We found the qualitative study by Xu et al.on how patients feel about laparoscopic incisions under enhanced recovery after surgery(ERAS)protocols to be very interesting.1 Xu et al.carried out a qualitative study on pa...We found the qualitative study by Xu et al.on how patients feel about laparoscopic incisions under enhanced recovery after surgery(ERAS)protocols to be very interesting.1 Xu et al.carried out a qualitative study on patient experience with laparoscopic incisions under an ERAS protocol to highlight the problem of psychosocial and aesthetic concerns,which are often overlooked when planning surgical operations.This study,which involved semistructured interviews with sixteen people,aimed to narrow perioperative education and the decision-making process for incision site selection,thus making the processes more focused on patient priorities.The study is based on a timely but under-researched subject area;however,it is possible to outline four possible areas of improvement that would allow the study to be more transparent and,at the same time,more applicable to clinical practice.展开更多
AIM:To investigate the association between functionaloutcomes and postoperative patient satisfaction 5y aftersmall incision lenticule extraction(SMILE)and femtosecondlaser-assisted in situ keratomileusis(FS-LASIK).MET...AIM:To investigate the association between functionaloutcomes and postoperative patient satisfaction 5y aftersmall incision lenticule extraction(SMILE)and femtosecondlaser-assisted in situ keratomileusis(FS-LASIK).METHODS:This is a cross-sectional study.Thepatients underwent basic ophthalmic examinations,axiallength measurement,wide-field fundus photography,andaccommodation function testing.Behavioral habits datawere collected using a self-administered questionnaire,andvisual symptoms were assessed with the Quality of Vision(QoV)questionnaire.Postoperative satisfaction was alsorecorded.RESULTS:Totally 410 subjects[820 eyes,160males(39.02%)and 250 females(60.98%)]who hadundergone SMILE or FS-LASIK 5y ago were enrolled.Themean(standard deviation,SD)age of all patients was29.83y(6.69).The mean(SD)preoperative manifest SEwas-5.80(2.04)diopters(D;range:-0.88 to-13.75).Patient satisfaction at 5y after undergoing SMILE or FSLASIKwas 91.70%.Patients were categorized into twogroups:dissatisfied group and satisfied group.Significantdifferences were observed between the two groups in termsof age(P=0.012),sex(P=0.021),preoperative degreeof myopia(P=0.049),postoperative visual symptoms(frequency,P=0.043;severity,P<0.001;bothersome,P=0.018),difficulty driving at night(P=0.001),andaccommodative amplitude(AMP,P=0.020).Multivariateanalysis confirmed that female sex(P=0.024),severityof visual symptoms(P=0.009),and difficulty driving atnight(P=0.006)were significantly associated with lowersatisfaction.The dissatisfied group showed higher rates ofstarbursts,double or multiple images,and high myopia,but lower age.The frequency,severity,and bothersome ofdistortion exhibited decreased with increasing age.CONCLUSION:Patient satisfaction 5y after SMILEand FS-LASIK is high and stable.Difficulty driving at night,sex,and severity of visual symptoms are important factorsinfluencing patient satisfaction.Special attention should bepaid to younger highly myopic female patients,particularlythose with starbursts and double or multiple images.It is crucial to monitor postoperative visual outcomesand provide patients with comprehensive preoperativecounseling to enhance long-term satisfaction.展开更多
Objective:To explore the clinical effect of improved incision in the extraction of impacted mandibular wisdom teeth.Methods:160 patients who were treated in our hospital from October,2024 to April,2025 and had their m...Objective:To explore the clinical effect of improved incision in the extraction of impacted mandibular wisdom teeth.Methods:160 patients who were treated in our hospital from October,2024 to April,2025 and had their mandibular impacted wisdom teeth removed according to the doctor’s advice were randomly divided into observation group and control group.The observation group used modified incision,while the control group used traditional triangular incision.The operation time,intraoperative visual analogue scale(VAS)pain score,pain VAS score on the 1st,2nd and 3rd day after operation,facial swelling on the 2nd day after operation,mouth opening limitation on the 2nd day after operation and the incidence of dry socket after operation were recorded and compared between the two groups.Results:There was no significant difference in operation time between the two groups(p>0.05).The VAS score of pain in the observation group was significantly lower than that in the control group at each time point during and after operation(p<0.05).On the second day after operation,the facial swelling and mouth opening limitation in the observation group were significantly lighter than those in the control group(p<0.05).The incidence of dry socket in the observation group was 1.25%(1/80),which was significantly lower than that in the control group(8.75%,7/80),and the difference was statistically significant(p<0.05).Conclusion:The application of modified triangular incision in the extraction of impacted mandibular wisdom teeth can effectively relieve the pain during and after operation,reduce postoperative facial swelling and mouth opening limitation,and reduce the incidence of dry socket.展开更多
