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
Non-contact debris removal methods are fuel-efficient in a single operation compared to contact-based strategies as spacecraft don’t need to match debris velocity.To comprehensively analyze this scheme,maneuvering sc...Non-contact debris removal methods are fuel-efficient in a single operation compared to contact-based strategies as spacecraft don’t need to match debris velocity.To comprehensively analyze this scheme,maneuvering schemes for maximum debris removal with minimum fuel consumption,including task assignment,sequence planning,and trajectory planning,must be formulated.The coupling between variables’dimensions and optimization results in task assignment poses challenges,as debris removal is repetitive and uncertain,leading to a vast search space.This paper proposes a novel Greedy Randomized Adaptive Search Procedure with Large Neighborhood and Crossover Mechanisms(GRASP-LNCM)to address this problem.The hybrid dynamic iteration mechanism improves computational efficiency and enhances the optimality of results.The model innovatively considers unsuccessful single removal by using a quantitative method to assess removal percentage.In addition,to improve the efficiency of sequence and trajectory planning,a Suboptimal Search Algorithm(SSA)based on the Lambert property and accelerated Multi-Revolution Lambert Problem(MRLP)solving strategy is established.Finally,a real Iridium-33 debris removal mission is studied.The simulation demonstrates that the proposed algorithm achieves state-of-the-art performance in several typical scenarios.Compared to the contact-based scheme,the new one is simpler,saving more fuel under certain conditions.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
Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedem...Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedema,typically in the limbs,to decompress blocked lymphatic drainage pathways.展开更多
This article constructs statistical selection procedures for exponential populations that may differ in only the threshold parameters. The scale parameters of the populations are assumed common and known. The independ...This article constructs statistical selection procedures for exponential populations that may differ in only the threshold parameters. The scale parameters of the populations are assumed common and known. The independent samples drawn from the populations are taken to be of the same size. The best population is defined as the one associated with the largest threshold parameter. In case more than one population share the largest threshold, one of these is tagged at random and denoted the best. Two procedures are developed for choosing a subset of the populations having the property that the chosen subset contains the best population with a prescribed probability. One procedure is based on the sample minimum values drawn from the populations, and another is based on the sample means from the populations. An “Indifference Zone” (IZ) selection procedure is also developed based on the sample minimum values. The IZ procedure asserts that the population with the largest test statistic (e.g., the sample minimum) is the best population. With this approach, the sample size is chosen so as to guarantee that the probability of a correct selection is no less than a prescribed probability in the parameter region where the largest threshold is at least a prescribed amount larger than the remaining thresholds. Numerical examples are given, and the computer R-codes for all calculations are given in the Appendices.展开更多
This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadi...This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.展开更多
Complete rectal prolapse,characterized by the protrusion of the rectal wall layers through the anal canal,poses significant treatment challenges,particularly due to controversies surrounding surgical approaches and th...Complete rectal prolapse,characterized by the protrusion of the rectal wall layers through the anal canal,poses significant treatment challenges,particularly due to controversies surrounding surgical approaches and the absence of a standardized assessment system.This study comprehensively reviews the main surgical tech-niques for complete rectal prolapse,categorized as transabdominal and transpe-rineal/transanal procedures.Despite various techniques,challenges persist,inclu-ding high recurrence rates and potential complications.Factors influencing the choice of the surgical approach include patient characteristics,symptomatology,and surgical expertise.With advances in medical technology,laparoscopic and robotic surgeries offer promising avenues,albeit with considerations of cost and accessibility.Ultimately,treatment plans tailored to the individual needs of the patient and surgical expertise are essential.Although controversies remain,the continued refinement of surgical techniques holds promise for improving out-comes in complete rectal prolapse surgery.展开更多
The management of gastrointestinal(GI)bleeding patients during endoscopy remains a challenge.Hemorrhage is still one of the significant causes of morbidity and even death.Several therapeutic options have been used ove...The management of gastrointestinal(GI)bleeding patients during endoscopy remains a challenge.Hemorrhage is still one of the significant causes of morbidity and even death.Several therapeutic options have been used over the years depending on the extent,site and cause of bleeding.These include thermal therapy,injection therapy,and mechanical methods of hemostasis(e.g.,endoscopic clips and ligation bands).Patients with refractory bleeding,high-risk ulcer lesions,malignant disease,antiplatelet medications,and chronic kidney disease are at increased risk of upper and lower GI bleeding(LGIB).In this editorial,I commented on the paper by Ballester et al.Their work aimed at evaluating PuraStat^(■)(TDM-621),a novel hemostatic agent,particularly its efficacy,applications,feasibility,and safety in treating GI bleeding lesions.The authors concluded that PuraStat^(■)is an effective therapy for GI bleeding and is usually easy to use.Although the authors recommended its consideration as a frontline therapy in the future,they did not explore the clinical and GI uses of PuraStat®.This editorial focuses on the pharmacology of PuraStat®and how it differs from Hemospray®(TC-325)(hemostatic powder).It also explores the current experience of using PuraStat^(■)in upper and LGIB,its uses and safety,and the need for further research to fully understand its potential.展开更多
