Neonatal procedural pain is one of the most frequent clinical challenges in the NICU.It not only causes acute physiological stress but also possibly has long-term neurodevelopmental adverse effects.In recent years,wit...Neonatal procedural pain is one of the most frequent clinical challenges in the NICU.It not only causes acute physiological stress but also possibly has long-term neurodevelopmental adverse effects.In recent years,with a change in pain concept and advancement in evidence-based medicine,strategies for managing neonatal procedural pain have been becoming increasingly systematic and individualized.By reviewing domestic and international research progress,this article summarizes the current status of procedural pain occurrence,pain assessment tool application and timing,and non-pharmacological and pharmacological interventions in clinical practice,including healthcare professional education and training;it aims to provide a reference for clinical practice and further improve the quality of neonatal pain management.展开更多
Objective:Prostate cancer is a common malignancy in men over 50 years old,and radical prostatectomy,particularly via laparoscopic and robotic-assisted techniques,significantly impacts quality of life,especially in ter...Objective:Prostate cancer is a common malignancy in men over 50 years old,and radical prostatectomy,particularly via laparoscopic and robotic-assisted techniques,significantly impacts quality of life,especially in terms of erectile dysfunction.This systematic review and meta-analysis aimed to evaluate the preservation of erectile function following robotic-assisted and laparoscopic radical prostatectomy,with a separate analysis of randomized clinical trials and non-randomized studies.Methods:This review was carried out using randomized and non-randomized studies involving adult patients diagnosed with localized prostate cancer undergoing radical prostatectomy,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO.Applicable literature from PubMed,Cochrane,Embase,and the Latin American and Caribbean Health Sciences Literature database was analysed.The bias in randomized clinical trials was assessed using the Cochrane Risk of Bias 2.0 tool,and observational studies were evaluated via the Newcastle-Ottawa Scale.The statistical analysis was performed using Review Manager version 5.4.Results:Our analysis included 13 studies involving 6281 patients.Comparative meta-analysis of non-randomized studies demonstrated that robotic techniques were significantly more effective in preserving erectile function at 3 months(risk difference[RD]0.05,95%confidence interval[CI]0.00-0.11;p=0.040),6 months(RD 0.10,95%CI 0.03-0.17;p=0.006),and 12 months postoperatively(RD 0.06,95%CI 0.02-0.10;p=0.002).Conclusion:Robotic-assisted surgery showed greater preservation of erectile function 3 months,6 months,and 12 months after radical prostatectomy.However,additional studies with meticulous methodological criteria are necessary for future analysis.展开更多
Existing literature indicates that prolonged insertion time is associated with procedural complexity and may influence adenoma detection.Xu et al recently reported that longer insertion time correlates with lower aden...Existing literature indicates that prolonged insertion time is associated with procedural complexity and may influence adenoma detection.Xu et al recently reported that longer insertion time correlates with lower adenoma detection,but this effect can be mitigated by sufficient withdrawal duration.Insertion time should not be regarded merely as a numeric variable but rather as a multidimensional marker of technical difficulty.Integrating the insertion-to-withdrawal ratio with composite indicators such as looping or bowel preparation quality may enhance predictive models of colonoscopy performance.Conceptualizing insertion time in this way provides a more nuanced understanding of its role in adenoma detection and highlights the need for improved frameworks that link procedural complexity with quality outcomes.展开更多
BACKGROUND Minimally invasive lumbar interbody fusion(LIF)procedures have evolved rapidly in recent years,with robot-assisted(RA)techniques increasingly integrated into clinical practice.However,questions remain regar...BACKGROUND Minimally invasive lumbar interbody fusion(LIF)procedures have evolved rapidly in recent years,with robot-assisted(RA)techniques increasingly integrated into clinical practice.However,questions remain regarding the relative advantages of RA over traditional fluoroscopy-guided and navigation-assisted methods in terms of perioperative,radiographic,and clinical outcomes.This systematic review synthesizes current evidence on these comparisons,focusing on the accuracy of screw placement,perioperative efficiency,radiographic and clinical outcomes,and complications.AIM To investigate the comparative effectiveness of RA vs conventional LIF techniques.METHODS A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and Cochrane guidelines.Databases searched included PubMed,EMBASE,Web of Science,Scopus,and the Cochrane Library(through May 2025).Eligible studies were randomized controlled trials and observational studies comparing RA with fluoroscopy-or navigation-guided LIF(transforaminal lumbar interbody fusion,lateral lumbar interbody fusion,oblique lumbar interbody fusion)in adults.Two reviewers independently extracted data and assessed risk of bias.The Grading of Recommendations Assessment,Development and Evaluation framework was used to evaluate certainty of evidence.Meta-analyses were performed where data were sufficiently homogeneous.RESULTS Twenty-two studies were included,encompassing a total of 2313 patients-1046 who underwent RA-guided procedures and 1267 who received comparator techniques.Meta-analyses showed that RA significantly improved perfect pedicle screw placement[pooled odds ratio=2.93;95%confidence interval(CI):1.40-6.14;I2=78.2%]and reduced intraoperative blood loss(pooled standardized mean difference=-0.28;95%CI:-0.47 to-0.08;I2=0%).Operative time did not significantly differ between groups(pooled standardized mean difference=0.01;95%CI:-0.30 to 0.31;I2=66%).Radiation dose could not be synthesized quantitatively due to heterogeneous definitions and measurement units.Narratively,RA demonstrated consistent advantages in reducing surgical exposure and adjacent segment degeneration.Clinical and radiographic outcomes,fusion success,and complication rates were generally comparable across groups.CONCLUSION RA LIF improves pedicle screw placement accuracy and reduces blood loss and surgeon radiation exposure while maintaining similar clinical outcomes and safety profiles to conventional techniques.These findings support the integration of RA into spine surgery but highlight the need for high-quality multicenter randomized controlled trials and cost-effectiveness studies to guide broader implementation.展开更多