The dynamic relationship between field management and reservoir characterization has often been a puzzle,especially in complex deepwater channel systems.Reservoir management and infill drilling success cases were ofte...The dynamic relationship between field management and reservoir characterization has often been a puzzle,especially in complex deepwater channel systems.Reservoir management and infill drilling success cases were often due to improved understanding of deepwater depositional systems and geological controls on channel architecture and the general distribution of individual rock facies.For confined to weakly-confined slope channel complexes,some controls on the degree of channel avulsion and aggradation are the interplay between flow hydraulics,sediment calibre,depositional gradient,and the interaction of the flow with underlying substrate.This work aims at documenting the stratigraphic characterization of a Miocene deepwater channel system in a brownfield with focus on the historical evolution of the framework interpretation as well as applications of the recent updates in field management.The initial stratigraphic model(2005)was done using the layer cake concept with minimal incision,continuous shales and limited vertical connectivity based on observations from available seismic data(pre-baseline survey acquisition)and limited well control.This was modified in 2009 following acquisition of a 4D Monitor 1 seismic volume and 3 years production data from 20 wells to a more erosive model with compensationally stacked channel complexes of similar width.With new 4D Monitor 2 acquired in 2014,broadband processed seismic data in 2020,a total of 36 wells and 11 years of production,an updated framework has recently been built.In the new framework,two key fairways namely the Upper and the Lower Fairway were delineated,each comprising of 8 and 6 channel complexes,respectively.A conceptual basin-fill sequence was utilized,as well as a genetic classification of the channel complexes into erosional-confined systems,meandering systems,and levee-confined channel systems.The cut-and-fill behaviors of the individual complexes have been tied to changes in depositional gradient,sediment sand vs mud ratio,interaction of the flow with the substrate,and this has impacted the degree of channel amalgamation,avulsion and the degree of preservation of both internal and external levees.At flow unit scale,potential inter,and intra-reservoir connection pathways and compartments defined through integrated use of excess pressures,geobody attributes,well production and 4D data,have been very helpful in defining reservoir connection windows,injector-producer connectivity,and channel compartments.The implication is that this exercise or study has provided renewed insights into infill drill-well opportunities,well production performance as well as overall field management strategy.展开更多
Cataract surgery is still the most common surgery performed worldwide.It has evolved tremendously in terms of incision,from 12 mm to 1.8 mm,in terms of capsulotomy from envelope type to automated capsulorhexis,and fro...Cataract surgery is still the most common surgery performed worldwide.It has evolved tremendously in terms of incision,from 12 mm to 1.8 mm,in terms of capsulotomy from envelope type to automated capsulorhexis,and from rigid intraocular lens to foldable intraocular lenses.Manual small incision cataract surgery(MSICS)remains a valuable technique,particularly in rural and underserved areas,due to its cost-effectiveness and simplicity.Its low logistics and favorable outcomes are particularly useful for managing the cataract backlog in developing countries.This review highlights the history and evolution of MSICS,and the reasons for the advent and popularity of this technique,especially in developing countries.It reviews the various recent modifications of the technique,for example,from a superior incision approach to temporal incision to customized MSICS,2 mm MSICS,and astigmatism-correcting MSICS.It provides an overview of its applicability in complicated scenarios(viz.,small pupil,compromised cornea,pseudoexfoliation,subluxated cataract,etc.).It briefly reviews the clinical trials on MSICS and its comparison with phacoemulsification.Finally,the review emphasizes why every ophthalmic surgeon must know MSICS,its relevance in postgraduate teaching,and the role of MSICS simulators for the same.Overall,the review presents a comprehensive picture of the present status of this technique in the surgical armamentarium of ophthalmology.展开更多
AIM:To investigate the response of the anterior and posterior corneal surface in femtosecond laser-assisted convex stromal lenticule addition keratoplasty(SLAK)combined with cross-linking(CXL)for treating keratoconus ...AIM:To investigate the response of the anterior and posterior corneal surface in femtosecond laser-assisted convex stromal lenticule addition keratoplasty(SLAK)combined with cross-linking(CXL)for treating keratoconus at the first 3mo of follow-up.METHODS:In this prospective observational study,20 eyes of 20 keratoconus patients who underwent SLAK combined with CXL were included.The morphological indices in keratometry and elevation data were recorded from the Sirius at baseline and 1 and 3mo postoperatively.The mean values of maximum keratometry(K_(max)),flat keratometry(K_(1)),and steep keratometry(K_(2))at the central,3-mm,5-mm,and 7-mm areas were measured from the curvature map.The changes in anterior and posterior corneal elevation under the best-fit sphere(BFS)radius at seven points horizontally of the center,3-mm,5-mm,and 7-mm area from the center at both nasal(N)and temporal(T)side were measured from elevation map.RESULTS:For the front corneal curvature,K_(1),and K_(2) at 3-mm,5-mm,and 7-mm of the anterior corneal surface increased significantly 1mo postoperatively(all P<0.05)and remained unchanged until 3mo(P>0.05).For the back corneal curvature,K_(1) and K_(2) along the 3-mm back meridian significantly decreased after month 1(P=0.002,0.077,respectively).Posterior K_(2)-readings along the 5-mm and 7-mm did not change after surgery(P>0.05).Anterior BFS decreased 1mo(P<0.001)postoperatively but remained unchanged until 3mo after SLAK(P>0.05).There was no change in posterior BFS before and after the surgery(P>0.05).Anterior elevation at N5,N3,central,and T5 points and posterior elevation at central and T7 points shifted backward 1mo postoperatively(all P<0.05)and remained stable until 3mo(P>0.05).CONCLUSION:The myopic SLAK combined with CXL is an economical alternative for stabilizing the corneal surface in severe keraoconus.“Pseudoprogression”occurs in the early phase postoperatively,but it is not an indicator of keratoconus progression.展开更多