The seepage of groundwater and the strain-softening of rock mass in a submarine tunnel expand the plastic region of rock,thereby affecting its overall stability.It is therefore essential to study the stress and strain...The seepage of groundwater and the strain-softening of rock mass in a submarine tunnel expand the plastic region of rock,thereby affecting its overall stability.It is therefore essential to study the stress and strain fields in the rocks surrounding the submarine tunnel by considering the coupled effect of strainsoftening and seepage.However,the evolution equation for the hydro-mechanical parameters in the existing fully coupled solution is a uniform equation that is unable to reproduce the characteristics of rock mass in practice.In this study,an updated numerical procedure for the submarine tunnel is derived by coupling strain-softening and seepage effect based on the experimental results.According to the hydro-mechanical coupling theory,the hydro-mechanical parameters such as elastic modulus,Poisson's ratio,Biot's coefficient and permeability coefficient of rocks are characterized by the fitting equations derived from the experimental data.Then,the updated numerical procedure is deduced with the governing equations,boundary conditions,seepage equations and fitting equations.The updated numerical procedure is verified accurately compared with the previous analytical solution.By utilizing the updated numerical procedure,the characteristics of stress field and the influences of initial pore water pressure,Biot's coefficient,and permeability coefficient on the stress,displacement and water-inflow of the surrounding rocks are discussed.Regardless of the variations in hydro-mechanical parameters,the stress distribution has a similar trend.The initial permeability coefficient exerts the most significant influence on the stress field.With the increases in initial pore water pressure and Biot's coefficient,the plastic region expands,and the water-inflow and displacement increase accordingly.Given the fact that the stability of the tunnel is more sensitive to the seepage force controlled by the hydraulic parameters,it is suggested to dewater the ground above the submarine tunnel to control the initial pore water pressure.展开更多
BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better...BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better short-term outcomes,including less postoperative pain,shorter operative time,faster return to work,and higher patient satisfaction.However,there is a risk-benefit debate surrounding SH due to significant complications from the procedure,such as anal stenosis,rectovaginal fistula,fecal incontinence,and recurrence.AIM To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.METHODS This retrospective,single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.Early(less than 7 days after SH)and late(7 or more days after SH)complications were analyzed.Recurrence rates were calculated as well.RESULTS Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.Recurrence was observed in 4 patients(23.6%)with grade IV hemorrhoids,and no recurrence was noted in patients with grade III hemorrhoids.Postoperative bleeding,incomplete defecation,urgent defecation,incontinence,skin tags,and anal fissure were complications reported by both groups.CONCLUSION Due to the high recurrence rate,SH is not an appropriate treatment option for patients with grade IV hemorrhoids.Open surgery may be a more suitable option for these patients.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
Objective:To investigate the clinical efficacy and safety of the extrapleural approach versus the traditional intrathoracic approach in minimally invasive correction of pectus excavatum in children,providing a more sc...Objective:To investigate the clinical efficacy and safety of the extrapleural approach versus the traditional intrathoracic approach in minimally invasive correction of pectus excavatum in children,providing a more scientific basis for selecting a more appropriate surgical method in clinical practice.Methods:This study included 50 children who underwent pectus excavatum correction at Harbin Children’s Hospital from January 2023 to January 2025.All patients were divided into two groups based on surgical approach:the observation group(n=26)and the control group(n=24).Children in the observation group underwent correction surgery via an extrapleural approach,while those in the control group underwent correction surgery via the traditional intrathoracic approach.Both groups underwent Nuss bar placement surgery under thoracoscopic guidance.Intraoperative indicators were compared between the two groups,including operative time,blood loss,pain scores at 24 and 48 hours postoperatively,hospital stay duration,thoracic correction outcomes,and the incidence of complications during a 6-month postoperative follow-up.Results:The intraoperative blood loss in the observation group was significantly lower than that in the control group(p<0.05),and the pain scores at 24 and 28 hours postoperatively were also significantly lower(p<0.05).The improvement in thoracic index postoperatively was relatively similar between the two groups,with no statistically significant difference(p>0.05).During the 6-month postoperative follow-up period,no complications such as pneumothorax,hemothorax,pleural effusion,plate displacement,or infection occurred in the observation group,whereas the overall complication rate in the control group was 25%,showing a significant difference(p<0.05).Conclusion:The extrapleural approach for corrective surgery can ensure the efficacy of thoracic deformity correction while reducing intraoperative blood loss,lowering the incidence of complications,alleviating postoperative pain,and accelerating recovery.It is a safe and effective approach for minimally invasive Nuss correction of pediatric pectus excavatum.展开更多
Benign prostatic hyperplasia(BPH),prevalent in the aging male population,presented a unique surgical challenge in a 58-year-old patient with a history of multiple pelvic and hip surgeries,precluding conventional litho...Benign prostatic hyperplasia(BPH),prevalent in the aging male population,presented a unique surgical challenge in a 58-year-old patient with a history of multiple pelvic and hip surgeries,precluding conventional lithotomy and transurethral approaches.This report introduces an innovative,single-port transvesical robot-assisted simple prostatectomy with total urethral preservation.This pioneering technique,tailored for complex BPH management,demonstrated its efficacy and potential through favorable postoperative outcomes.This report underscores single-port transvesical robot-assisted simple prostatectomy with total urethral preservation as a promising surgical option for patients with BPH who are unable to assume the lithotomy position.展开更多