BACKGROUND Single-ventricle congenital heart disease often requires the Fontan procedure,which can lead to Fontan-associated liver disease(FALD)and multi-organ failure.Combined heart-liver transplantation(CHLT)is a po...BACKGROUND Single-ventricle congenital heart disease often requires the Fontan procedure,which can lead to Fontan-associated liver disease(FALD)and multi-organ failure.Combined heart-liver transplantation(CHLT)is a potential lifesaving option for these patients.AIMTo investigate the outcomes and complications of CHLT in patients with failing Fontan physiology.METHODSSeven retrospective studies of 121 patients undergoing CHLT were systematically reviewed. Quality was assessedwith the Newcastle-Ottawa Scale. A meta-analysis using random-effects models to calculate odds ratios (ORs) ormean differences (MDs) with 95% confidence intervals.RESULTSThe pooled 30-day, 1-year, 5-year, and 10-year survival rates after CHLT were 92.6%, 86.78%, 81.17%, and 77.8%,respectively. The mean intensive care unit and total hospital lengths of stay were 8.46 and 28.16 days. Meanischemic time was 267.29 minutes, while cardiopulmonary bypass time was 260.27 minutes. Infections (30%), renalreplacement therapy (36.84%), and graft rejection (12.34%) were notable complications. Compared to orthotopicheart transplantation (OHT), CHLT significantly reduced mortality (OR: 0.30, P = 0.009) and ischemic time (MD:–65.93 minutes), with no major differences in perioperative morbidity.CONCLUSIONCHLT offers a survival advantage over OHT for patients with FALD and failing Fontan physiology. Futureprospective studies are warranted to refine eligibility and improve long-term survival.展开更多
Practical jurisprudence is a completely new proposition in legal education and research.The introduction of the concept of“practical jurisprudence”in the teaching of the Civil Procedure Law of the People’s Republic...Practical jurisprudence is a completely new proposition in legal education and research.The introduction of the concept of“practical jurisprudence”in the teaching of the Civil Procedure Law of the People’s Republic of China(the“Civil Procedure Law”)is a major innovation in terms of values and methodology.Practical jurisprudence focuses more on practical issues,Chinese characteristics,and major needs,while strengthening the practical nature of the Civil Procedure Law.China’s traditional education system for juris masters(for non-law graduates)(“non-law JMs”)emphasizes the development of foundational legal theoretical knowledge.However,it has not fully achieved its goal of cultivating interdisciplinary and practical legal professionals.Therefore,the traditional education system for the Civil Procedure Law needs reconstruction and supplementation through the practical jurisprudence teaching system in the following areas:(a)System composition:The focus should be on the eight tertiary subsystems under the two secondary subsystems—“the knowledge teaching system and the practical teaching system”of practical jurisprudence in the Civil Procedure Law,as well as the management of their interrelationships.(b)Credit structure:The proportion of credits for“practical teaching and training”should be increased.(c)Practical ability requirements:Legal professionals should be cultivated according to the standards for juris masters(for law graduates)as stipulated by the Law of the People’s Republic of China on Academic Degrees.(d)Practice evaluation:“Formalization of the evaluations,”“homogeneity of the evaluators,”and“reliance on written formats”should be avoided.展开更多
Background 3D botanical tree reconstruction from a single image plays a vital role in the field of computer graphics.However,accurately capturing the intricate branching patterns and detailed morphologies of trees rem...Background 3D botanical tree reconstruction from a single image plays a vital role in the field of computer graphics.However,accurately capturing the intricate branching patterns and detailed morphologies of trees remains a challenge.Methods In this study,we proposed a novel approach for single-image tree reconstruction using a conditional generative adversarial network to infer the 3D skeleton of a tree in the form of a 2D skeleton depth map.Based on the 2D skeleton depth map,a corresponding branching structure(3D skeleton)that inherits the tree shape in the input image and leaves can be generated using a procedural modeling technique.Result Experimental results show that the proposed method accurately reconstructs diverse tree structures across species.Both quantitative and qualitative evaluations demonstrate improved skeleton completeness,branching accuracy,and visual realism over baseline methods,while requiring no user input.Conclusions Our proposed approach for generating lifelike 3D tree models from a single image with no user input shows its proficiency in achieving efficient and reliable reconstruction.These results showcase the capability of the proposed model to recreate complex tree architectures while capturing their visual authenticity.展开更多
BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints...BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints,and patient safety concerns have constrained its practicality.Simulation-based training has become a reliable,safe,and cost-efficient alternative.Dry lab techniques,especially virtual and augmented reality,make up 78%of current dry lab research,whereas wet labs still set the standard for anatomical realism.AIM To evaluate the effectiveness,limitations,and future directions of wet and dry lab simulation in orthopaedic training.METHODS A scoping review was carried out across four databases-PubMed,Cochrane Library,Web of Science,and EBSCOhost-up to 2025.Medical Subject Headings included:"Orthopaedic Education","Wet Lab","Dry Lab","Simulation Training","Virtual Reality",and"Surgical Procedure".Eligible studies focused on orthopaedic or spinal surgical education,employed wet or dry lab techniques,and assessed training effectiveness.Exclusion criteria consisted of non-English publications,abstracts only,non-orthopaedic research,and studies unrelated to simulation.Two reviewers independently screened titles,abstracts,and full texts,resolving discrepancies with a third reviewer.RESULTS From 1851 records,101 studies met inclusion:78 on dry labs,7 on wet labs,4 on both.Virtual reality(VR)simulations were most common,with AI increasingly used for feedback and assessment.Cadaveric training remains the gold standard for accuracy and tactile feedback,while dry labs-especially VR-offer scalability,lower cost(40%-60%savings in five studies),and accessibility for novices.Senior residents prefer wet labs for complex tasks;juniors favour dry labs for basics.Challenges include limited transferability data,lack of standard outcome metrics,and ethical concerns about cadaver use and AI assessment.CONCLUSION Wet and dry labs each have unique strengths in orthopaedic training.A hybrid approach combining both,supported by standardised assessments and outcome studies,is most effective.Future efforts should aim for uniform reporting,integrating new technologies,and policy support for hybrid curricula to enhance skills and patient care.展开更多
