer-aided diagnosis and analyzes the practical application effects of AI in the diagnostic process of skin diseases.This provides new data support and methodological foundations for clinical teaching and research on skin diseases.展开更多
BACKGROUND Early detection of precancerous lesions is of vital importance for reducing the incidence and mortality of upper gastrointestinal(UGI)tract cancer.However,traditional endoscopy has certain limitations in de...BACKGROUND Early detection of precancerous lesions is of vital importance for reducing the incidence and mortality of upper gastrointestinal(UGI)tract cancer.However,traditional endoscopy has certain limitations in detecting precancerous lesions.In contrast,real-time computer-aided detection(CAD)systems enhanced by artificial intelligence(AI)systems,although they may increase unnecessary medical procedures,can provide immediate feedback during examination,thereby improving the accuracy of lesion detection.This article aims to conduct a meta-analysis of the diagnostic performance of CAD systems in identifying precancerous lesions of UGI tract cancer during esophagogastroduodenoscopy(EGD),evaluate their potential clinical application value,and determine the direction for further research.AIM To investigate the improvement of the efficiency of EGD examination by the realtime AI-enabled real-time CAD system(AI-CAD)system.METHODS PubMed,EMBASE,Web of Science and Cochrane Library databases were searched by two independent reviewers to retrieve literature with per-patient analysis with a deadline up until April 2025.A meta-analysis was performed with R Studio software(R4.5.0).A random-effects model was used and subgroup analysis was carried out to identify possible sources of heterogeneity.RESULTS The initial search identified 802 articles.According to the inclusion criteria,2113 patients from 10 studies were included in this meta-analysis.The pooled accuracy difference,logarithmic difference of diagnostic odds ratios,sensitivity,specificity and the area under the summary receiver operating characteristic curve(area under the curve)of both AI group and endoscopist group for detecting precancerous lesion were 0.16(95%CI:0.12-0.20),-0.19(95%CI:-0.75-0.37),0.89(95%CI:0.85-0.92,AI group),0.67(95%CI:0.63-0.71,endoscopist group),0.89(95%CI:0.84-0.93,AI group),0.77(95%CI:0.70-0.83,endoscopist group),0.928(95%CI:0.841-0.948,AI group),0.722(95%CI:0.677-0.821,endoscopist group),respectively.CONCLUSION The present studies further provide evidence that the AI-CAD is a reliable endoscopic diagnostic tool that can be used to assist endoscopists in detection of precancerous lesions in the UGI tract.It may be introduced on a large scale for clinical application to enhance the accuracy of detecting precancerous lesions in the UGI tract.展开更多
The development of pancreatic surgery in China has progressed remarkably over 7 decades.China initiated its pancreatic surgery journey in the 1950s,marked by the first pancreaticoduodenectomy performed by Zeng Xianjiu...The development of pancreatic surgery in China has progressed remarkably over 7 decades.China initiated its pancreatic surgery journey in the 1950s,marked by the first pancreaticoduodenectomy performed by Zeng Xianjiu in 1951.Early progress was hindered by technological limitations and fragmented practices,but the establishment of academic platforms such as the National Pancreatic Disease Symposia in the 1980s catalyzed standardized research and interdisciplinary collaboration.In 2006,Zhang Shengdao spearheaded China’s first Guidelines for the Diagnosis and Treatment of Severe Acute Pancreatitis.The 21st century has seen remarkable progress in pancreatic surgery,marked by the China-specific treatment guidelines,technological breakthroughs in laparoscopic and robotic surgical systems,and the increasing centralization of pancreatic surgery in high-volume medical centers.These synergistic advancements have collectively propelled a paradigm shift in contemporary cancer care.By 2022,China Pancreas Data Center reported a postoperative mortality rate of 0.4% and 3-year survival rates of 43% for resected pancreatic cancer,rivaling global benchmarks.China has also emerged as a leader in minimally invasive pancreatic surgery,with advancements in laparoscopic and robotic pancreatic surgery.Academic growth paralleled clinical progress:the Chinese Pancreatic Association,established in 2022,fosters global collaboration,evidenced by its 2024 annual conference attracting over 10,000 participants.Through technological innovation,centralized care models,and international partnerships,China continues to redefine its role in advancing pancreatic surgery.展开更多
The year 2025 marked a significantmilestone for Laparoscopic,Endoscopic and Robotic Surgery(LERS)—we have awarded our first Impact Factor of 2.0 released by the Journal Citation Reports from Clarivate Analytics,which...The year 2025 marked a significantmilestone for Laparoscopic,Endoscopic and Robotic Surgery(LERS)—we have awarded our first Impact Factor of 2.0 released by the Journal Citation Reports from Clarivate Analytics,which ranks in the second quartile in the surgery category.This remarkable achievement,which reflects LERS’s steadily increasing influencein the area of surgery,would not be possible without the peer reviewer’s invaluable contributions.On behalf of the Editorial Board and Editorial Office,we would express our sincere appreciation to the following reviewers,who reviewed at least one paper with rigorous and insightful comments.We sincerely hope to engage further with them,either as esteemed reviewers or outstanding authors,in 2026 and beyond.展开更多
Objective:To explore the relationship between anesthetic depth and surgical stress response in minimally invasive cardiothoracic surgery.Methods:A total of 89 patients who underwent thoracoscopic minimally invasive ca...Objective:To explore the relationship between anesthetic depth and surgical stress response in minimally invasive cardiothoracic surgery.Methods:A total of 89 patients who underwent thoracoscopic minimally invasive cardiothoracic surgery in our hospital from June 2024 to December 2024 were selected as the research objects.They were divided into the light anesthesia group(n=45)and the deep anesthesia group(n=44).The vital signs at different intraoperative nodes and perioperative stress status of the two groups were compared.Results:Before lesion resection and after surgery,the mean arterial pressure and heart rate of the deep anesthesia group were lower than those of the light anesthesia group,with statistically significant differences.Conclusion:In thoracoscopic minimally invasive cardiothoracic surgery,deep anesthesia can effectively control the patient’s surgical stress response,but the postoperative awakening time is longer;patients under light anesthesia have a shorter awakening time,but the intraoperative stress response is obvious.展开更多
1Introduction A 25-year-old woman presented with a 3-month history of otalgia and aural fullness in the left ear,without associated otological or systemic symptoms.Her medical history was unremarkable,and she denied a...1Introduction A 25-year-old woman presented with a 3-month history of otalgia and aural fullness in the left ear,without associated otological or systemic symptoms.Her medical history was unremarkable,and she denied any history of hepatitis,hypertension,diabetes,cardiovascular disease,or other significant conditions.The patient was diagnosed with external auditory canal cholesteatoma and subsequently underwent canalplasty under general anesthesia.Routine anesthetic drugs,including 2%lidocaine,dexamethasone,propofol,sufentanil,rocuronium bromide,ondansetron,flurbiprofen axetil,neostigmine,and atropine,were used during surgery and anesthesia recovery.No significant events were noted,and the patient experienced only a blood loss of 10 mL.展开更多