An appropriate spatial structure of a power battery supply network is crucial for the specialization and scale development of key components in new energy vehicles, accelerating the transformation and upgrade of the i...An appropriate spatial structure of a power battery supply network is crucial for the specialization and scale development of key components in new energy vehicles, accelerating the transformation and upgrade of the industry. This paper investigates the cooperative relationships among supply chain enterprises from the perspective of complex networks.Employing methodologies such as the gravity model and Moran's I analysis, it explores the spatial structural characteristics and correlation patterns of the power battery supply network in China and discusses the influencing factors using the quadratic assignment procedure,revealing the mechanisms behind the differences in the spatial distributions of the power battery supply network. The results indicate that the distribution of power battery enterprises is densely concentrated in the eastern and southern regions, whereas the western region has a sparse distribution. The spatial supply network consists of a four-tier linkage system, encompassing 135 prefecture-level cities, with Chongqing, Shanghai, Nanjing, and other cities particularly prominent. Overall, the degree of agglomeration is low, with coastal cities dominating the landscape and inland cities serving as complementary regions. Most areas are characterized as insignificant or low-high regions, and the regional linkage effect of core cities is not pronounced. There is a notable lack of significance and high spatial heterogeneity.Four types of factors—spatial factors, market factors, agglomeration economies, and innovation levels—jointly influence and shape the spatial structure of the power battery supply network.展开更多
Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating se...Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating severe obesity,its invasive nature has led to the development of minimally invasive alternatives.Endoscopic sleeve gastroplasty(ESG)is a promising,minimally invasive procedure for weight loss,offering significant weight reduction without the need for surgical incisions.This editorial evaluates the efficacy and safety of ESG,highlighting its weight loss outcomes,safety profile,and comparison with other bariatric procedures,including intragastric balloon,laparoscopic sleeve gastrectomy,and robotic sleeve gastrectomy.ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03%to 17.51%at 12 months and sustained weight reduction over 36 months.The safety profile is favorable,with low rates of serious adverse events and minimal complications compared to surgical alternatives.ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options.However,further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.展开更多
Congenital heart disease(CHD)stands as the most common cardiovascular disorder among children,exerting a profound impact on the growth,development,and quality of life of the affected pediatric population.The modified ...Congenital heart disease(CHD)stands as the most common cardiovascular disorder among children,exerting a profound impact on the growth,development,and quality of life of the affected pediatric population.The modified Fontan procedure,the total cavopulmonary connection(TCPC),has become a pivotal palliative or definitive surgical method for treating complex CHD cases,including single ventricle and tricuspid valve atresia.Through staged surgical processes,this technique directly diverts vena cava blood into the pulmonary artery,thus improving the patient’s oxygenation status.Despite the initial success of the Fontan circulation in providing a means for survival in patients with complex CHD,a significant proportion of patients will eventually experience Fontan failure.Fontan failure is a complex syndrome characterized by a constellation of symptoms and signs,including heart failure,arrhythmia,protein-losing enteropathy,and plastic bronchitis.Understanding the contemporary management of failing modified Fontan after TCPC is crucial for optimizing patient outcomes,as the number of adult patients with Fontan circulation continues to grow due to improved surgical techniques and postoperative care.展开更多
Recent engineering applications increasingly adopt smart materials,whose mechanical responses are sensitive to magnetic and electric fields.In this context,new and computationally efficient modeling strategies are ess...Recent engineering applications increasingly adopt smart materials,whose mechanical responses are sensitive to magnetic and electric fields.In this context,new and computationally efficient modeling strategies are essential to predict the multiphysic behavior of advanced structures accurately.Therefore,the manuscript presents a higher-order formulation for the static analysis of laminated anisotropic magneto-electro-elastic doubly-curved shell structures.The fundamental relations account for the full coupling between the electric field,magnetic field,and mechanical elasticity.The configuration variables are expanded along the thickness direction using a generalized formulation based on the Equivalent Layer-Wise approach.Higher-order polynomials are selected,allowing for the assessment of prescribed values of the configuration variables at the top and bottom sides of solids.In addition,an effective strategy is provided for modeling general surface distributions of mechanical pressures and electromagnetic external fluxes.The model is based on a continuum-based formulation which employs an analytical homogenization of the multifield material properties,based on Mori&Tanaka approach,of a magneto-electro-elastic composite material obtained from a piezoelectric and a piezomagnetic phase,with coupled magneto-electro-elastic effects.A semi-analytical Navier solution is applied to the fundamental equations,and an efficient post-processing equilibrium-based procedure is here used,based on the numerical assessment with the Generalized Differential Quadrature(GDQ)method,to recover the response of three-dimensional shells.The formulation is validated through various examples,investigating the multifield response of panels of different curvatures and lamination schemes.An efficient homogenization procedure,based on the Mori&Tanaka approach,is employed to obtain the three-dimensional constitutive relation of magneto-electro-elastic materials.Each model is validated against three-dimensional finite-element simulations,as developed in commercial codes.Furthermore,the full