1.Introduction.Pancreaticoduodenectomy is an essential surgical procedure for the treatment of malignant tumors in the pancreatic head,distal common bile duct,and duodenal papilla,and is widely used in clinical practi...1.Introduction.Pancreaticoduodenectomy is an essential surgical procedure for the treatment of malignant tumors in the pancreatic head,distal common bile duct,and duodenal papilla,and is widely used in clinical practice.One of the primary determinants of surgical success is the durability of the pancreaticojejunal anastomosis.展开更多
For ordinary tourists, simpler entry and exit procedures and a broader range of duty-free goods in Hainan create a better travel and shopping experience.For China’s earnest endeavor to deepen reform and opening-up, i...For ordinary tourists, simpler entry and exit procedures and a broader range of duty-free goods in Hainan create a better travel and shopping experience.For China’s earnest endeavor to deepen reform and opening-up, implementation of the special customs operations policy in Hainan represents a significant step forward. For businesses in Malaysia and other ASEAN member states, especially export-oriented small and medium-sized enterprises (SMEs), Hainan serves as a“transit hub” for accessing the Chinese market and even other Asian markets.展开更多
Objective:To evaluate the implementation effectiveness of standardized protective care procedures during hydrofluoric acid procedures in the dental department.Methods:This study was conducted from June 2023 to June 20...Objective:To evaluate the implementation effectiveness of standardized protective care procedures during hydrofluoric acid procedures in the dental department.Methods:This study was conducted from June 2023 to June 2025,selecting 90 patients who underwent hydrofluoric acid-related treatments in the outpatient dental department of this hospital during this period as subjects.Forty-five patients treated between June 2023 and June 2024 received conventional protective care(pre-intervention group),while 45 patients treated between June 2024 and June 2025 underwent the standardized protective care protocol(post-intervention group).Thirteen healthcare personnel participated in both pre-and post-intervention treatment phases.Based on the different nursing models,indicators such as the incidence of adverse events in patients and the exposure rate of healthcare personnel before and after implementation were compared to evaluate the effectiveness of the nursing intervention.Results:The incidence of oral mucosal irritation reactions in patients was lower after implementation,p<0.05.Compared with the pre-implementation period,the incidence of procedure-related adverse events decreased after implementation,p<0.05.There was a significant difference in the occupational exposure rate of healthcare personnel before and after implementation,with a higher rate observed before implementation(p<0.05).Post-implementation,healthcare personnel achieved higher compliance scores for pre-procedure preparation,intra-procedure protection,and post-procedure handling(p<0.05).Patient satisfaction with treatment was lower pre-implementation than post-implementation(p<0.05).Conclusion:Adherence to standardized protective care procedures during hydrofluoric acid operations by dental department staff in outpatient settings standardizes practitioner techniques,effectively prevents oral mucosal irritation in patients,reduces occupational exposure risks for staff,minimizes adverse procedural events,and consequently enhances patient treatment satisfaction.This demonstrates significant practical value.展开更多
Hainan Province in south China is the country’s second-largest island and the largest free trade port by area.It has entered a historic phase in China’s drive to promote high-level institutional opening up.On 18 Dec...Hainan Province in south China is the country’s second-largest island and the largest free trade port by area.It has entered a historic phase in China’s drive to promote high-level institutional opening up.On 18 December 2025,Hainan officially launched island-wide special customs operations,commonly referred to as“customs closure.”From that date,goods entering or leaving the island,except those traded with the Chinese mainland,are subject to simplified customs procedures and potentially reduced or zero tariffs.展开更多
Self-Centering Piston-Based Braced Frames(SC-PBBFs)are designed to curtail structural damage under severe ground motions.The self-centering mechanism in this bracing mitigates structural damage during an earthquake,th...Self-Centering Piston-Based Braced Frames(SC-PBBFs)are designed to curtail structural damage under severe ground motions.The self-centering mechanism in this bracing mitigates structural damage during an earthquake,thereby reducing post-earthquake repair costs and contributing to seismic resilience.However,non-structural components,particularly those sensitive to floor acceleration,remain vulnerable,resulting in prolonged func-tional recovery times.This paper aims to address this limitation by introducing a novel structural archetype,the Self-Centering Viscous-Based Braced Frame(SC-VBBF),which integrates superelastic shape memory alloy(SMA)bars,viscous dampers(VDs),and friction springs(FSs).A streamlined analytical approach relies on the strength decoupling of VD from other components using aλfactor to design SC-VBBFs.To evaluate the effectiveness of the hybrid brace,a set of 4-,8-,and 12-story archetypes equipped with SC-PBBs and SC-VBBFs are simulated in OpenSees and analyzed under various earthquake types,including crustal,subcrustal,and subduction events.The results demonstrate the superior performance of the SC-VBBF withλ≤0.5 system compared to SC-PBBFs in mitigating floor accelerations under design-level earthquakes and improving seismic resilience.展开更多