Background Computed tomography(CT) and cone-beam computed tomography(CBCT) image registration play pivotal roles in computer-assisted navigation for orthopedic surgery. Traditional methods often apply uniform deformat...Background Computed tomography(CT) and cone-beam computed tomography(CBCT) image registration play pivotal roles in computer-assisted navigation for orthopedic surgery. Traditional methods often apply uniform deformation models, neglecting the biomechanical differences between rigid structures and soft tissues, which compromises registration accuracy, especially during significant bone displacements. Method To address this issue, we introduce RE-Reg, a rigid-elastic CT-CBCT image registration framework that jointly learns rigid bone motion and soft tissue deformation. RE-Reg incorporates a rigid alignment(RA) module to estimate global bone motion and an elastic deformation(ED) module to model soft tissue deformation, preserving bony structures through bone shape preservation(BSP) loss. Result Our comprehensive evaluation on publicly available datasets demonstrates that RE-Reg significantly outperforms existing methods in terms of registration accuracy and rigid bone structure preservation, achieving a 1.3% improvement in Dice similarity coefficient(DSC) and a 23% reduction in rigid bone deformation(%Δvol) compared with the best baseline. Conclusion This framework not only enhances anatomical fidelity but also ensures biomechanical plausibility and provides a valuable tool for image-guided orthopedic surgery. This code is available athttps://github.com/Zq-Huang/RE-Reg.展开更多
AIM:To assess the visual acuity and visual quality of cataract patients who received femtosecond laser-assisted cataract surgery(FLACS)and multifocal intraocular lens(MIOL)implantation with an improved polishing techn...AIM:To assess the visual acuity and visual quality of cataract patients who received femtosecond laser-assisted cataract surgery(FLACS)and multifocal intraocular lens(MIOL)implantation with an improved polishing technique during a 1-year follow-up period.METHODS:This study included 74 eyes from 37 patients,comprising 17 males and 20 females,with a mean age of 51.74±7.80 years.Using a coin toss method,one eye per patient was randomly selected for improved anterior capsular polishing,while the other eye received standard irrigation/aspiration(I/A)polishing.The polishing group consisted of 37 eyes,including 21 right and 16 left eyes,while the control group comprised the contralateral fellow eyes of the same individuals in the polishing group.Visual acuity and quality of the patients were evaluated before surgery and at 1 wk,1,6,and 12 mo after surgery.The OPD-Scan III was utilized to assess high-order aberrations,while the optical quality analysis system(OQAS)was employed to evaluate modulation transfer function(MTF cutoff),Strehl ratio(SR),and objective scatter index(OSI)for the purpose of visual quality assessment.Paired t-tests and repeated measures analysis of variance(ANOVA)were utilized to compare the results,and the SNK-q post hoc test was applied to identify significant differences.RESULTS:The polishing group’s uncorrected distant visual acuity(UDVA)and uncorrected near visual acuity(UNVA)significantly improved 1-week post-surgery(all P<0.05).At 12-months,UDVA,UNVA,and corrected distant visual acuity(CDVA)were better than the control group(P<0.05).The MTF cutoff,SR,OSI,and high-order aberrations in the polishing group also showed significant improvements compared to the control group at 12 mo(P<0.05).CONCLUSION:The improved capsular polishing method has been demonstrated to effectively maintain visual acuity and visual quality in patients with MIOL after FLACS within 1 a.展开更多
The concept of Damage Control Surgery(DCS)emphasizes prioritizing hemorrhage control,preventing hypothermia,correcting coagulopathy,and acidosis in trauma treatment.The application of the DCS concept in trauma treatme...The concept of Damage Control Surgery(DCS)emphasizes prioritizing hemorrhage control,preventing hypothermia,correcting coagulopathy,and acidosis in trauma treatment.The application of the DCS concept in trauma treatment at grassroots hospitals faces numerous challenges such as limited resources,high technical difficulty,and insufficient multidisciplinary collaboration.Therefore,DCS strategies need to be adapted to simplified processes to create conditions for subsequent treatment.This paper retrieves relevant literature to discuss the proposal,promotion,and application of the DCS concept,aiming to provide evidence-based basis for optimizing trauma treatment outcomes at grassroots hospitals.展开更多
Background:Pressure injury(PI)is a prevalent complication in pediatric cardiac surgery,with higher incidence than in general pediatric populations due to children’s thin skin,underdeveloped subcutaneous tissue,and pr...Background:Pressure injury(PI)is a prevalent complication in pediatric cardiac surgery,with higher incidence than in general pediatric populations due to children’s thin skin,underdeveloped subcutaneous tissue,and prolonged intraoperative pressure.Objective:To evaluate the effectiveness of the curvilinear supine position(CSP)in preventing PI among children undergoing congenital heart disease(CHD)surgery.Methods:Between October 2024 and February 2025,a single-center randomized controlled trial was conducted.Of the 80 children initially enrolled for congenital heart disease(CHD)surgery,77(aged 1 month to 14 years)completed the study and were included in the final analysis after 3 were excluded due to protocol violations.Participants were randomly assigned to the CSP group(n=38)or the conventional supine position group(n=39).Results:The incidence of PI was significantly lower in the CSP group(2.6%)compared to the control group(20.5%)(p=0.029).Postoperative LDH levels were also significantly reduced in the CSP group(422.67±86.52 U/L vs.592.92±215.71 U/L;p=0.031),while preoperative LDH and surgical variables(e.g.,cardiopulmonary bypass time)were comparable between groups.Although the CSP group had a shorter hospital stay(17.24 vs.22.51 days),the difference was not statistically significant(p=0.085).Caregiver satisfaction was significantly higher in the CSP group(100.0%vs.84.6%;p=0.025).Conclusion:CSP effectively reduces PI incidence,mitigates tissue injury,and enhances caregiver satisfaction in pediatric cardiac surgery,offering a safe and feasible strategy for perioperative PI prevention.展开更多
Objective:To analyze the impact of nursing interventions based on quantitative assessment using the Kano model on the quality of rehabilitation in patients with early-stage ovarian cancer following laparoscopic radica...Objective:To analyze the impact of nursing interventions based on quantitative assessment using the Kano model on the quality of rehabilitation in patients with early-stage ovarian cancer following laparoscopic radical surgery.Methods:A prospective clinical study was conducted involving 96 patients with newly diagnosed early-stage ovarian cancer who underwent laparoscopic radical surgery from December 2023 to December 2025.Patients were randomly assigned to groups using a random number table method before surgery.After surgery,the control group(n=48)received routine quantitative assessment nursing interventions,while the observation group(n=48)received nursing interventions based on quantitative assessment using the Kano model.Both groups received continuous nursing care until discharge.Differences between the groups were compared in terms of negative emotions,quality of life scores before and after postoperative intervention,postoperative recovery indicators,and nursing satisfaction evaluations on the day of discharge.Results:After intervention,the observation group had lower scores on the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS),as well as shorter recovery times for gastrointestinal function and food intake,and a shorter hospital stay compared to the control group.Additionally,the observation group had higher scores on the Quality-of-Life Instrument for Cancer Patients-Ovarian Cancer(QLICP-OV)than the control group,with statistically significant differences(p<0.05).The overall satisfaction with nursing care in the observation group was also higher than that in the control group,with a statistically significant difference(p<0.05).Conclusion:Implementing quantitative evaluation nursing interventions based on the Kano model for patients with early-stage ovarian cancer after laparoscopic radical surgery can,by addressing their postoperative basic health,disease awareness,and other intervention content needs to a comprehensive degree,actively promote postoperative recovery and improve their mental health and quality of life.展开更多