coupling effect between the electric and magnetic response is evaluated via a parametric investigation,with useful insights for design purposes of many engineering applications.The paper,thus,provides a formulation for the magneto-electro-elastic analysis of laminated structures,with a high computational efficiency,since it provides results with three-dimensional capabilities with a two-dimensional formulation.The adoption of higher-order theories,indeed,allows us to efficiently predict not only the mechanical response of the structure as happens in existing literature,but also the through-the-thickness distribution of electric and magnetic variables.A novel higher-order theory has been proposed in this work for the magneto-electro-elastic analysis of laminated shell structures with varying curvatures.This theory employs a generalized method to model the distribution of the displacement field components,electrostatic,and magneto-static potential,accounting for higher-order polynomials.The thickness functions have been defined to prescribe the arbitrary values of configuration variables at the top and bottom surfaces,even though the model is ESL-based.The fundamental governing equations have been derived in curvilinear principal coordinates,considering all coupling effects among different physical phenomena,including piezoelectric,piezomagnetic,and magneto-electric effects.A homogenization algorithm based on a Mori&Tanaka approach has been adopted to obtain the equivalent magneto-electro-mechanical properties of a two-phase transversely isotropic composite.In addition,an effective method has been adopted involving the external loads in terms of surface tractions,as well as the electric and magnetic fluxes.In the post-processing stage,a GDQ-based procedure provides the actual 3D response of a doubly-curved solid.The model has been validated through significant numerical examples,showing that the results of this semi-analytical theory align well with those obtained from 3D numerical models from commercial codes.In particular,the accuracy of the model has been verified for lamination schemes with soft layers and various curvatures under different loading conditions.Moreover,this formulation has been used to predict the effect of combined electric and magnetic loads on the mechanical response of panels with different curvatures and lamination schemes.As a consequence,this theory can be applied in engineering applications where the combined effect of electric and magnetic loads is crucial,thus facilitating their study and design.An existing limitation of this study is that the solution is that it is derived only for structures with uniform curvature,cross-ply lamination scheme,and simply supported boundary conditions.Furthermore,it requires that each lamina within the stacking sequence exhibits magneto-electro-elastic behavior.Therefore,at the present stage,it cannot be used for multifield analysis of classical composite structures with magneto-electric patches.A further enhancement of the research work could be the derivation of a solution employing a numerical technique,to overcome the limitations of the Navier method.In this way,the same theory may be adopted to predict the multifield response of structures with variable curvatures and thickness,as well as anisotropic materials and more complicated boundary conditions.Acknowledgement:The authors are grateful to the Department of Innovation Engineering of Univer-sity of Salento for the support.展开更多
BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may comprom...BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may compromise reduction stability.Conservative management is generally limited to minimally displaced fractures.Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction.It offers distinct advantages including lower cost,minimal soft tissue trauma,and the avoidance of expensive reduction equipment or internal fixation materials.CASE SUMMARY A 60-year-old female presented with left foot pain and limited mobility following a fall.Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°.A standardized,stepwise Traditional Chinese manual bone-setting was initially performed,followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy.The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3.The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months,indicating rapid functional recovery and high patient satisfaction.At 7 months postoperatively,the American Orthopaedic Foot and Ankle Society score reached 95,prompting removal of internal fixation.At the 6-year follow-up,reduction remained well maintained,with the Böhler angle preserved at 22°.CONCLUSION The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.展开更多
BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male pa...BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.展开更多
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.
基金co-supported by the National Natural Science Foundation of China(Nos.U23B6001,62273118,12150008)the Fundamental Research Funds for the Central Universities,China(No.2023FRFK02043)+1 种基金the Natural Science Foundation of Heilongjiang Province,China(No.LH2022F023)China Aerospace Science and Technology Corporation Youth Talent Support Program.
文摘Non-contact debris removal methods are fuel-efficient in a single operation compared to contact-based strategies as spacecraft don’t need to match debris velocity.To comprehensively analyze this scheme,maneuvering schemes for maximum debris removal with minimum fuel consumption,including task assignment,sequence planning,and trajectory planning,must be formulated.The coupling between variables’dimensions and optimization results in task assignment poses challenges,as debris removal is repetitive and uncertain,leading to a vast search space.This paper proposes a novel Greedy Randomized Adaptive Search Procedure with Large Neighborhood and Crossover Mechanisms(GRASP-LNCM)to address this problem.The hybrid dynamic iteration mechanism improves computational efficiency and enhances the optimality of results.The model innovatively considers unsuccessful single removal by using a quantitative method to assess removal percentage.In addition,to improve the efficiency of sequence and trajectory planning,a Suboptimal Search Algorithm(SSA)based on the Lambert property and accelerated Multi-Revolution Lambert Problem(MRLP)solving strategy is established.Finally,a real Iridium-33 debris removal mission is studied.The simulation demonstrates that the proposed algorithm achieves state-of-the-art performance in several typical scenarios.Compared to the contact-based scheme,the new one is simpler,saving more fuel under certain conditions.