The original online version of this article was revised:Several errors occurred in the published version of the article.These have now been corrected as follows:Page 2,section"2.2 Laser Texturing Procedure of Sur...The original online version of this article was revised:Several errors occurred in the published version of the article.These have now been corrected as follows:Page 2,section"2.2 Laser Texturing Procedure of Surfaces",line 2:The device name was corrected from"YDFLP-E-50-M8"to"YDFLP-50-M8."Page 3,Section 2.4:The phrase"95%confidence interval"has been corrected to"95%confidence level."Page 3,Figure 1 caption:The phrase"fandg"has been corrected to"f and g."The order"C4 and C12"has been reversed to"C12 and C4,"in accordance with the display order in the figure.Page 4,Figure reference:The phrase"Figs.4c and d"has been corrected to"Figs.5b and c."Page 5,paragraph starting with"The ANOVA results are presented...":The phrase"95%confidence interval"has been corrected to"95%confidence level."展开更多
Deep cervical lymph-venous anastomosis(LVA)is a surgical procedure initially developed to treat cervical lymphatic obstruction,such as lymphedema,a condition caused by the accumulation of lymphatic fluid due to blocke...Deep cervical lymph-venous anastomosis(LVA)is a surgical procedure initially developed to treat cervical lymphatic obstruction,such as lymphedema,a condition caused by the accumulation of lymphatic fluid due to blocked or damaged lymphatic vessels.In early 2024,Dr.Qingping Xie from Hangzhou Qiushi Hospital,China,and Dr.Wei F.Chen from the Cleveland Clinic,USA,adapted LVA for the treatment of patients with Alzheimer’s disease(AD).As a VIEWPOINT,they presented a video showcasing the post-surgery cognitive recovery of an 84-year-old AD patient(Xie et al.,2024).展开更多
Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical sys...Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.展开更多
Objectives To evaluate the effects of white noise on pain-related cortical response,pain score,and behavioral and physiological parameters in neonates with procedural pain.Methods A double-blind,randomized controlled ...Objectives To evaluate the effects of white noise on pain-related cortical response,pain score,and behavioral and physiological parameters in neonates with procedural pain.Methods A double-blind,randomized controlled trial was conducted.Sixty-six neonates from the Neonatal Intensive Care Unit in a university-affiliated general hospital were randomly assigned to listen to white noise at 50 dB(experimental group)or 0 dB(control group)2 min before radial artery blood sampling and continued until 5 min after needle withdrawal.Pain-related cortical response was measured by regional cerebral oxygen saturation(rScO_(2))monitored with near-infrared spectroscopy,and facial expressions and physiological parameters were recorded by two video cameras.Two assessors scored the Premature Infant Pain Profile-Revised(PIPP-R)independently when viewing the videos.Primary outcomes were pain score and rScO_(2)during arterial puncture and 5 min after needle withdrawal.Secondary outcomes were pulse oximetric oxygen saturation(SpO_(2))and heart rate(HR)during arterial puncture,and duration of painful expressions.The study was registered at the Chinese Clinical Trial Registry(ChiCTR2200055571).Results Sixty neonates(experimental group,n=29;control group,n=31)were included in the final analysis.The maximum PIPP-R score in the experimental and control groups was 12.00(9.50,13.00),12.50(10.50,13.75),respectively(median difference−0.5,95%CI−2.0 to 0.5),and minimum rScO_(2)was(61.22±3.07)%,(61.32±2.79)%,respectively(mean difference−0.325,95%CI−1.382 to 0.732),without significant differences.During arterial puncture,the mean rScO_(2),HR,and SpO_(2)did not differ between groups.After needle withdrawal,the trends for rScO_(2),PIPP-R score,and facial expression returning to baseline were different between the two groups without statistical significance.Conclusion The white noise intervention did not show beneficial effects on pain-related cortical response as well as pain score,behavioral and physiological parameters in neonates with procedural pain.展开更多
Inverted batch distillation column(stripper) is opposed to a conventional batch distillation col-umn(rectifier). It has a storage vessel at the top and products leave the column at the bottom. The batch stripper is fa...Inverted batch distillation column(stripper) is opposed to a conventional batch distillation col-umn(rectifier). It has a storage vessel at the top and products leave the column at the bottom. The batch stripper is favourable to separate mixtures with a small amount of light components by removing the heavy components as bottom products. In this paper, we are presenting a shortcut procedure based on our earlier work for design and simulation of the inverted batch distillation column, which is equivalent to the Fenske-Underwood-Gilliland procedure for continuous distillation. Given a separation task, we propose to compute the minimum number of stages(Nbmin) and the minimum reboil ratio(Rbmin) required in a batch stripper,which are the stages and reboil ratio required in a hypothetical inverted batch distillation column operating in total reboil ratio or having an infinite number of stages, respectively. Then, it is shown that the performance of inverted batch columns with a finite number of stages and reboil ratios could be correlated in Gilliland coordinates with the minimum stages Nbmin and the minimum reboil ratio Rbmin.展开更多
基金National Health Commission Hospital Management Research Institute 2024 Medical Quality(Evidence-Based)Management Research Project(Project No.:YLZLXZ24G090)。
文摘Neonatal procedural pain is one of the most frequent clinical challenges in the NICU.It not only causes acute physiological stress but also possibly has long-term neurodevelopmental adverse effects.In recent years,with a change in pain concept and advancement in evidence-based medicine,strategies for managing neonatal procedural pain have been becoming increasingly systematic and individualized.By reviewing domestic and international research progress,this article summarizes the current status of procedural pain occurrence,pain assessment tool application and timing,and non-pharmacological and pharmacological interventions in clinical practice,including healthcare professional education and training;it aims to provide a reference for clinical practice and further improve the quality of neonatal pain management.