A decellularized extracellular matrix(dECM)constitutes a pivotal biomaterial created by decellularizing the natural extracellular matrix(ECM).This material serves as a supportive medium for intricate cellular interact...A decellularized extracellular matrix(dECM)constitutes a pivotal biomaterial created by decellularizing the natural extracellular matrix(ECM).This material serves as a supportive medium for intricate cellular interactions,fostering cell growth,differentiation,and organization.However,challenges persist in decellularization,necessitating a balance between preserving the ECM structural integrity and achieving effective cellular removal.An approach to enhancing decellularization involves pre-eliminating unnecessary tissues and effectively reducing final DNA levels to lower than 50 ng/mg ECM on preprocessed tissues.Although this strategic step augments decellularization efficiency,the current manual execution method depends on the operator’s skill.To address this limitation,this study proposed an automated raw tissue slicing system that does not require tissue preparation for slicing.Through carefully controlled tissue applanation pressure and oscillatory incisions with optimized parameters,the system achieved a precision within±10µm in obtaining submillimeter-scale tissue slices of the porcine cornea while avoiding significant microscopic complications in the tissue structure,as observed by tissue histology.These findings suggested the system’s capability to streamline and automate preliminary tissue slicing operations.The efficacy of this approach for decellularization was validated by processing porcine corneas using the proposed system and subsequently decellularizing the processed tissues.DNA level analysis revealed that sliced,subdivided tissues created by this system could expedite DNA reduction even at the initial steps of decellularization,enhancing the overall decellularization procedure.展开更多
AIM:To evaluate the effect of femtosecond laser small incision lenticule extraction(SMILE)on the binocular visual function in myopic patients with glasses-free threedimensional(3D)technique.METHODS:Totally 50 myopic p...AIM:To evaluate the effect of femtosecond laser small incision lenticule extraction(SMILE)on the binocular visual function in myopic patients with glasses-free threedimensional(3D)technique.METHODS:Totally 50 myopic patients(39 females and 11 males)with SMILE were enrolled in this prospective study.The glasses-free 3D technique was used to evaluate the binocular visual function in these subjects including static stereopsis,dynamic stereopsis,foveal suppression,and binocular balance point of signal to noise ratio(s/n ratio).All subjects received measurements in 1d before operation,and 1d,1wk,and 1mo postoperatively.RESULTS:Both static and dynamic stereopsis showed no significant difference after SMILE.The foveal suppression improved significantly 1wk and 1mo after SMILE(P=0.005 and P=0.007 respectively).The binocular balance point of signal to noise ratio showed a significant improvement 1d,1wk and 1mo after SMILE for both eyes(P<0.001 for each eye respectively).CONCLUSION:Glasses-free 3D technique can be used to evaluate the effect of SMILE on the binocular visual function in myopic patients perceptively,and SMILE can improve both foveal suppression and binocular imbalance in these patients.展开更多
Inappropriate use of antibiotics leads to microbial resistance.Single-dose antibio-tic prophylaxis prior to laparoscopic cholecystectomy is well known for reducing the risk of postoperative infection in high-risk pati...Inappropriate use of antibiotics leads to microbial resistance.Single-dose antibio-tic prophylaxis prior to laparoscopic cholecystectomy is well known for reducing the risk of postoperative infection in high-risk patients despite some conflicting aspects.High-risk patients are those who are older than 70 years,have diabetes mellitus,whose operation time exceeded 120 minutes,have acute cholecystitis,experienced iatrogenic intraoperative gallbladder perforation resulting in bile or gallstone spillage,suffered from obstructive jaundice,or were deemed immuno-compromised.For gallbladder perforation,one dose of antibiotic prophylaxis is sufficient.Therefore,guidelines are needed and must be strictly followed.Prophy-lactic treatment is not needed for patients at low risk of developing sepsis fo-llowing elective laparoscopic cholecystectomy,although the opposite is suppor-ted.Similarly,superficial surgical infections are related to low morbidity.Patients without risk factors have a very low risk of infection.Thus,the routine use of anti-biotic prophylaxis in elective laparoscopic cholecystectomy is not recommended.展开更多
The transverse incision with longitudinal ligation(TILL)procedure is a new method for treating circumferential prolapsed hemorrhoids.A study by Song et al found TILL to be better than the traditional Milligan-Morgan h...The transverse incision with longitudinal ligation(TILL)procedure is a new method for treating circumferential prolapsed hemorrhoids.A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results,showing less pain,quicker healing,and lower risk of anal stenosis.TILL reduces tissue tension and controls blood supply,allowing effective removal of diseased tissue while maintaining anal function and structure.However,the study's limitations,including its retrospective,single-center design,small sample size,and short follow-up,restrict the findings'generalizability and ability to assess long-term outcomes like recurrence.Larger,multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.展开更多