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.
基金the Ministry of Science and Technology of the People's Republic of China(2021ZD0201804,GW)the National Natural Science Foundation of China(82371416,HW).
文摘Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedema,typically in the limbs,to decompress blocked lymphatic drainage pathways.
文摘This article constructs statistical selection procedures for exponential populations that may differ in only the threshold parameters. The scale parameters of the populations are assumed common and known. The independent samples drawn from the populations are taken to be of the same size. The best population is defined as the one associated with the largest threshold parameter. In case more than one population share the largest threshold, one of these is tagged at random and denoted the best. Two procedures are developed for choosing a subset of the populations having the property that the chosen subset contains the best population with a prescribed probability. One procedure is based on the sample minimum values drawn from the populations, and another is based on the sample means from the populations. An “Indifference Zone” (IZ) selection procedure is also developed based on the sample minimum values. The IZ procedure asserts that the population with the largest test statistic (e.g., the sample minimum) is the best population. With this approach, the sample size is chosen so as to guarantee that the probability of a correct selection is no less than a prescribed probability in the parameter region where the largest threshold is at least a prescribed amount larger than the remaining thresholds. Numerical examples are given, and the computer R-codes for all calculations are given in the Appendices.
基金supported by funding from the Medical Research Funding of Guangdong(No.A2022499 to QGX)the National Natural Science Foundation of China(No.82301796 to PL)the Guangdong Province Regional Joint Fund-Youth Fund Project of China(No.2022A1515111201 to PL).
文摘This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.
基金Supported by Science and Technology Fund Project of Guizhou Health Commission,No.gzwkj2023-042 and No.gzwkj2024-010National Natural Science Foundation of China,No.82060440+2 种基金Guizhou Provincial Science and Technology Projects,No.QKHJC ZK[2024]-210Cultivation Program for General Projects of the National Natural Science Foundation of China,No.gyfynsfc[2023]-01Cultivation Program for Regional Projects of the National Natural Science Foundation of China,No.gyfynsfc[2024]-19.
文摘Complete rectal prolapse,characterized by the protrusion of the rectal wall layers through the anal canal,poses significant treatment challenges,particularly due to controversies surrounding surgical approaches and the absence of a standardized assessment system.This study comprehensively reviews the main surgical tech-niques for complete rectal prolapse,categorized as transabdominal and transpe-rineal/transanal procedures.Despite various techniques,challenges persist,inclu-ding high recurrence rates and potential complications.Factors influencing the choice of the surgical approach include patient characteristics,symptomatology,and surgical expertise.With advances in medical technology,laparoscopic and robotic surgeries offer promising avenues,albeit with considerations of cost and accessibility.Ultimately,treatment plans tailored to the individual needs of the patient and surgical expertise are essential.Although controversies remain,the continued refinement of surgical techniques holds promise for improving out-comes in complete rectal prolapse surgery.
文摘The management of gastrointestinal(GI)bleeding patients during endoscopy remains a challenge.Hemorrhage is still one of the significant causes of morbidity and even death.Several therapeutic options have been used over the years depending on the extent,site and cause of bleeding.These include thermal therapy,injection therapy,and mechanical methods of hemostasis(e.g.,endoscopic clips and ligation bands).Patients with refractory bleeding,high-risk ulcer lesions,malignant disease,antiplatelet medications,and chronic kidney disease are at increased risk of upper and lower GI bleeding(LGIB).In this editorial,I commented on the paper by Ballester et al.Their work aimed at evaluating PuraStat^(■)(TDM-621),a novel hemostatic agent,particularly its efficacy,applications,feasibility,and safety in treating GI bleeding lesions.The authors concluded that PuraStat^(■)is an effective therapy for GI bleeding and is usually easy to use.Although the authors recommended its consideration as a frontline therapy in the future,they did not explore the clinical and GI uses of PuraStat®.This editorial focuses on the pharmacology of PuraStat®and how it differs from Hemospray®(TC-325)(hemostatic powder).It also explores the current experience of using PuraStat^(■)in upper and LGIB,its uses and safety,and the need for further research to fully understand its potential.
基金supported by the National Natural Science Foundation of China(Grant Nos.52279118 and U21A20159)Sub-project of National Key Research and Development(Grant No.2023YFC3007403).