文摘Objective:Prostate cancer is a common malignancy in men over 50 years old,and radical prostatectomy,particularly via laparoscopic and robotic-assisted techniques,significantly impacts quality of life,especially in terms of erectile dysfunction.This systematic review and meta-analysis aimed to evaluate the preservation of erectile function following robotic-assisted and laparoscopic radical prostatectomy,with a separate analysis of randomized clinical trials and non-randomized studies.Methods:This review was carried out using randomized and non-randomized studies involving adult patients diagnosed with localized prostate cancer undergoing radical prostatectomy,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO.Applicable literature from PubMed,Cochrane,Embase,and the Latin American and Caribbean Health Sciences Literature database was analysed.The bias in randomized clinical trials was assessed using the Cochrane Risk of Bias 2.0 tool,and observational studies were evaluated via the Newcastle-Ottawa Scale.The statistical analysis was performed using Review Manager version 5.4.Results:Our analysis included 13 studies involving 6281 patients.Comparative meta-analysis of non-randomized studies demonstrated that robotic techniques were significantly more effective in preserving erectile function at 3 months(risk difference[RD]0.05,95%confidence interval[CI]0.00-0.11;p=0.040),6 months(RD 0.10,95%CI 0.03-0.17;p=0.006),and 12 months postoperatively(RD 0.06,95%CI 0.02-0.10;p=0.002).Conclusion:Robotic-assisted surgery showed greater preservation of erectile function 3 months,6 months,and 12 months after radical prostatectomy.However,additional studies with meticulous methodological criteria are necessary for future analysis.
文摘Existing literature indicates that prolonged insertion time is associated with procedural complexity and may influence adenoma detection.Xu et al recently reported that longer insertion time correlates with lower adenoma detection,but this effect can be mitigated by sufficient withdrawal duration.Insertion time should not be regarded merely as a numeric variable but rather as a multidimensional marker of technical difficulty.Integrating the insertion-to-withdrawal ratio with composite indicators such as looping or bowel preparation quality may enhance predictive models of colonoscopy performance.Conceptualizing insertion time in this way provides a more nuanced understanding of its role in adenoma detection and highlights the need for improved frameworks that link procedural complexity with quality outcomes.
文摘BACKGROUND Minimally invasive lumbar interbody fusion(LIF)procedures have evolved rapidly in recent years,with robot-assisted(RA)techniques increasingly integrated into clinical practice.However,questions remain regarding the relative advantages of RA over traditional fluoroscopy-guided and navigation-assisted methods in terms of perioperative,radiographic,and clinical outcomes.This systematic review synthesizes current evidence on these comparisons,focusing on the accuracy of screw placement,perioperative efficiency,radiographic and clinical outcomes,and complications.AIM To investigate the comparative effectiveness of RA vs conventional LIF techniques.METHODS A systematic review and meta-analysis was conducted in accordance with PRISMA 2020 and Cochrane guidelines.Databases searched included PubMed,EMBASE,Web of Science,Scopus,and the Cochrane Library(through May 2025).Eligible studies were randomized controlled trials and observational studies comparing RA with fluoroscopy-or navigation-guided LIF(transforaminal lumbar interbody fusion,lateral lumbar interbody fusion,oblique lumbar interbody fusion)in adults.Two reviewers independently extracted data and assessed risk of bias.The Grading of Recommendations Assessment,Development and Evaluation framework was used to evaluate certainty of evidence.Meta-analyses were performed where data were sufficiently homogeneous.RESULTS Twenty-two studies were included,encompassing a total of 2313 patients-1046 who underwent RA-guided procedures and 1267 who received comparator techniques.Meta-analyses showed that RA significantly improved perfect pedicle screw placement[pooled odds ratio=2.93;95%confidence interval(CI):1.40-6.14;I2=78.2%]and reduced intraoperative blood loss(pooled standardized mean difference=-0.28;95%CI:-0.47 to-0.08;I2=0%).Operative time did not significantly differ between groups(pooled standardized mean difference=0.01;95%CI:-0.30 to 0.31;I2=66%).Radiation dose could not be synthesized quantitatively due to heterogeneous definitions and measurement units.Narratively,RA demonstrated consistent advantages in reducing surgical exposure and adjacent segment degeneration.Clinical and radiographic outcomes,fusion success,and complication rates were generally comparable across groups.CONCLUSION RA LIF improves pedicle screw placement accuracy and reduces blood loss and surgeon radiation exposure while maintaining similar clinical outcomes and safety profiles to conventional techniques.These findings support the integration of RA into spine surgery but highlight the need for high-quality multicenter randomized controlled trials and cost-effectiveness studies to guide broader implementation.