AIM:To compare the visual outcomes and corneal higherorder aberrations(HOAs)of patients with high or low myopic astigmatism after small incision lenticule extraction(SMILE).METHODS:A total of 157 eyes of 157 patients ...AIM:To compare the visual outcomes and corneal higherorder aberrations(HOAs)of patients with high or low myopic astigmatism after small incision lenticule extraction(SMILE).METHODS:A total of 157 eyes of 157 patients who underwent SMILE were included in this retrospective,nonrandomized,comparative study.All the eyes which were with the rule astigmatism were divided into high astigmatism group(HAG;astigmatism≤-2.00 D,73 eyes)and low astigmatism group(LAG;astigmatism≥-1.00 D,84 eyes).Visual and refractive examinations were performed,HOAs of the anterior surface,posterior surface,and total cornea of the eyes were evaluated preoperatively and 6mo postoperatively.RESULTS:At the postoperative 6-month follow-up,uncorrected distance visual acuity of 20/20 or better was achieved in 97%and 100%eyes in HAG and LAG respectively and 74%and 100%eyes were within-0.50 D.Vector analysis revealed no significant differences in the correction index(P=0.066),angle of error(P=0.091)or flattening index(P=0.987)between two groups.The magnitude of error was-0.37±0.31 D in HAG and-0.04±0.19 D in LAG(P<0.001).Index of success(IOS)was 0.22±0.09 in the HAG and 0.50±0.46 in the LAG(P<0.001).HOAs of most anterior,posterior and total cornea significantly increased after SMILE,especially the spherical aberration and coma.For HAG,the SMILE procedure induced significantly higher anterior,posterior and total cornea horizontal coma and total corneal total HOAs compared with LAG(P<0.001)and these surgically induced HOAs predominantly originated from the anterior surface of the cornea.CONCLUSION:SMILE surgery induces more HOAs and a mild under-correction of astigmatism in eyes with high astigmatism.The increment in HOAs after SMILE is related to preoperative astigmatism.展开更多
1.Introduction Many abdominopelvic surgeries are now performed laparoscopically rather than through open approaches.This trend continued despite reports of increased rates of unintended complications,such as bile duct...1.Introduction Many abdominopelvic surgeries are now performed laparoscopically rather than through open approaches.This trend continued despite reports of increased rates of unintended complications,such as bile duct injuries during cholecystectomy,in the early phase of laparoscopic adoption^([1,2]).展开更多
AIM:To investigate the changes in posterior corneal elevation within 6mo after small incision lenticule extraction(SMILE)surgery for myopia and myopic astigmatism in patients with thin corneas.METHODS:A prospective st...AIM:To investigate the changes in posterior corneal elevation within 6mo after small incision lenticule extraction(SMILE)surgery for myopia and myopic astigmatism in patients with thin corneas.METHODS:A prospective study included patients with thin corneas(preoperative thinnest corneal thickness ranging from 480 to 520μm)who underwent SMILE for myopia or myopic astigmatism.Corneal topography and posterior corneal elevation were assessed using Pentacam HR at three time points:preoperatively,1mo,and 6mo postoperatively.The measured parameters included thinnest point elevation(PTE),posterior maximal elevation(PME),posterior central elevation(PCE),and 24 additional reference points.RESULTS:A total of 106 eyes from 106 patients(age range:18-34)were included in the study.Uncorrected distance visual acuity(UDVA)improved significantly,with a mean logMAR value of-0.07±0.06 at the final follow-up visit.Measurements of posterior corneal elevation showed no significant changes in most points,hemispheres,and meridians at 6mo postoperatively.Notably,only two points,ΔE_(2mm-45°)andΔE_(2mm-90°),exhibited statistically significant elevation changes:the elevation ofΔE_(2mm-45°)increased from-2.3±4.99 to-1.0±5.9μm(P=0.0037),and that ofΔE_(2mm-90°)increased from-16±7.53 to-15±7.4μm(P=0.016).However,these changes were within the measurement error range of the Pentacam HR(±5μm in a 5 mm area).CONCLUSION:SMILE surgery is a safe and stable procedure for correcting myopia or myopic astigmatism in patients with thin corneas,as evidenced by the stability of posterior corneal elevation.展开更多
Objective Enhanced recovery after surgery(ERAS)protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma....Objective Enhanced recovery after surgery(ERAS)protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma.However,the cognitive and experiential dimensions of surgical incisions under ERAS remain underexplored,particularly in non-Western populations.This study aims to explore patients’perceptions and preferences regarding laparoscopic incisions under ERAS,providing evidence to optimize incision planning and perioperative education.Methods A qualitative descriptive study was conducted at the Department of Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,between November 2022 and February 2023.The participants were adults(≥18 years)who underwent elective laparoscopic abdominal surgery under ERAS,excluding those with cognitive impairments,language barriers,or emergency procedures.Semi-structured interviews,covering physical function,social function,emotional function,self and others’acceptance,and confidence in the nature and treatment of the disease,were audio-recorded and transcribed verbatim and guided by a thematic framework co-developed by surgeons,nurses,and psychologists.The data were analyzed via the framework method to identify themes related to incision experiences.Results This qualitative study included 16 participants,8(50%)females and 6(37.5%)cancer patients,with a mean age of 41.5±12.2 years.Qualitative analysis revealed that the participants experienced minimal psychological distress and great emphasis on pain management and expressed specific concerns regarding the location,size,and cosmetic appearance of the incision.They also voiced high expectations for preventing incision complications and sought information regarding postoperative care.There was notable variation in preferences regarding the choice of incision site before surgery.Participants with cancer focused on disease cure rather than aesthetics.Conclusion Personalized preoperative discussions,incision site selection,and postoperative education are critical for increasing patient satisfaction.Laparoscopic incisions under ERAS minimally impact psychological well-being,but location-specific discomfort and aesthetic preferences require attention.展开更多
BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with signifi...BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.展开更多
AIM:To assess early visual outcomes and corneal stability following small incision lenticule extraction(SMILE)in eyes with a pre-planned residual stromal thickness(RST)ranging from 280 to 300μm.METHODS:This retrospec...AIM:To assess early visual outcomes and corneal stability following small incision lenticule extraction(SMILE)in eyes with a pre-planned residual stromal thickness(RST)ranging from 280 to 300μm.METHODS:This retrospective study was designed to evaluate 82 eyes from 82 patients,all of whom had a pre-planned RST of 280 to 300μm and normal corneal topography prior to undergoing SMILE surgery.The mean preoperative spherical equivalent(SE)was-4.82±1.30 D.A standard follow-up protocol was conducted between 1 to 6mo postoperatively.Visual outcomes were recorded using uncorrected visual acuity(UCVA)and subjective refraction.The curvature of the anterior and posterior corneal surfaces,as well as the posterior elevation at the thinnest point(PTE)were derived from the Pentacam system.RESULTS:At the final follow-up,the efficacy index was 1.14±0.15,the safety index was 1.20±0.13.The mean preoperative UDVA was 0.78±0.16 logMAR,which improved significantly to-0.07±0.06 logMAR postoperatively(P<0.001).The preoperative mean SE was-4.82±1.30 D,which decreased to-0.14±0.30 D by the last visit.The curvature of the anterior cornea at the flat meridian(AK1)were 42.62±1.02 D preoperatively,38.56±1.37 D and 38.59±1.39 D at 1 and 6mo after operation,respectively.Corresponding measurements at the steep meridian(AK2)were 43.55±1.14 D preoperatively,39.18±1.46 D and 39.22±1.50 D at 1 and 6mo after operation,respectively.Both AK1 and AK2 remained stable at 1 and 6-mo postoperative intervals(P=0.126 and 0.082,respectively).There were no observed changes in the curvature of the posterior cornea at the flat meridian or at the steep meridian,or the PTE before and after surgery.CONCLUSION:SMILE represents a safe and effective procedure for the correction of myopia and astigmatism in eyes featuring a pre-planned RST ranging from 280 to 300μm accompanied by normal corneal topography,on the premise of strict control of surgical indications.展开更多
Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic s...Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.展开更多
文摘We found the qualitative study by Xu et al.on how patients feel about laparoscopic incisions under enhanced recovery after surgery(ERAS)protocols to be very interesting.1 Xu et al.carried out a qualitative study on patient experience with laparoscopic incisions under an ERAS protocol to highlight the problem of psychosocial and aesthetic concerns,which are often overlooked when planning surgical operations.This study,which involved semistructured interviews with sixteen people,aimed to narrow perioperative education and the decision-making process for incision site selection,thus making the processes more focused on patient priorities.The study is based on a timely but under-researched subject area;however,it is possible to outline four possible areas of improvement that would allow the study to be more transparent and,at the same time,more applicable to clinical practice.
基金Supported by Research and Transformation Application of Capital Clinical Diagnosis and Treatment Technology by Beijing Municipal Commission of Science and Technology(No.Z201100005520043).
文摘AIM:To investigate the association between functionaloutcomes and postoperative patient satisfaction 5y aftersmall incision lenticule extraction(SMILE)and femtosecondlaser-assisted in situ keratomileusis(FS-LASIK).METHODS:This is a cross-sectional study.Thepatients underwent basic ophthalmic examinations,axiallength measurement,wide-field fundus photography,andaccommodation function testing.Behavioral habits datawere collected using a self-administered questionnaire,andvisual symptoms were assessed with the Quality of Vision(QoV)questionnaire.Postoperative satisfaction was alsorecorded.RESULTS:Totally 410 subjects[820 eyes,160males(39.02%)and 250 females(60.98%)]who hadundergone SMILE or FS-LASIK 5y ago were enrolled.Themean(standard deviation,SD)age of all patients was29.83y(6.69).The mean(SD)preoperative manifest SEwas-5.80(2.04)diopters(D;range:-0.88 to-13.75).Patient satisfaction at 5y after undergoing SMILE or FSLASIKwas 91.70%.Patients were categorized into twogroups:dissatisfied group and satisfied group.Significantdifferences were observed between the two groups in termsof age(P=0.012),sex(P=0.021),preoperative degreeof myopia(P=0.049),postoperative visual symptoms(frequency,P=0.043;severity,P<0.001;bothersome,P=0.018),difficulty driving at night(P=0.001),andaccommodative amplitude(AMP,P=0.020).Multivariateanalysis confirmed that female sex(P=0.024),severityof visual symptoms(P=0.009),and difficulty driving atnight(P=0.006)were significantly associated with lowersatisfaction.The dissatisfied group showed higher rates ofstarbursts,double or multiple images,and high myopia,but lower age.The frequency,severity,and bothersome ofdistortion exhibited decreased with increasing age.CONCLUSION:Patient satisfaction 5y after SMILEand FS-LASIK is high and stable.Difficulty driving at night,sex,and severity of visual symptoms are important factorsinfluencing patient satisfaction.Special attention should bepaid to younger highly myopic female patients,particularlythose with starbursts and double or multiple images.It is crucial to monitor postoperative visual outcomesand provide patients with comprehensive preoperativecounseling to enhance long-term satisfaction.