文摘The seepage of groundwater and the strain-softening of rock mass in a submarine tunnel expand the plastic region of rock,thereby affecting its overall stability.It is therefore essential to study the stress and strain fields in the rocks surrounding the submarine tunnel by considering the coupled effect of strainsoftening and seepage.However,the evolution equation for the hydro-mechanical parameters in the existing fully coupled solution is a uniform equation that is unable to reproduce the characteristics of rock mass in practice.In this study,an updated numerical procedure for the submarine tunnel is derived by coupling strain-softening and seepage effect based on the experimental results.According to the hydro-mechanical coupling theory,the hydro-mechanical parameters such as elastic modulus,Poisson's ratio,Biot's coefficient and permeability coefficient of rocks are characterized by the fitting equations derived from the experimental data.Then,the updated numerical procedure is deduced with the governing equations,boundary conditions,seepage equations and fitting equations.The updated numerical procedure is verified accurately compared with the previous analytical solution.By utilizing the updated numerical procedure,the characteristics of stress field and the influences of initial pore water pressure,Biot's coefficient,and permeability coefficient on the stress,displacement and water-inflow of the surrounding rocks are discussed.Regardless of the variations in hydro-mechanical parameters,the stress distribution has a similar trend.The initial permeability coefficient exerts the most significant influence on the stress field.With the increases in initial pore water pressure and Biot's coefficient,the plastic region expands,and the water-inflow and displacement increase accordingly.Given the fact that the stability of the tunnel is more sensitive to the seepage force controlled by the hydraulic parameters,it is suggested to dewater the ground above the submarine tunnel to control the initial pore water pressure.
文摘BACKGROUND Stapled hemorrhoidopexy(SH)is one of the most commonly used surgical techniques for hemorrhoidal disease,being particularly effective for grade III and IV hemorrhoids.The procedure is associated with better short-term outcomes,including less postoperative pain,shorter operative time,faster return to work,and higher patient satisfaction.However,there is a risk-benefit debate surrounding SH due to significant complications from the procedure,such as anal stenosis,rectovaginal fistula,fecal incontinence,and recurrence.AIM To evaluate recurrence rates and factors influencing surgical outcomes following SH in patients with grade III and IV hemorrhoids.METHODS This retrospective,single-center study enrolled a total of 77 patients with grade III/IV hemorrhoids for analysis.Early(less than 7 days after SH)and late(7 or more days after SH)complications were analyzed.Recurrence rates were calculated as well.RESULTS Patients were categorized by hemorrhoid grade and showed no differences in demographic data between the two groups.Recurrence was observed in 4 patients(23.6%)with grade IV hemorrhoids,and no recurrence was noted in patients with grade III hemorrhoids.Postoperative bleeding,incomplete defecation,urgent defecation,incontinence,skin tags,and anal fissure were complications reported by both groups.CONCLUSION Due to the high recurrence rate,SH is not an appropriate treatment option for patients with grade IV hemorrhoids.Open surgery may be a more suitable option for these patients.
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.
基金Research on Surgical Strategies for the Correction of Pectus Excavatum in Children via an Extrapleural Approach(Project No.:20220404021010)。
文摘Objective:To investigate the clinical efficacy and safety of the extrapleural approach versus the traditional intrathoracic approach in minimally invasive correction of pectus excavatum in children,providing a more scientific basis for selecting a more appropriate surgical method in clinical practice.Methods:This study included 50 children who underwent pectus excavatum correction at Harbin Children’s Hospital from January 2023 to January 2025.All patients were divided into two groups based on surgical approach:the observation group(n=26)and the control group(n=24).Children in the observation group underwent correction surgery via an extrapleural approach,while those in the control group underwent correction surgery via the traditional intrathoracic approach.Both groups underwent Nuss bar placement surgery under thoracoscopic guidance.Intraoperative indicators were compared between the two groups,including operative time,blood loss,pain scores at 24 and 48 hours postoperatively,hospital stay duration,thoracic correction outcomes,and the incidence of complications during a 6-month postoperative follow-up.Results:The intraoperative blood loss in the observation group was significantly lower than that in the control group(p<0.05),and the pain scores at 24 and 28 hours postoperatively were also significantly lower(p<0.05).The improvement in thoracic index postoperatively was relatively similar between the two groups,with no statistically significant difference(p>0.05).During the 6-month postoperative follow-up period,no complications such as pneumothorax,hemothorax,pleural effusion,plate displacement,or infection occurred in the observation group,whereas the overall complication rate in the control group was 25%,showing a significant difference(p<0.05).Conclusion:The extrapleural approach for corrective surgery can ensure the efficacy of thoracic deformity correction while reducing intraoperative blood loss,lowering the incidence of complications,alleviating postoperative pain,and accelerating recovery.It is a safe and effective approach for minimally invasive Nuss correction of pediatric pectus excavatum.
文摘Benign prostatic hyperplasia(BPH),prevalent in the aging male population,presented a unique surgical challenge in a 58-year-old patient with a history of multiple pelvic and hip surgeries,precluding conventional lithotomy and transurethral approaches.This report introduces an innovative,single-port transvesical robot-assisted simple prostatectomy with total urethral preservation.This pioneering technique,tailored for complex BPH management,demonstrated its efficacy and potential through favorable postoperative outcomes.This report underscores single-port transvesical robot-assisted simple prostatectomy with total urethral preservation as a promising surgical option for patients with BPH who are unable to assume the lithotomy position.