文摘BACKGROUND Single-ventricle congenital heart disease often requires the Fontan procedure,which can lead to Fontan-associated liver disease(FALD)and multi-organ failure.Combined heart-liver transplantation(CHLT)is a potential lifesaving option for these patients.AIMTo investigate the outcomes and complications of CHLT in patients with failing Fontan physiology.METHODSSeven retrospective studies of 121 patients undergoing CHLT were systematically reviewed. Quality was assessedwith the Newcastle-Ottawa Scale. A meta-analysis using random-effects models to calculate odds ratios (ORs) ormean differences (MDs) with 95% confidence intervals.RESULTSThe pooled 30-day, 1-year, 5-year, and 10-year survival rates after CHLT were 92.6%, 86.78%, 81.17%, and 77.8%,respectively. The mean intensive care unit and total hospital lengths of stay were 8.46 and 28.16 days. Meanischemic time was 267.29 minutes, while cardiopulmonary bypass time was 260.27 minutes. Infections (30%), renalreplacement therapy (36.84%), and graft rejection (12.34%) were notable complications. Compared to orthotopicheart transplantation (OHT), CHLT significantly reduced mortality (OR: 0.30, P = 0.009) and ischemic time (MD:–65.93 minutes), with no major differences in perioperative morbidity.CONCLUSIONCHLT offers a survival advantage over OHT for patients with FALD and failing Fontan physiology. Futureprospective studies are warranted to refine eligibility and improve long-term survival.
文摘Practical jurisprudence is a completely new proposition in legal education and research.The introduction of the concept of“practical jurisprudence”in the teaching of the Civil Procedure Law of the People’s Republic of China(the“Civil Procedure Law”)is a major innovation in terms of values and methodology.Practical jurisprudence focuses more on practical issues,Chinese characteristics,and major needs,while strengthening the practical nature of the Civil Procedure Law.China’s traditional education system for juris masters(for non-law graduates)(“non-law JMs”)emphasizes the development of foundational legal theoretical knowledge.However,it has not fully achieved its goal of cultivating interdisciplinary and practical legal professionals.Therefore,the traditional education system for the Civil Procedure Law needs reconstruction and supplementation through the practical jurisprudence teaching system in the following areas:(a)System composition:The focus should be on the eight tertiary subsystems under the two secondary subsystems—“the knowledge teaching system and the practical teaching system”of practical jurisprudence in the Civil Procedure Law,as well as the management of their interrelationships.(b)Credit structure:The proportion of credits for“practical teaching and training”should be increased.(c)Practical ability requirements:Legal professionals should be cultivated according to the standards for juris masters(for law graduates)as stipulated by the Law of the People’s Republic of China on Academic Degrees.(d)Practice evaluation:“Formalization of the evaluations,”“homogeneity of the evaluators,”and“reliance on written formats”should be avoided.
文摘Background 3D botanical tree reconstruction from a single image plays a vital role in the field of computer graphics.However,accurately capturing the intricate branching patterns and detailed morphologies of trees remains a challenge.Methods In this study,we proposed a novel approach for single-image tree reconstruction using a conditional generative adversarial network to infer the 3D skeleton of a tree in the form of a 2D skeleton depth map.Based on the 2D skeleton depth map,a corresponding branching structure(3D skeleton)that inherits the tree shape in the input image and leaves can be generated using a procedural modeling technique.Result Experimental results show that the proposed method accurately reconstructs diverse tree structures across species.Both quantitative and qualitative evaluations demonstrate improved skeleton completeness,branching accuracy,and visual realism over baseline methods,while requiring no user input.Conclusions Our proposed approach for generating lifelike 3D tree models from a single image with no user input shows its proficiency in achieving efficient and reliable reconstruction.These results showcase the capability of the proposed model to recreate complex tree architectures while capturing their visual authenticity.