BACKGROUND Gastrointestinal(GI)tumors are among the most prevalent malignancies,and surgical intervention remains a primary treatment modality.However,the complexity of GI surgery often leads to prolonged recovery and...BACKGROUND Gastrointestinal(GI)tumors are among the most prevalent malignancies,and surgical intervention remains a primary treatment modality.However,the complexity of GI surgery often leads to prolonged recovery and high postoperative complication rates,which threaten patient safety and functional outcomes.Enhanced recovery after surgery(ERAS)principles have been shown to improve perioperative outcomes through evidence-based,multidisciplinary care pathways.Despite its widespread adoption,there is a paucity of research focusing specifically on optimizing ERAS-guided nursing processes in the post-anesthesia care unit(PACU)and evaluating its impact on perioperative safety in patients undergoing GI tumor surgery.This study aimed to investigate whether an ERASbased PACU nursing protocol could enhance recovery,reduce complications,and improve patient safety in this surgical population.AIM To explore the impact of optimizing the recovery room nursing process based on ERAS on the perioperative safety of patients with GI tumors.METHODS A total of 260 patients with GI tumors who underwent elective surgeries under general anesthesia in our hospital from August 2023 to August 2025 and were then observed in the recovery unit(PACU)were selected.They were randomly divided into the observation group(the PACU nursing process was optimized based on ERAS)and the control group(the conventional PACU nursing process was adopted)by the random number grouping method,with 130 cases in each group.The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,time of leaving the room after tube removal,retention time in the recovery room,occurrence of complications,satisfaction and readmission rate were compared between the two groups after entering the room.Compare the occurrence of adverse events in the PACU nursing process between the two groups.RESULTS The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,retention time in the recovery room,total incidence of complications and readmission rate in the observation group were significantly lower than those in the control group,and the satisfaction rate was higher than that in the control group(P<0.05).The occurrence of adverse events in the PACU nursing process in the observation group was lower than that in the control group(P<0.05).CONCLUSION Optimizing the PACU nursing process based on ERAS can effectively accelerate the recovery process of patients undergoing GI tumor surgery,reduce adverse events,improve nursing satisfaction,and at the same time,lower the incidence of adverse events in the PACU nursing process,providing a more refined management basis for clinical practice.展开更多
With the intensification of population aging,knee and hip joint replacement surgeries have become core methods for treating end-stage joint diseases,with over a million cases performed globally each year.Postoperative...With the intensification of population aging,knee and hip joint replacement surgeries have become core methods for treating end-stage joint diseases,with over a million cases performed globally each year.Postoperative rehabilitation nursing,as a crucial aspect of enhancing surgical outcomes,reducing complications,and facilitating patients’return to normal life,has its scientific and effective protocols directly influencing patient prognosis.This article systematically reviews the core research findings on rehabilitation nursing after joint replacement surgery based on the concept of evidence-based medicine,aiming to provide references for the formulation of standardized and personalized rehabilitation nursing plans in clinical settings.展开更多
BACKGROUND There has been an increasing focus in recent years on health-care disparities.Studies investigating return to work(RTW)or sports are often performed in large,urban areas.Relatively few studies have investig...BACKGROUND There has been an increasing focus in recent years on health-care disparities.Studies investigating return to work(RTW)or sports are often performed in large,urban areas.Relatively few studies have investigated rates of return to farming or other heavy labor that is of interest to patients in rural areas.AIM To evaluate the literature regarding RTW in farming or heavy labor after orthopedic hip,knee,or shoulder surgery.METHODS A search was performed in the PubMed and EMBASE databases using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Studies were included if they reported patients employed in farming or heavy labor,RTW rates after orthopedic surgery of the hip,knee,or shoulder,and had a minimum 6-month follow-up.A meta-analysis of proportions using a random-effects model was performed on three single-arm observational studies to estimate the pooled RTW rate following arthroscopic shoulder surgery.RESULTS Ten studies were included,and 101 farmers were identified among 440 total patients.One study involved hip surgery,two studies involved knee surgery,and seven studies involved shoulder surgery.RTW rates across studies varied by type of surgery and follow-up interval,ranging from 24%to 100%.The RTW rate was only 53.6%at 1 year following total hip arthroplasty.No studies investigated RTW in farmers following total knee arthroplasty.Among non-comparative studies,meta-analysis revealed a pooled RTW rate of 89%following arthroscopic shoulder surgery,with low heterogeneity(I^(2)=30.1%).Among comparative studies,one study reported significantly higher RTW odds for patients undergoing anatomic total shoulder arthroplasty compared to reverse shoulder arthroplasty(odds ratio=5.45).Overall,surgical intervention for shoulder pathology was associated with a high likelihood of RTW across multiple techniques,with particularly favorable outcomes for anatomic total shoulder arthroplasty.CONCLUSION This systematic review highlights the high rates of RTW in farmers and heavy laborers after shoulder surgery.However,our findings also underscore the need for more rural-specific research to guide patient counseling,rehabilitation expectations,and shared decision-making in this underserved population,particularly for orthopedic surgery of the hip and knee.展开更多