文摘Objective:To explore the clinical effect of improved incision in the extraction of impacted mandibular wisdom teeth.Methods:160 patients who were treated in our hospital from October,2024 to April,2025 and had their mandibular impacted wisdom teeth removed according to the doctor’s advice were randomly divided into observation group and control group.The observation group used modified incision,while the control group used traditional triangular incision.The operation time,intraoperative visual analogue scale(VAS)pain score,pain VAS score on the 1st,2nd and 3rd day after operation,facial swelling on the 2nd day after operation,mouth opening limitation on the 2nd day after operation and the incidence of dry socket after operation were recorded and compared between the two groups.Results:There was no significant difference in operation time between the two groups(p>0.05).The VAS score of pain in the observation group was significantly lower than that in the control group at each time point during and after operation(p<0.05).On the second day after operation,the facial swelling and mouth opening limitation in the observation group were significantly lighter than those in the control group(p<0.05).The incidence of dry socket in the observation group was 1.25%(1/80),which was significantly lower than that in the control group(8.75%,7/80),and the difference was statistically significant(p<0.05).Conclusion:The application of modified triangular incision in the extraction of impacted mandibular wisdom teeth can effectively relieve the pain during and after operation,reduce postoperative facial swelling and mouth opening limitation,and reduce the incidence of dry socket.
文摘The dynamic relationship between field management and reservoir characterization has often been a puzzle,especially in complex deepwater channel systems.Reservoir management and infill drilling success cases were often due to improved understanding of deepwater depositional systems and geological controls on channel architecture and the general distribution of individual rock facies.For confined to weakly-confined slope channel complexes,some controls on the degree of channel avulsion and aggradation are the interplay between flow hydraulics,sediment calibre,depositional gradient,and the interaction of the flow with underlying substrate.This work aims at documenting the stratigraphic characterization of a Miocene deepwater channel system in a brownfield with focus on the historical evolution of the framework interpretation as well as applications of the recent updates in field management.The initial stratigraphic model(2005)was done using the layer cake concept with minimal incision,continuous shales and limited vertical connectivity based on observations from available seismic data(pre-baseline survey acquisition)and limited well control.This was modified in 2009 following acquisition of a 4D Monitor 1 seismic volume and 3 years production data from 20 wells to a more erosive model with compensationally stacked channel complexes of similar width.With new 4D Monitor 2 acquired in 2014,broadband processed seismic data in 2020,a total of 36 wells and 11 years of production,an updated framework has recently been built.In the new framework,two key fairways namely the Upper and the Lower Fairway were delineated,each comprising of 8 and 6 channel complexes,respectively.A conceptual basin-fill sequence was utilized,as well as a genetic classification of the channel complexes into erosional-confined systems,meandering systems,and levee-confined channel systems.The cut-and-fill behaviors of the individual complexes have been tied to changes in depositional gradient,sediment sand vs mud ratio,interaction of the flow with the substrate,and this has impacted the degree of channel amalgamation,avulsion and the degree of preservation of both internal and external levees.At flow unit scale,potential inter,and intra-reservoir connection pathways and compartments defined through integrated use of excess pressures,geobody attributes,well production and 4D data,have been very helpful in defining reservoir connection windows,injector-producer connectivity,and channel compartments.The implication is that this exercise or study has provided renewed insights into infill drill-well opportunities,well production performance as well as overall field management strategy.
文摘Cataract surgery is still the most common surgery performed worldwide.It has evolved tremendously in terms of incision,from 12 mm to 1.8 mm,in terms of capsulotomy from envelope type to automated capsulorhexis,and from rigid intraocular lens to foldable intraocular lenses.Manual small incision cataract surgery(MSICS)remains a valuable technique,particularly in rural and underserved areas,due to its cost-effectiveness and simplicity.Its low logistics and favorable outcomes are particularly useful for managing the cataract backlog in developing countries.This review highlights the history and evolution of MSICS,and the reasons for the advent and popularity of this technique,especially in developing countries.It reviews the various recent modifications of the technique,for example,from a superior incision approach to temporal incision to customized MSICS,2 mm MSICS,and astigmatism-correcting MSICS.It provides an overview of its applicability in complicated scenarios(viz.,small pupil,compromised cornea,pseudoexfoliation,subluxated cataract,etc.).It briefly reviews the clinical trials on MSICS and its comparison with phacoemulsification.Finally,the review emphasizes why every ophthalmic surgeon must know MSICS,its relevance in postgraduate teaching,and the role of MSICS simulators for the same.Overall,the review presents a comprehensive picture of the present status of this technique in the surgical armamentarium of ophthalmology.