基金Humanities and Social Sciences Project of the Ministry of Education of China,No.23YJCZH195Scientific Research Program funded by the Shaanxi Provincial Education Department,No.20JK0358, No.21JK0908+2 种基金Natural Science Basic Research Program of Shaanxi,No.2024JC-YBQN-0738, No.2023-JC-QN-0560Shaanxi Provincial Education Science Planning Project,No.SGH23Y2484China Logistics Society&China Federation of Logistics and Purchasing Research Fund,No.2023CSLKT3-220。
文摘An appropriate spatial structure of a power battery supply network is crucial for the specialization and scale development of key components in new energy vehicles, accelerating the transformation and upgrade of the industry. This paper investigates the cooperative relationships among supply chain enterprises from the perspective of complex networks.Employing methodologies such as the gravity model and Moran's I analysis, it explores the spatial structural characteristics and correlation patterns of the power battery supply network in China and discusses the influencing factors using the quadratic assignment procedure,revealing the mechanisms behind the differences in the spatial distributions of the power battery supply network. The results indicate that the distribution of power battery enterprises is densely concentrated in the eastern and southern regions, whereas the western region has a sparse distribution. The spatial supply network consists of a four-tier linkage system, encompassing 135 prefecture-level cities, with Chongqing, Shanghai, Nanjing, and other cities particularly prominent. Overall, the degree of agglomeration is low, with coastal cities dominating the landscape and inland cities serving as complementary regions. Most areas are characterized as insignificant or low-high regions, and the regional linkage effect of core cities is not pronounced. There is a notable lack of significance and high spatial heterogeneity.Four types of factors—spatial factors, market factors, agglomeration economies, and innovation levels—jointly influence and shape the spatial structure of the power battery supply network.
文摘Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating severe obesity,its invasive nature has led to the development of minimally invasive alternatives.Endoscopic sleeve gastroplasty(ESG)is a promising,minimally invasive procedure for weight loss,offering significant weight reduction without the need for surgical incisions.This editorial evaluates the efficacy and safety of ESG,highlighting its weight loss outcomes,safety profile,and comparison with other bariatric procedures,including intragastric balloon,laparoscopic sleeve gastrectomy,and robotic sleeve gastrectomy.ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03%to 17.51%at 12 months and sustained weight reduction over 36 months.The safety profile is favorable,with low rates of serious adverse events and minimal complications compared to surgical alternatives.ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options.However,further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.
文摘Congenital heart disease(CHD)stands as the most common cardiovascular disorder among children,exerting a profound impact on the growth,development,and quality of life of the affected pediatric population.The modified Fontan procedure,the total cavopulmonary connection(TCPC),has become a pivotal palliative or definitive surgical method for treating complex CHD cases,including single ventricle and tricuspid valve atresia.Through staged surgical processes,this technique directly diverts vena cava blood into the pulmonary artery,thus improving the patient’s oxygenation status.Despite the initial success of the Fontan circulation in providing a means for survival in patients with complex CHD,a significant proportion of patients will eventually experience Fontan failure.Fontan failure is a complex syndrome characterized by a constellation of symptoms and signs,including heart failure,arrhythmia,protein-losing enteropathy,and plastic bronchitis.Understanding the contemporary management of failing modified Fontan after TCPC is crucial for optimizing patient outcomes,as the number of adult patients with Fontan circulation continues to grow due to improved surgical techniques and postoperative care.
基金funded by the Project PNRR M4C2—Innovation Grant DIRECT:Digital twIns foR EmergenCy supporT—CUP F83C22000740001.
文摘Recent engineering applications increasingly adopt smart materials,whose mechanical responses are sensitive to magnetic and electric fields.In this context,new and computationally efficient modeling strategies are essential to predict the multiphysic behavior of advanced structures accurately.Therefore,the manuscript presents a higher-order formulation for the static analysis of laminated anisotropic magneto-electro-elastic doubly-curved shell structures.The fundamental relations account for the full coupling between the electric field,magnetic field,and mechanical elasticity.The configuration variables are expanded along the thickness direction using a generalized formulation based on the Equivalent Layer-Wise approach.Higher-order polynomials are selected,allowing for the assessment of prescribed values of the configuration variables at the top and bottom sides of solids.In addition,an effective strategy is provided for modeling general surface distributions of mechanical pressures and electromagnetic external fluxes.The model is based on a continuum-based formulation which employs an analytical homogenization of the multifield material properties,based on Mori&Tanaka approach,of a magneto-electro-elastic composite material obtained from a piezoelectric and a piezomagnetic phase,with coupled magneto-electro-elastic effects.A semi-analytical Navier solution is applied to the fundamental equations,and an efficient post-processing equilibrium-based procedure is here used,based on the numerical assessment with the Generalized Differential Quadrature(GDQ)method,to recover the response of three-dimensional shells.The formulation is validated through various examples,investigating the multifield response of panels of different curvatures and lamination schemes.An efficient homogenization procedure,based on the Mori&Tanaka approach,is employed to obtain the three-dimensional constitutive relation of magneto-electro-elastic materials.Each model is validated against three-dimensional finite-element simulations,as