Objective:Sepsis exhibits remarkable heterogeneity in disease progression trajectories,and accurate identificationof distinct trajectory-based phenotypes is critical for implementing personalized therapeutic strategie...Objective:Sepsis exhibits remarkable heterogeneity in disease progression trajectories,and accurate identificationof distinct trajectory-based phenotypes is critical for implementing personalized therapeutic strategies and prognostic assessment.However,trajectory clustering analysis of time-series clinical data poses substantial methodological challenges for researchers.This study provides a comprehensive tutorial framework demonstrating six trajectory modeling approaches integrated with proteomic analysis to guide researchers in identifying sepsis subtypes after laparoscopic surgery.Methods:This study employs simulated longitudinal data from 300 septic patients after laparoscopic surgery to demonstrate six trajectory modeling methods(group-based trajectory modeling,latent growth mixture modeling,latent transition analysis,time-varying effect modeling,K-means for longitudinal data,agglomerative hierarchical clustering)for identifying associations between predefinedsequential organ failure assessment trajectories and 25 proteomic biomarkers.Clustering performance was evaluated via multiple metrics,and a biomarker discovery pipeline integrating principal component analysis,random forests,feature selection,and receiver operating characteristic analysis was developed.Results:The six methods demonstrated varying performance in identifying trajectory structures,with each approach exhibiting distinct analytical characteristics.The performance metrics revealed differences across methods,which may inform context-specificmethod selection and interpretation strategies.Conclusion:This study illustrates practical implementations of trajectory modeling approaches under controlled conditions,facilitating informed method selection for clinical researchers.The inclusion of complete R code and integrated proteomics workflows offers a reproducible analytical framework connecting temporal pattern recognition to biomarker discovery.Beyond sepsis,this pipeline-oriented approach may be adapted to diverse clinical scenarios requiring longitudinal disease characterization and precision medicine applications.The comparative analysis reveals that each method has distinct strengths,providing a practical guide for clinical researchers in selecting appropriate methods based on their specificstudy goals and data characteristics.展开更多
Objective:To investigate the long-term prognosis and postoperative cosmetic outcomes of breast-conserving surgery combined with sentinel lymph node biopsy in patients with early-stage breast cancer,providing a referen...Objective:To investigate the long-term prognosis and postoperative cosmetic outcomes of breast-conserving surgery combined with sentinel lymph node biopsy in patients with early-stage breast cancer,providing a reference for the selection of clinical treatment plans.Methods:A retrospective analysis was conducted on the clinical data of 68 patients with early-stage breast cancer admitted from January 2022 to December 2025.Based on the surgical approach,patients were divided into an observation group(breast-conserving surgery+sentinel lymph node biopsy)and a control group(other surgical methods such as modified radical mastectomy/total mastectomy).Clinical and pathological characteristics,incidence of postoperative complications,follow-up prognosis,and satisfaction with cosmetic outcomes were compared between the two groups.Results:Among the 68 patients,41 were in the observation group and 27 in the control group.The average age of patients in the observation group was(54.32±8.15)years,while that in the control group was(62.45±9.76)years.The average tumor size in the observation group was(1.86±0.72)cm,compared to(3.21±1.45)cm in the control group.The incidence of postoperative complications in the observation group was 9.76%,significantly lower than that in the control group at 33.33%(P<0.05).The 6-month disease-free survival rate was 95.12%in the observation group and 88.89%in the control group,with no statistically significant difference between the two groups(P>0.05).The excellent and good rate of cosmetic outcomes in the observation group was 87.80%,significantly higher than that in the control group at 29.63%(P<0.05).Conclusion:Breast-conserving surgery combined with sentinel lymph node biopsy for early-stage breast cancer can achieve long-term prognostic outcomes comparable to those of traditional radical surgery,with the advantages of fewer postoperative complications and superior cosmetic results.This approach is worthy of clinical promotion and application,particularly for early-stage breast cancer patients who have a demand for preserving breast morphology.展开更多
AIM:To investigate the long-term outcomes in acute primary angle closure(APAC)patients treated with lens extraction(LE)surgery and to identify risk factors for glaucomatous optic neuropathy(GON).METHODS:In this longit...AIM:To investigate the long-term outcomes in acute primary angle closure(APAC)patients treated with lens extraction(LE)surgery and to identify risk factors for glaucomatous optic neuropathy(GON).METHODS:In this longitudinal observational study,detailed medical histories of APAC patients and comprehensive ophthalmic examinations at final followup were collected.Logistic regression analysis was performed to identify predictors of blindness.Univariate and multivariate linear regression analyses were conducted to determine risk factors associated with visual outcomes.RESULTS:This study included 39 affected eyes of 31 subjects(26 females)with an average age of 74.1±8.0y.At 6.7±4.2y after APAC attack,2(5.7%)eyes had bestcorrected visual acuity(VA)worse than 3/60.Advanced glaucomatous visual field loss was observed in 15(39.5%)affected eyes and 5(25.0%)fellow eyes.Nine affected eyes(23.7%)had GON,and 11(28.9%)were blind.Six(15.4%)affected eyes and 2(9.1%)fellow eyes had suspicious progression.A significantly higher blindness rate in factory workers compared to office workers.Logistic regression identified that worse VA at attack(OR 10.568,95%CI 1.288-86.695;P=0.028)and worse early postoperative VA(OR 13.214,95%CI 1.157-150.881;P=0.038)were risk factors for blindness.Multivariate regression showed that longer duration of elevated intraocular pressure(P=0.004)and worse early postoperative VA(P=0.009)were associated with worse visual outcomes.CONCLUSION:Despite LE surgery,some APAC patients experience continued visual function deterioration.Lifelong monitoring is necessary.Target pressure and progression rates should be re-evaluated during follow-up.展开更多
文摘Purpose: Surgical templates produced by digital simulation and CAD/CAM allow for three-dimensional control of implant placement. However, due to clinical limitations, there are complications during the use of the template. The purpose of this study was to summarize the complications associated with the use of surgical templates for static computer-aided implant surgery. Methods: Complications were collected during the observation period, and then their implant sites were reanalyzed with simulation software. Results: There were 104 cases during the observation period, 5 cases had complications. Mechanical complications were observed in four cases, including three cases in which the frame of the template fractured during implant placement surgery and one case in which the sleeve fell off the surgical template. In one case, there was an error in the planned position. All cases were mandibular molar cases, and all cases of frame fracture were at the free end defect site. All cases had a Hounsfield unit of more than 700 at the implant site, and some of them had a significantly small jaw opening. Conclusion: Although the spread of CAD/CAM surgical templates has made it possible to avoid problems caused by the position of the implant, it has been difficult to avoid fractures in cases of mandibular free end defects with high Hounsfield unit.