基金Supported by the Social Development Grant of Shaanxi Province(No.2022SF-404)the Science and Technology Program of Xi’an,China(No.23YXYJ0010,No.23YXYJ0037)+1 种基金the Research Project of Xi’an Health Commission(No.2024ms05)the Technology Innovation Supporting Program of Shaanxi(No.2024RS-CXTD-11).
文摘AIM:To investigate the response of the anterior and posterior corneal surface in femtosecond laser-assisted convex stromal lenticule addition keratoplasty(SLAK)combined with cross-linking(CXL)for treating keratoconus at the first 3mo of follow-up.METHODS:In this prospective observational study,20 eyes of 20 keratoconus patients who underwent SLAK combined with CXL were included.The morphological indices in keratometry and elevation data were recorded from the Sirius at baseline and 1 and 3mo postoperatively.The mean values of maximum keratometry(K_(max)),flat keratometry(K_(1)),and steep keratometry(K_(2))at the central,3-mm,5-mm,and 7-mm areas were measured from the curvature map.The changes in anterior and posterior corneal elevation under the best-fit sphere(BFS)radius at seven points horizontally of the center,3-mm,5-mm,and 7-mm area from the center at both nasal(N)and temporal(T)side were measured from elevation map.RESULTS:For the front corneal curvature,K_(1),and K_(2) at 3-mm,5-mm,and 7-mm of the anterior corneal surface increased significantly 1mo postoperatively(all P<0.05)and remained unchanged until 3mo(P>0.05).For the back corneal curvature,K_(1) and K_(2) along the 3-mm back meridian significantly decreased after month 1(P=0.002,0.077,respectively).Posterior K_(2)-readings along the 5-mm and 7-mm did not change after surgery(P>0.05).Anterior BFS decreased 1mo(P<0.001)postoperatively but remained unchanged until 3mo after SLAK(P>0.05).There was no change in posterior BFS before and after the surgery(P>0.05).Anterior elevation at N5,N3,central,and T5 points and posterior elevation at central and T7 points shifted backward 1mo postoperatively(all P<0.05)and remained stable until 3mo(P>0.05).CONCLUSION:The myopic SLAK combined with CXL is an economical alternative for stabilizing the corneal surface in severe keraoconus.“Pseudoprogression”occurs in the early phase postoperatively,but it is not an indicator of keratoconus progression.
基金supported by the Alchemist Project 1415180884(No.20012378,Development of Meta Soft Organ Module Manufacturing Technology without Immunity Rejection and Module Assembly Robot System)funded by the Ministry of Trade,Industry&Energy(MOTIE,Republic of Korea)the Technology Development Program(No.S3318933)funded by the Ministry of SMEs and Startups(MSS,Republic of Korea).
文摘A decellularized extracellular matrix(dECM)constitutes a pivotal biomaterial created by decellularizing the natural extracellular matrix(ECM).This material serves as a supportive medium for intricate cellular interactions,fostering cell growth,differentiation,and organization.However,challenges persist in decellularization,necessitating a balance between preserving the ECM structural integrity and achieving effective cellular removal.An approach to enhancing decellularization involves pre-eliminating unnecessary tissues and effectively reducing final DNA levels to lower than 50 ng/mg ECM on preprocessed tissues.Although this strategic step augments decellularization efficiency,the current manual execution method depends on the operator’s skill.To address this limitation,this study proposed an automated raw tissue slicing system that does not require tissue preparation for slicing.Through carefully controlled tissue applanation pressure and oscillatory incisions with optimized parameters,the system achieved a precision within±10µm in obtaining submillimeter-scale tissue slices of the porcine cornea while avoiding significant microscopic complications in the tissue structure,as observed by tissue histology.These findings suggested the system’s capability to streamline and automate preliminary tissue slicing operations.The efficacy of this approach for decellularization was validated by processing porcine corneas using the proposed system and subsequently decellularizing the processed tissues.DNA level analysis revealed that sliced,subdivided tissues created by this system could expedite DNA reduction even at the initial steps of decellularization,enhancing the overall decellularization procedure.
基金Supported by Sichuan Science and Technology Program(No.23NSFSC0856).