文摘BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints,and patient safety concerns have constrained its practicality.Simulation-based training has become a reliable,safe,and cost-efficient alternative.Dry lab techniques,especially virtual and augmented reality,make up 78%of current dry lab research,whereas wet labs still set the standard for anatomical realism.AIM To evaluate the effectiveness,limitations,and future directions of wet and dry lab simulation in orthopaedic training.METHODS A scoping review was carried out across four databases-PubMed,Cochrane Library,Web of Science,and EBSCOhost-up to 2025.Medical Subject Headings included:"Orthopaedic Education","Wet Lab","Dry Lab","Simulation Training","Virtual Reality",and"Surgical Procedure".Eligible studies focused on orthopaedic or spinal surgical education,employed wet or dry lab techniques,and assessed training effectiveness.Exclusion criteria consisted of non-English publications,abstracts only,non-orthopaedic research,and studies unrelated to simulation.Two reviewers independently screened titles,abstracts,and full texts,resolving discrepancies with a third reviewer.RESULTS From 1851 records,101 studies met inclusion:78 on dry labs,7 on wet labs,4 on both.Virtual reality(VR)simulations were most common,with AI increasingly used for feedback and assessment.Cadaveric training remains the gold standard for accuracy and tactile feedback,while dry labs-especially VR-offer scalability,lower cost(40%-60%savings in five studies),and accessibility for novices.Senior residents prefer wet labs for complex tasks;juniors favour dry labs for basics.Challenges include limited transferability data,lack of standard outcome metrics,and ethical concerns about cadaver use and AI assessment.CONCLUSION Wet and dry labs each have unique strengths in orthopaedic training.A hybrid approach combining both,supported by standardised assessments and outcome studies,is most effective.Future efforts should aim for uniform reporting,integrating new technologies,and policy support for hybrid curricula to enhance skills and patient care.
文摘1.Introduction.Pancreaticoduodenectomy is an essential surgical procedure for the treatment of malignant tumors in the pancreatic head,distal common bile duct,and duodenal papilla,and is widely used in clinical practice.One of the primary determinants of surgical success is the durability of the pancreaticojejunal anastomosis.
文摘For ordinary tourists, simpler entry and exit procedures and a broader range of duty-free goods in Hainan create a better travel and shopping experience.For China’s earnest endeavor to deepen reform and opening-up, implementation of the special customs operations policy in Hainan represents a significant step forward. For businesses in Malaysia and other ASEAN member states, especially export-oriented small and medium-sized enterprises (SMEs), Hainan serves as a“transit hub” for accessing the Chinese market and even other Asian markets.
基金Construction of Standardized Protective Nursing Plan for Hydrofluoric Acid Operation in Stomatology and Re search on Injury Prevention Effect(Project No.:FZ2025101)。
文摘Objective:To evaluate the implementation effectiveness of standardized protective care procedures during hydrofluoric acid procedures in the dental department.Methods:This study was conducted from June 2023 to June 2025,selecting 90 patients who underwent hydrofluoric acid-related treatments in the outpatient dental department of this hospital during this period as subjects.Forty-five patients treated between June 2023 and June 2024 received conventional protective care(pre-intervention group),while 45 patients treated between June 2024 and June 2025 underwent the standardized protective care protocol(post-intervention group).Thirteen healthcare personnel participated in both pre-and post-intervention treatment phases.Based on the different nursing models,indicators such as the incidence of adverse events in patients and the exposure rate of healthcare personnel before and after implementation were compared to evaluate the effectiveness of the nursing intervention.Results:The incidence of oral mucosal irritation reactions in patients was lower after implementation,p<0.05.Compared with the pre-implementation period,the incidence of procedure-related adverse events decreased after implementation,p<0.05.There was a significant difference in the occupational exposure rate of healthcare personnel before and after implementation,with a higher rate observed before implementation(p<0.05).Post-implementation,healthcare personnel achieved higher compliance scores for pre-procedure preparation,intra-procedure protection,and post-procedure handling(p<0.05).Patient satisfaction with treatment was lower pre-implementation than post-implementation(p<0.05).Conclusion:Adherence to standardized protective care procedures during hydrofluoric acid operations by dental department staff in outpatient settings standardizes practitioner techniques,effectively prevents oral mucosal irritation in patients,reduces occupational exposure risks for staff,minimizes adverse procedural events,and consequently enhances patient treatment satisfaction.This demonstrates significant practical value.
文摘Hainan Province in south China is the country’s second-largest island and the largest free trade port by area.It has entered a historic phase in China’s drive to promote high-level institutional opening up.On 18 December 2025,Hainan officially launched island-wide special customs operations,commonly referred to as“customs closure.”From that date,goods entering or leaving the island,except those traded with the Chinese mainland,are subject to simplified customs procedures and potentially reduced or zero tariffs.
文摘Self-Centering Piston-Based Braced Frames(SC-PBBFs)are designed to curtail structural damage under severe ground motions.The self-centering mechanism in this bracing mitigates structural damage during an earthquake,thereby reducing post-earthquake repair costs and contributing to seismic resilience.However,non-structural components,particularly those sensitive to floor acceleration,remain vulnerable,resulting in prolonged func-tional recovery times.This paper aims to address this limitation by introducing a novel structural archetype,the Self-Centering Viscous-Based Braced Frame(SC-VBBF),which integrates superelastic shape memory alloy(SMA)bars,viscous dampers(VDs),and friction springs(FSs).A streamlined analytical approach relies on the strength decoupling of VD from other components using aλfactor to design SC-VBBFs.To evaluate the effectiveness of the hybrid brace,a set of 4-,8-,and 12-story archetypes equipped with SC-PBBs and SC-VBBFs are simulated in OpenSees and analyzed under various earthquake types,including crustal,subcrustal,and subduction events.The results demonstrate the superior performance of the SC-VBBF withλ≤0.5 system compared to SC-PBBFs in mitigating floor accelerations under design-level earthquakes and improving seismic resilience.