developed in commercial codes.Furthermore,the full coupling effect between the electric and magnetic response is evaluated via a parametric investigation,with useful insights for design purposes of many engineering applications.The paper,thus,provides a formulation for the magneto-electro-elastic analysis of laminated structures,with a high computational efficiency,since it provides results with three-dimensional capabilities with a two-dimensional formulation.The adoption of higher-order theories,indeed,allows us to efficiently predict not only the mechanical response of the structure as happens in existing literature,but also the through-the-thickness distribution of electric and magnetic variables.A novel higher-order theory has been proposed in this work for the magneto-electro-elastic analysis of laminated shell structures with varying curvatures.This theory employs a generalized method to model the distribution of the displacement field components,electrostatic,and magneto-static potential,accounting for higher-order polynomials.The thickness functions have been defined to prescribe the arbitrary values of configuration variables at the top and bottom surfaces,even though the model is ESL-based.The fundamental governing equations have been derived in curvilinear principal coordinates,considering all coupling effects among different physical phenomena,including piezoelectric,piezomagnetic,and magneto-electric effects.A homogenization algorithm based on a Mori&Tanaka approach has been adopted to obtain the equivalent magneto-electro-mechanical properties of a two-phase transversely isotropic composite.In addition,an effective method has been adopted involving the external loads in terms of surface tractions,as well as the electric and magnetic fluxes.In the post-processing stage,a GDQ-based procedure provides the actual 3D response of a doubly-curved solid.The model has been validated through significant numerical examples,showing that the results of this semi-analytical theory align well with those obtained from 3D numerical models from commercial codes.In particular,the accuracy of the model has been verified for lamination schemes with soft layers and various curvatures under different loading conditions.Moreover,this formulation has been used to predict the effect of combined electric and magnetic loads on the mechanical response of panels with different curvatures and lamination schemes.As a consequence,this theory can be applied in engineering applications where the combined effect of electric and magnetic loads is crucial,thus facilitating their study and design.An existing limitation of this study is that the solution is that it is derived only for structures with uniform curvature,cross-ply lamination scheme,and simply supported boundary conditions.Furthermore,it requires that each lamina within the stacking sequence exhibits magneto-electro-elastic behavior.Therefore,at the present stage,it cannot be used for multifield analysis of classical composite structures with magneto-electric patches.A further enhancement of the research work could be the derivation of a solution employing a numerical technique,to overcome the limitations of the Navier method.In this way,the same theory may be adopted to predict the multifield response of structures with variable curvatures and thickness,as well as anisotropic materials and more complicated boundary conditions.Acknowledgement:The authors are grateful to the Department of Innovation Engineering of Univer-sity of Salento for the support.
基金Supported by Jin-Wen Liu Academic Experience Heritage Studio Special Fund of National Famous Traditional Chinese Medicine,No.75.
文摘BACKGROUND Comminuted calcaneal fractures present significant treatment challenges.Open reduction and internal fixation carries risks such as infection and skin necrosis,while minimally invasive techniques may compromise reduction stability.Conservative management is generally limited to minimally displaced fractures.Traditional Chinese manual bone-setting has a long history in fracture treatment and is renowned globally for achieving functional reduction.It offers distinct advantages including lower cost,minimal soft tissue trauma,and the avoidance of expensive reduction equipment or internal fixation materials.CASE SUMMARY A 60-year-old female presented with left foot pain and limited mobility following a fall.Computed tomography scan revealed a Sanders type IV calcaneal fracture with a Böhler angle of 0°.A standardized,stepwise Traditional Chinese manual bone-setting was initially performed,followed by percutaneous screw fixation through several mini-incisions after satisfactory alignment was confirmed under fluoroscopy.The Visual Analog Scale score decreased from 5 on postoperative day 1 to 3 by day 3.The American Orthopaedic Foot and Ankle Society score improved from 73 at 6 weeks to 90 at 3 months,indicating rapid functional recovery and high patient satisfaction.At 7 months postoperatively,the American Orthopaedic Foot and Ankle Society score reached 95,prompting removal of internal fixation.At the 6-year follow-up,reduction remained well maintained,with the Böhler angle preserved at 22°.CONCLUSION The combination of Traditional Chinese manual bone-setting and percutaneous screw fixation achieved satisfactory functional reduction for comminuted calcaneal fractures.
文摘BACKGROUND In open heart surgery requiring cardiopulmonary bypass(CPB),ventricular fibrillation(VF)is common,but refractory recurrent VF is uncommon but perilous.CASE SUMMARY This article reports a 58-year-old male patient with an ascending aortic aneurysm who presented for a Bentall procedure and subsequently experienced multiple occurrences of unexplained VF after weaning from CPB.The recurrent episodes of VF in this case were felt to be related to coronary insufficiency after reconstruction of the aortic root.Coronary artery bypass grafting(CABG)of the proximal right coronary artery and the left anterior descending artery successfully resolved VF.Finally,this patient was safely transferred to the postoperative intensive care unit,and was discharged successfully after subsequent supportive treatment.CONCLUSION In aortic root replacement,coronary insufficiency is a potential cause of VF episodes and should be considered in the differential diagnosis.CABG is the sole effective treatment for VF caused by coronary insufficiency.