基金Supported by Science and Technology Projects in Guangzhou,No.2023A04J2282。
文摘BACKGROUND Computer-aided diagnosis(CAD)may assist endoscopists in identifying and classifying polyps during colonoscopy for detecting colorectal cancer.AIM To build a system using CAD to detect and classify polyps based on the Yamada classification.METHODS A total of 24045 polyp and 72367 nonpolyp images were obtained.We established a computer-aided detection and Yamada classification model based on the YOLOv7 neural network algorithm.Frame-based and image-based evaluation metrics were employed to assess the performance.RESULTS Computer-aided detection and Yamada classification screened polyps with a precision of 96.7%,a recall of 95.8%,and an F1-score of 96.2%,outperforming those of all groups of endoscopists.In regard to the Yamada classification of polyps,the CAD system displayed a precision of 82.3%,a recall of 78.5%,and an F1-score of 80.2%,outper-forming all levels of endoscopists.In addition,according to the image-based method,the CAD had an accuracy of 99.2%,a specificity of 99.5%,a sensitivity of 98.5%,a positive predictive value of 99.0%,a negative predictive value of 99.2%for polyp detection and an accuracy of 97.2%,a specificity of 98.4%,a sensitivity of 79.2%,a positive predictive value of 83.0%,and a negative predictive value of 98.4%for poly Yamada classification.CONCLUSION We developed a novel CAD system based on a deep neural network for polyp detection,and the Yamada classi-fication outperformed that of nonexpert endoscopists.This CAD system could help community-based hospitals enhance their effectiveness in polyp detection and classification.
基金funded by the Indian Council of Medical Research(ICMR),New Delhi,Government of India under Grant No.EM/SG/Dev.Res/124/0812-2023.
文摘Jaundice,common condition in newborns,is characterized by yellowing of the skin and eyes due to elevated levels of bilirubin in the blood.Timely detection and management of jaundice are crucial to prevent potential complications.Traditional jaundice assessment methods rely on visual inspection or invasive blood tests that are subjective and painful for infants,respectively.Although several automated methods for jaundice detection have been developed during the past few years,a limited number of reviews consolidating these developments have been presented till date,making it essential to systematically evaluate and present the existing advancements.This paper fills this gap by providing a thorough survey of automated methods for jaundice detection in neonates.The primary focus of the survey is to review the existing methodologies,techniques,and technologies used for neonatal jaundice detection.The key findings from the review indicate that image-based bilirubinometers and transcutaneous bilirubinometers are promising non-invasive alternatives,and provide a good trade-off between accuracy and ease of use.However,their effectiveness varies with factors like skin pigmentation,gestational age,and measurement site.Spectroscopic and biosensor-based techniques show high sensitivity but need further clinical validation.Despite advancements,several challenges including device calibration,large-scale validation,and regulatory barriers still haunt the researchers.Standardization,regulatory compliances,and seamless integration into healthcare workflows are the key hurdles to be addressed.By consolidating the current knowledge and discussing the challenges and opportunities in this field,this survey aims to contribute to the advancement of automatic jaundice detection and ultimately improve neonatal care.
文摘With the development of artificial intelligence technology,AI computer-aided diagnosis has found certain applications in the field of dermatology.However,due to the vast variety and complex manifestations of skin diseases,the specific mechanisms underlying AI computer-aided diagnosis in this context still require further exploration.Therefore,this paper,based on the imaging characteristics of skin diseases,elucidates the technical principles of AI computer-aided diagnosis and analyzes the practical application effects of AI in the diagnostic process of skin diseases.This provides new data support and methodological foundations for clinical teaching and research on skin diseases.
文摘BACKGROUND Early detection of precancerous lesions is of vital importance for reducing the incidence and mortality of upper gastrointestinal(UGI)tract cancer.However,traditional endoscopy has certain limitations in detecting precancerous lesions.In contrast,real-time computer-aided detection(CAD)systems enhanced by artificial intelligence(AI)systems,although they may increase unnecessary medical procedures,can provide immediate feedback during examination,thereby improving the accuracy of lesion detection.This article aims to conduct a meta-analysis of the diagnostic performance of CAD systems in identifying precancerous lesions of UGI tract cancer during esophagogastroduodenoscopy(EGD),evaluate their potential clinical application value,and determine the direction for further research.AIM To investigate the improvement of the efficiency of EGD examination by the realtime AI-enabled real-time CAD system(AI-CAD)system.METHODS PubMed,EMBASE,Web of Science and Cochrane Library databases were searched by two independent reviewers to retrieve literature with per-patient analysis with a deadline up until April 2025.A meta-analysis was performed with R Studio software(R4.5.0).A random-effects model was used and subgroup analysis was carried out to identify possible sources of heterogeneity.RESULTS The initial search identified 802 articles.According to the inclusion criteria,2113 patients from 10 studies were included in this meta-analysis.The pooled accuracy difference,logarithmic difference of diagnostic odds ratios,sensitivity,specificity and the area under the summary receiver operating characteristic curve(area under the curve)of both AI group and endoscopist group for detecting precancerous lesion were 0.16(95%CI:0.12-0.20),-0.19(95%CI:-0.75-0.37),0.89(95%CI:0.85-0.92,AI group),0.67(95%CI:0.63-0.71,endoscopist group),0.89(95%CI:0.84-0.93,AI group),0.77(95%CI:0.70-0.83,endoscopist group),0.928(95%CI:0.841-0.948,AI group),0.722(95%CI:0.677-0.821,endoscopist group),respectively.CONCLUSION The present studies further provide evidence that the AI-CAD is a reliable endoscopic diagnostic tool that can be used to assist endoscopists in detection of precancerous lesions in the UGI tract.It may be introduced on a large scale for clinical application to enhance the accuracy of detecting precancerous lesions in the UGI tract.
文摘The development of pancreatic surgery in China has progressed remarkably over 7 decades.China initiated its pancreatic surgery journey in the 1950s,marked by the first pancreaticoduodenectomy performed by Zeng Xianjiu in 1951.Early progress was hindered by technological limitations and fragmented practices,but the establishment of academic platforms such as the National Pancreatic Disease Symposia in the 1980s catalyzed standardized research and interdisciplinary collaboration.In 2006,Zhang Shengdao spearheaded China’s first Guidelines for the Diagnosis and Treatment of Severe Acute Pancreatitis.The 21st century has seen remarkable progress in pancreatic surgery,marked by the China-specific treatment guidelines,technological breakthroughs in laparoscopic and robotic surgical systems,and the increasing centralization of pancreatic surgery in high-volume medical centers.These synergistic advancements have collectively propelled a paradigm shift in contemporary cancer care.By 2022,China Pancreas Data Center reported a postoperative mortality rate of 0.4% and 3-year survival rates of 43% for resected pancreatic cancer,rivaling global benchmarks.China has also emerged as a leader in minimally invasive pancreatic surgery,with advancements in laparoscopic and robotic pancreatic surgery.Academic growth paralleled clinical progress:the Chinese Pancreatic Association,established in 2022,fosters global collaboration,evidenced by its 2024 annual conference attracting over 10,000 participants.Through technological innovation,centralized care models,and international partnerships,China continues to redefine its role in advancing pancreatic surgery.