文摘The original online version of this article was revised:Several errors occurred in the published version of the article.These have now been corrected as follows:Page 2,section"2.2 Laser Texturing Procedure of Surfaces",line 2:The device name was corrected from"YDFLP-E-50-M8"to"YDFLP-50-M8."Page 3,Section 2.4:The phrase"95%confidence interval"has been corrected to"95%confidence level."Page 3,Figure 1 caption:The phrase"fandg"has been corrected to"f and g."The order"C4 and C12"has been reversed to"C12 and C4,"in accordance with the display order in the figure.Page 4,Figure reference:The phrase"Figs.4c and d"has been corrected to"Figs.5b and c."Page 5,paragraph starting with"The ANOVA results are presented...":The phrase"95%confidence interval"has been corrected to"95%confidence level."
基金supported by AG057842 from the National Institutes of Health,TRIBA/Physiology Faculty Startup Fund from Augusta University (to FF)the National Natural Science Foundation of China (82173384)(to MG)
文摘Deep cervical lymph-venous anastomosis(LVA)is a surgical procedure initially developed to treat cervical lymphatic obstruction,such as lymphedema,a condition caused by the accumulation of lymphatic fluid due to blocked or damaged lymphatic vessels.In early 2024,Dr.Qingping Xie from Hangzhou Qiushi Hospital,China,and Dr.Wei F.Chen from the Cleveland Clinic,USA,adapted LVA for the treatment of patients with Alzheimer’s disease(AD).As a VIEWPOINT,they presented a video showcasing the post-surgery cognitive recovery of an 84-year-old AD patient(Xie et al.,2024).
文摘Throughout the twenty-first century, robotic surgery has been used in multiple oral surgical procedures for the treatment of head and neck tumors and non-malignant diseases. With the assistance of robotic surgical systems, maxillofacial surgery is performed with less blood loss, fewer complications, shorter hospitalization and better cosmetic results than standard open surgery.However, the application of robotic surgery techniques to the treatment of head and neck diseases remains in an experimental stage, and the long-lasting effects on surgical morbidity, oncologic control and quality of life are yet to be established. More well-designed studies are needed before this approach can be recommended as a standard treatment paradigm. Nonetheless,robotic surgical systems will inevitably be extended to maxillofacial surgery. This article reviews the current clinical applications of robotic surgery in the head and neck region and highlights the benefits and limitations of current robotic surgical systems.
基金This work was supported by grants from Guangdong Nurse Association[gdshsxh2021a058]Department of Science and Technology of Guangdong Province[2014A020212396].
文摘Objectives To evaluate the effects of white noise on pain-related cortical response,pain score,and behavioral and physiological parameters in neonates with procedural pain.Methods A double-blind,randomized controlled trial was conducted.Sixty-six neonates from the Neonatal Intensive Care Unit in a university-affiliated general hospital were randomly assigned to listen to white noise at 50 dB(experimental group)or 0 dB(control group)2 min before radial artery blood sampling and continued until 5 min after needle withdrawal.Pain-related cortical response was measured by regional cerebral oxygen saturation(rScO_(2))monitored with near-infrared spectroscopy,and facial expressions and physiological parameters were recorded by two video cameras.Two assessors scored the Premature Infant Pain Profile-Revised(PIPP-R)independently when viewing the videos.Primary outcomes were pain score and rScO_(2)during arterial puncture and 5 min after needle withdrawal.Secondary outcomes were pulse oximetric oxygen saturation(SpO_(2))and heart rate(HR)during arterial puncture,and duration of painful expressions.The study was registered at the Chinese Clinical Trial Registry(ChiCTR2200055571).Results Sixty neonates(experimental group,n=29;control group,n=31)were included in the final analysis.The maximum PIPP-R score in the experimental and control groups was 12.00(9.50,13.00),12.50(10.50,13.75),respectively(median difference−0.5,95%CI−2.0 to 0.5),and minimum rScO_(2)was(61.22±3.07)%,(61.32±2.79)%,respectively(mean difference−0.325,95%CI−1.382 to 0.732),without significant differences.During arterial puncture,the mean rScO_(2),HR,and SpO_(2)did not differ between groups.After needle withdrawal,the trends for rScO_(2),PIPP-R score,and facial expression returning to baseline were different between the two groups without statistical significance.Conclusion The white noise intervention did not show beneficial effects on pain-related cortical response as well as pain score,behavioral and physiological parameters in neonates with procedural pain.
文摘Inverted batch distillation column(stripper) is opposed to a conventional batch distillation col-umn(rectifier). It has a storage vessel at the top and products leave the column at the bottom. The batch stripper is favourable to separate mixtures with a small amount of light components by removing the heavy components as bottom products. In this paper, we are presenting a shortcut procedure based on our earlier work for design and simulation of the inverted batch distillation column, which is equivalent to the Fenske-Underwood-Gilliland procedure for continuous distillation. Given a separation task, we propose to compute the minimum number of stages(Nbmin) and the minimum reboil ratio(Rbmin) required in a batch stripper,which are the stages and reboil ratio required in a hypothetical inverted batch distillation column operating in total reboil ratio or having an infinite number of stages, respectively. Then, it is shown that the performance of inverted batch columns with a finite number of stages and reboil ratios could be correlated in Gilliland coordinates with the minimum stages Nbmin and the minimum reboil ratio Rbmin.