文摘The year 2025 marked a significantmilestone for Laparoscopic,Endoscopic and Robotic Surgery(LERS)—we have awarded our first Impact Factor of 2.0 released by the Journal Citation Reports from Clarivate Analytics,which ranks in the second quartile in the surgery category.This remarkable achievement,which reflects LERS’s steadily increasing influencein the area of surgery,would not be possible without the peer reviewer’s invaluable contributions.On behalf of the Editorial Board and Editorial Office,we would express our sincere appreciation to the following reviewers,who reviewed at least one paper with rigorous and insightful comments.We sincerely hope to engage further with them,either as esteemed reviewers or outstanding authors,in 2026 and beyond.
文摘Objective:To explore the relationship between anesthetic depth and surgical stress response in minimally invasive cardiothoracic surgery.Methods:A total of 89 patients who underwent thoracoscopic minimally invasive cardiothoracic surgery in our hospital from June 2024 to December 2024 were selected as the research objects.They were divided into the light anesthesia group(n=45)and the deep anesthesia group(n=44).The vital signs at different intraoperative nodes and perioperative stress status of the two groups were compared.Results:Before lesion resection and after surgery,the mean arterial pressure and heart rate of the deep anesthesia group were lower than those of the light anesthesia group,with statistically significant differences.Conclusion:In thoracoscopic minimally invasive cardiothoracic surgery,deep anesthesia can effectively control the patient’s surgical stress response,but the postoperative awakening time is longer;patients under light anesthesia have a shorter awakening time,but the intraoperative stress response is obvious.
基金supported by grants from Young Scientists Fund of the National Natural Science Foundation of China(grant number.82301295).
文摘1Introduction A 25-year-old woman presented with a 3-month history of otalgia and aural fullness in the left ear,without associated otological or systemic symptoms.Her medical history was unremarkable,and she denied any history of hepatitis,hypertension,diabetes,cardiovascular disease,or other significant conditions.The patient was diagnosed with external auditory canal cholesteatoma and subsequently underwent canalplasty under general anesthesia.Routine anesthetic drugs,including 2%lidocaine,dexamethasone,propofol,sufentanil,rocuronium bromide,ondansetron,flurbiprofen axetil,neostigmine,and atropine,were used during surgery and anesthesia recovery.No significant events were noted,and the patient experienced only a blood loss of 10 mL.
基金Supported by the National Natural Science Foundation of China(Grant Nos.62025104,62331005,and U22A2052)the Beijing Natural Science Foundation(Grant No.L242100).
文摘Background Computed tomography(CT) and cone-beam computed tomography(CBCT) image registration play pivotal roles in computer-assisted navigation for orthopedic surgery. Traditional methods often apply uniform deformation models, neglecting the biomechanical differences between rigid structures and soft tissues, which compromises registration accuracy, especially during significant bone displacements. Method To address this issue, we introduce RE-Reg, a rigid-elastic CT-CBCT image registration framework that jointly learns rigid bone motion and soft tissue deformation. RE-Reg incorporates a rigid alignment(RA) module to estimate global bone motion and an elastic deformation(ED) module to model soft tissue deformation, preserving bony structures through bone shape preservation(BSP) loss. Result Our comprehensive evaluation on publicly available datasets demonstrates that RE-Reg significantly outperforms existing methods in terms of registration accuracy and rigid bone structure preservation, achieving a 1.3% improvement in Dice similarity coefficient(DSC) and a 23% reduction in rigid bone deformation(%Δvol) compared with the best baseline. Conclusion This framework not only enhances anatomical fidelity but also ensures biomechanical plausibility and provides a valuable tool for image-guided orthopedic surgery. This code is available athttps://github.com/Zq-Huang/RE-Reg.
文摘AIM:To assess the visual acuity and visual quality of cataract patients who received femtosecond laser-assisted cataract surgery(FLACS)and multifocal intraocular lens(MIOL)implantation with an improved polishing technique during a 1-year follow-up period.METHODS:This study included 74 eyes from 37 patients,comprising 17 males and 20 females,with a mean age of 51.74±7.80 years.Using a coin toss method,one eye per patient was randomly selected for improved anterior capsular polishing,while the other eye received standard irrigation/aspiration(I/A)polishing.The polishing group consisted of 37 eyes,including 21 right and 16 left eyes,while the control group comprised the contralateral fellow eyes of the same individuals in the polishing group.Visual acuity and quality of the patients were evaluated before surgery and at 1 wk,1,6,and 12 mo after surgery.The OPD-Scan III was utilized to assess high-order aberrations,while the optical quality analysis system(OQAS)was employed to evaluate modulation transfer function(MTF cutoff),Strehl ratio(SR),and objective scatter index(OSI)for the purpose of visual quality assessment.Paired t-tests and repeated measures analysis of variance(ANOVA)were utilized to compare the results,and the SNK-q post hoc test was applied to identify significant differences.RESULTS:The polishing group’s uncorrected distant visual acuity(UDVA)and uncorrected near visual acuity(UNVA)significantly improved 1-week post-surgery(all P<0.05).At 12-months,UDVA,UNVA,and corrected distant visual acuity(CDVA)were better than the control group(P<0.05).The MTF cutoff,SR,OSI,and high-order aberrations in the polishing group also showed significant improvements compared to the control group at 12 mo(P<0.05).CONCLUSION:The improved capsular polishing method has been demonstrated to effectively maintain visual acuity and visual quality in patients with MIOL after FLACS within 1 a.
文摘The concept of Damage Control Surgery(DCS)emphasizes prioritizing hemorrhage control,preventing hypothermia,correcting coagulopathy,and acidosis in trauma treatment.The application of the DCS concept in trauma treatment at grassroots hospitals faces numerous challenges such as limited resources,high technical difficulty,and insufficient multidisciplinary collaboration.Therefore,DCS strategies need to be adapted to simplified processes to create conditions for subsequent treatment.This paper retrieves relevant literature to discuss the proposal,promotion,and application of the DCS concept,aiming to provide evidence-based basis for optimizing trauma treatment outcomes at grassroots hospitals.
文摘Background:Pressure injury(PI)is a prevalent complication in pediatric cardiac surgery,with higher incidence than in general pediatric populations due to children’s thin skin,underdeveloped subcutaneous tissue,and prolonged intraoperative pressure.Objective:To evaluate the effectiveness of the curvilinear supine position(CSP)in preventing PI among children undergoing congenital heart disease(CHD)surgery.Methods:Between October 2024 and February 2025,a single-center randomized controlled trial was conducted.Of the 80 children initially enrolled for congenital heart disease(CHD)surgery,77(aged 1 month to 14 years)completed the study and were included in the final analysis after 3 were excluded due to protocol violations.Participants were randomly assigned to the CSP group(n=38)or the conventional supine position group(n=39).Results:The incidence of PI was significantly lower in the CSP group(2.6%)compared to the control group(20.5%)(p=0.029).Postoperative LDH levels were also significantly reduced in the CSP group(422.67±86.52 U/L vs.592.92±215.71 U/L;p=0.031),while preoperative LDH and surgical variables(e.g.,cardiopulmonary bypass time)were comparable between groups.Although the CSP group had a shorter hospital stay(17.24 vs.22.51 days),the difference was not statistically significant(p=0.085).Caregiver satisfaction was significantly higher in the CSP group(100.0%vs.84.6%;p=0.025).Conclusion:CSP effectively reduces PI incidence,mitigates tissue injury,and enhances caregiver satisfaction in pediatric cardiac surgery,offering a safe and feasible strategy for perioperative PI prevention.
文摘Objective:To analyze the impact of nursing interventions based on quantitative assessment using the Kano model on the quality of rehabilitation in patients with early-stage ovarian cancer following laparoscopic radical surgery.Methods:A prospective clinical study was conducted involving 96 patients with newly diagnosed early-stage ovarian cancer who underwent laparoscopic radical surgery from December 2023 to December 2025.Patients were randomly assigned to groups using a random number table method before surgery.After surgery,the control group(n=48)received routine quantitative assessment nursing interventions,while the observation group(n=48)received nursing interventions based on quantitative assessment using the Kano model.Both groups received continuous nursing care until discharge.Differences between the groups were compared in terms of negative emotions,quality of life scores before and after postoperative intervention,postoperative recovery indicators,and nursing satisfaction evaluations on the day of discharge.Results:After intervention,the observation group had lower scores on the Self-Rating Anxiety Scale(SAS)and Self-Rating Depression Scale(SDS),as well as shorter recovery times for gastrointestinal function and food intake,and a shorter hospital stay compared to the control group.Additionally,the observation group had higher scores on the Quality-of-Life Instrument for Cancer Patients-Ovarian Cancer(QLICP-OV)than the control group,with statistically significant differences(p<0.05).The overall satisfaction with nursing care in the observation group was also higher than that in the control group,with a statistically significant difference(p<0.05).Conclusion:Implementing quantitative evaluation nursing interventions based on the Kano model for patients with early-stage ovarian cancer after laparoscopic radical surgery can,by addressing their postoperative basic health,disease awareness,and other intervention content needs to a comprehensive degree,actively promote postoperative recovery and improve their mental health and quality of life.
基金Supported by 2025 Henan Medical Education Research Project,No.WJLX2025038.
文摘BACKGROUND Gastrointestinal(GI)tumors are among the most prevalent malignancies,and surgical intervention remains a primary treatment modality.However,the complexity of GI surgery often leads to prolonged recovery and high postoperative complication rates,which threaten patient safety and functional outcomes.Enhanced recovery after surgery(ERAS)principles have been shown to improve perioperative outcomes through evidence-based,multidisciplinary care pathways.Despite its widespread adoption,there is a paucity of research focusing specifically on optimizing ERAS-guided nursing processes in the post-anesthesia care unit(PACU)and evaluating its impact on perioperative safety in patients undergoing GI tumor surgery.This study aimed to investigate whether an ERASbased PACU nursing protocol could enhance recovery,reduce complications,and improve patient safety in this surgical population.AIM To explore the impact of optimizing the recovery room nursing process based on ERAS on the perioperative safety of patients with GI tumors.METHODS A total of 260 patients with GI tumors who underwent elective surgeries under general anesthesia in our hospital from August 2023 to August 2025 and were then observed in the recovery unit(PACU)were selected.They were randomly divided into the observation group(the PACU nursing process was optimized based on ERAS)and the control group(the conventional PACU nursing process was adopted)by the random number grouping method,with 130 cases in each group.The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,time of leaving the room after tube removal,retention time in the recovery room,occurrence of complications,satisfaction and readmission rate were compared between the two groups after entering the room.Compare the occurrence of adverse events in the PACU nursing process between the two groups.RESULTS The time of gastric tube removal,urinary catheter removal,defecation time,hospital stay,retention time in the recovery room,total incidence of complications and readmission rate in the observation group were significantly lower than those in the control group,and the satisfaction rate was higher than that in the control group(P<0.05).The occurrence of adverse events in the PACU nursing process in the observation group was lower than that in the control group(P<0.05).CONCLUSION Optimizing the PACU nursing process based on ERAS can effectively accelerate the recovery process of patients undergoing GI tumor surgery,reduce adverse events,improve nursing satisfaction,and at the same time,lower the incidence of adverse events in the PACU nursing process,providing a more refined management basis for clinical practice.
文摘With the intensification of population aging,knee and hip joint replacement surgeries have become core methods for treating end-stage joint diseases,with over a million cases performed globally each year.Postoperative rehabilitation nursing,as a crucial aspect of enhancing surgical outcomes,reducing complications,and facilitating patients’return to normal life,has its scientific and effective protocols directly influencing patient prognosis.This article systematically reviews the core research findings on rehabilitation nursing after joint replacement surgery based on the concept of evidence-based medicine,aiming to provide references for the formulation of standardized and personalized rehabilitation nursing plans in clinical settings.
文摘BACKGROUND There has been an increasing focus in recent years on health-care disparities.Studies investigating return to work(RTW)or sports are often performed in large,urban areas.Relatively few studies have investigated rates of return to farming or other heavy labor that is of interest to patients in rural areas.AIM To evaluate the literature regarding RTW in farming or heavy labor after orthopedic hip,knee,or shoulder surgery.METHODS A search was performed in the PubMed and EMBASE databases using Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines.Studies were included if they reported patients employed in farming or heavy labor,RTW rates after orthopedic surgery of the hip,knee,or shoulder,and had a minimum 6-month follow-up.A meta-analysis of proportions using a random-effects model was performed on three single-arm observational studies to estimate the pooled RTW rate following arthroscopic shoulder surgery.RESULTS Ten studies were included,and 101 farmers were identified among 440 total patients.One study involved hip surgery,two studies involved knee surgery,and seven studies involved shoulder surgery.RTW rates across studies varied by type of surgery and follow-up interval,ranging from 24%to 100%.The RTW rate was only 53.6%at 1 year following total hip arthroplasty.No studies investigated RTW in farmers following total knee arthroplasty.Among non-comparative studies,meta-analysis revealed a pooled RTW rate of 89%following arthroscopic shoulder surgery,with low heterogeneity(I^(2)=30.1%).Among comparative studies,one study reported significantly higher RTW odds for patients undergoing anatomic total shoulder arthroplasty compared to reverse shoulder arthroplasty(odds ratio=5.45).Overall,surgical intervention for shoulder pathology was associated with a high likelihood of RTW across multiple techniques,with particularly favorable outcomes for anatomic total shoulder arthroplasty.CONCLUSION This systematic review highlights the high rates of RTW in farmers and heavy laborers after shoulder surgery.However,our findings also underscore the need for more rural-specific research to guide patient counseling,rehabilitation expectations,and shared decision-making in this underserved population,particularly for orthopedic surgery of the hip and knee.
基金funding from the China National Key Research and Development Program(No.2023YFC3603104)the National Natural Science Foundation of China(Nos.82472243 and 82272180)+6 种基金the Fundamental Research Funds for the Central Universities(No.226-2025-00024)the Huadong Medicine Joint Funds of the Zhejiang Provincial Natural Science Foundation of China(No.LHDMD24H150001)the Key Research&Development Project of Zhejiang Province(No.2024C03240)a collaborative scientific project co-established by the Science and Technology Department of the National Administration of Traditional Chinese Medicine and the Zhejiang Provincial Administration of Traditional Chinese Medicine(No.GZY-ZJ-KJ-24082)he General Health Science and Technology Program of Zhejiang Province(No.2024KY1099)the Project of Zhejiang University Longquan Innovation Center(No.ZJDXLQCXZCJBGS2024016)Wu Jieping Medical Foundation Special Research Grant(No.320.6750.2024-23-07).
文摘Objective:Sepsis exhibits remarkable heterogeneity in disease progression trajectories,and accurate identificationof distinct trajectory-based phenotypes is critical for implementing personalized therapeutic strategies and prognostic assessment.However,trajectory clustering analysis of time-series clinical data poses substantial methodological challenges for researchers.This study provides a comprehensive tutorial framework demonstrating six trajectory modeling approaches integrated with proteomic analysis to guide researchers in identifying sepsis subtypes after laparoscopic surgery.Methods:This study employs simulated longitudinal data from 300 septic patients after laparoscopic surgery to demonstrate six trajectory modeling methods(group-based trajectory modeling,latent growth mixture modeling,latent transition analysis,time-varying effect modeling,K-means for longitudinal data,agglomerative hierarchical clustering)for identifying associations between predefinedsequential organ failure assessment trajectories and 25 proteomic biomarkers.Clustering performance was evaluated via multiple metrics,and a biomarker discovery pipeline integrating principal component analysis,random forests,feature selection,and receiver operating characteristic analysis was developed.Results:The six methods demonstrated varying performance in identifying trajectory structures,with each approach exhibiting distinct analytical characteristics.The performance metrics revealed differences across methods,which may inform context-specificmethod selection and interpretation strategies.Conclusion:This study illustrates practical implementations of trajectory modeling approaches under controlled conditions,facilitating informed method selection for clinical researchers.The inclusion of complete R code and integrated proteomics workflows offers a reproducible analytical framework connecting temporal pattern recognition to biomarker discovery.Beyond sepsis,this pipeline-oriented approach may be adapted to diverse clinical scenarios requiring longitudinal disease characterization and precision medicine applications.The comparative analysis reveals that each method has distinct strengths,providing a practical guide for clinical researchers in selecting appropriate methods based on their specificstudy goals and data characteristics.
文摘Objective:To investigate the long-term prognosis and postoperative cosmetic outcomes of breast-conserving surgery combined with sentinel lymph node biopsy in patients with early-stage breast cancer,providing a reference for the selection of clinical treatment plans.Methods:A retrospective analysis was conducted on the clinical data of 68 patients with early-stage breast cancer admitted from January 2022 to December 2025.Based on the surgical approach,patients were divided into an observation group(breast-conserving surgery+sentinel lymph node biopsy)and a control group(other surgical methods such as modified radical mastectomy/total mastectomy).Clinical and pathological characteristics,incidence of postoperative complications,follow-up prognosis,and satisfaction with cosmetic outcomes were compared between the two groups.Results:Among the 68 patients,41 were in the observation group and 27 in the control group.The average age of patients in the observation group was(54.32±8.15)years,while that in the control group was(62.45±9.76)years.The average tumor size in the observation group was(1.86±0.72)cm,compared to(3.21±1.45)cm in the control group.The incidence of postoperative complications in the observation group was 9.76%,significantly lower than that in the control group at 33.33%(P<0.05).The 6-month disease-free survival rate was 95.12%in the observation group and 88.89%in the control group,with no statistically significant difference between the two groups(P>0.05).The excellent and good rate of cosmetic outcomes in the observation group was 87.80%,significantly higher than that in the control group at 29.63%(P<0.05).Conclusion:Breast-conserving surgery combined with sentinel lymph node biopsy for early-stage breast cancer can achieve long-term prognostic outcomes comparable to those of traditional radical surgery,with the advantages of fewer postoperative complications and superior cosmetic results.This approach is worthy of clinical promotion and application,particularly for early-stage breast cancer patients who have a demand for preserving breast morphology.
文摘AIM:To investigate the long-term outcomes in acute primary angle closure(APAC)patients treated with lens extraction(LE)surgery and to identify risk factors for glaucomatous optic neuropathy(GON).METHODS:In this longitudinal observational study,detailed medical histories of APAC patients and comprehensive ophthalmic examinations at final followup were collected.Logistic regression analysis was performed to identify predictors of blindness.Univariate and multivariate linear regression analyses were conducted to determine risk factors associated with visual outcomes.RESULTS:This study included 39 affected eyes of 31 subjects(26 females)with an average age of 74.1±8.0y.At 6.7±4.2y after APAC attack,2(5.7%)eyes had bestcorrected visual acuity(VA)worse than 3/60.Advanced glaucomatous visual field loss was observed in 15(39.5%)affected eyes and 5(25.0%)fellow eyes.Nine affected eyes(23.7%)had GON,and 11(28.9%)were blind.Six(15.4%)affected eyes and 2(9.1%)fellow eyes had suspicious progression.A significantly higher blindness rate in factory workers compared to office workers.Logistic regression identified that worse VA at attack(OR 10.568,95%CI 1.288-86.695;P=0.028)and worse early postoperative VA(OR 13.214,95%CI 1.157-150.881;P=0.038)were risk factors for blindness.Multivariate regression showed that longer duration of elevated intraocular pressure(P=0.004)and worse early postoperative VA(P=0.009)were associated with worse visual outcomes.CONCLUSION:Despite LE surgery,some APAC patients experience continued visual function deterioration.Lifelong monitoring is necessary.Target pressure and progression rates should be re-evaluated during follow-up.