文摘AIM:To evaluate the effect of femtosecond laser small incision lenticule extraction(SMILE)on the binocular visual function in myopic patients with glasses-free threedimensional(3D)technique.METHODS:Totally 50 myopic patients(39 females and 11 males)with SMILE were enrolled in this prospective study.The glasses-free 3D technique was used to evaluate the binocular visual function in these subjects including static stereopsis,dynamic stereopsis,foveal suppression,and binocular balance point of signal to noise ratio(s/n ratio).All subjects received measurements in 1d before operation,and 1d,1wk,and 1mo postoperatively.RESULTS:Both static and dynamic stereopsis showed no significant difference after SMILE.The foveal suppression improved significantly 1wk and 1mo after SMILE(P=0.005 and P=0.007 respectively).The binocular balance point of signal to noise ratio showed a significant improvement 1d,1wk and 1mo after SMILE for both eyes(P<0.001 for each eye respectively).CONCLUSION:Glasses-free 3D technique can be used to evaluate the effect of SMILE on the binocular visual function in myopic patients perceptively,and SMILE can improve both foveal suppression and binocular imbalance in these patients.
文摘Inappropriate use of antibiotics leads to microbial resistance.Single-dose antibio-tic prophylaxis prior to laparoscopic cholecystectomy is well known for reducing the risk of postoperative infection in high-risk patients despite some conflicting aspects.High-risk patients are those who are older than 70 years,have diabetes mellitus,whose operation time exceeded 120 minutes,have acute cholecystitis,experienced iatrogenic intraoperative gallbladder perforation resulting in bile or gallstone spillage,suffered from obstructive jaundice,or were deemed immuno-compromised.For gallbladder perforation,one dose of antibiotic prophylaxis is sufficient.Therefore,guidelines are needed and must be strictly followed.Prophy-lactic treatment is not needed for patients at low risk of developing sepsis fo-llowing elective laparoscopic cholecystectomy,although the opposite is suppor-ted.Similarly,superficial surgical infections are related to low morbidity.Patients without risk factors have a very low risk of infection.Thus,the routine use of anti-biotic prophylaxis in elective laparoscopic cholecystectomy is not recommended.
文摘The transverse incision with longitudinal ligation(TILL)procedure is a new method for treating circumferential prolapsed hemorrhoids.A study by Song et al found TILL to be better than the traditional Milligan-Morgan hemorrhoidectomy for short-term results,showing less pain,quicker healing,and lower risk of anal stenosis.TILL reduces tissue tension and controls blood supply,allowing effective removal of diseased tissue while maintaining anal function and structure.However,the study's limitations,including its retrospective,single-center design,small sample size,and short follow-up,restrict the findings'generalizability and ability to assess long-term outcomes like recurrence.Larger,multicenter trials are needed for a thorough evaluation and wider clinical adoption of TILL.
文摘AIM:To compare the visual outcomes and corneal higherorder aberrations(HOAs)of patients with high or low myopic astigmatism after small incision lenticule extraction(SMILE).METHODS:A total of 157 eyes of 157 patients who underwent SMILE were included in this retrospective,nonrandomized,comparative study.All the eyes which were with the rule astigmatism were divided into high astigmatism group(HAG;astigmatism≤-2.00 D,73 eyes)and low astigmatism group(LAG;astigmatism≥-1.00 D,84 eyes).Visual and refractive examinations were performed,HOAs of the anterior surface,posterior surface,and total cornea of the eyes were evaluated preoperatively and 6mo postoperatively.RESULTS:At the postoperative 6-month follow-up,uncorrected distance visual acuity of 20/20 or better was achieved in 97%and 100%eyes in HAG and LAG respectively and 74%and 100%eyes were within-0.50 D.Vector analysis revealed no significant differences in the correction index(P=0.066),angle of error(P=0.091)or flattening index(P=0.987)between two groups.The magnitude of error was-0.37±0.31 D in HAG and-0.04±0.19 D in LAG(P<0.001).Index of success(IOS)was 0.22±0.09 in the HAG and 0.50±0.46 in the LAG(P<0.001).HOAs of most anterior,posterior and total cornea significantly increased after SMILE,especially the spherical aberration and coma.For HAG,the SMILE procedure induced significantly higher anterior,posterior and total cornea horizontal coma and total corneal total HOAs compared with LAG(P<0.001)and these surgically induced HOAs predominantly originated from the anterior surface of the cornea.CONCLUSION:SMILE surgery induces more HOAs and a mild under-correction of astigmatism in eyes with high astigmatism.The increment in HOAs after SMILE is related to preoperative astigmatism.
文摘1.Introduction Many abdominopelvic surgeries are now performed laparoscopically rather than through open approaches.This trend continued despite reports of increased rates of unintended complications,such as bile duct injuries during cholecystectomy,in the early phase of laparoscopic adoption^([1,2]).
文摘AIM:To investigate the changes in posterior corneal elevation within 6mo after small incision lenticule extraction(SMILE)surgery for myopia and myopic astigmatism in patients with thin corneas.METHODS:A prospective study included patients with thin corneas(preoperative thinnest corneal thickness ranging from 480 to 520μm)who underwent SMILE for myopia or myopic astigmatism.Corneal topography and posterior corneal elevation were assessed using Pentacam HR at three time points:preoperatively,1mo,and 6mo postoperatively.The measured parameters included thinnest point elevation(PTE),posterior maximal elevation(PME),posterior central elevation(PCE),and 24 additional reference points.RESULTS:A total of 106 eyes from 106 patients(age range:18-34)were included in the study.Uncorrected distance visual acuity(UDVA)improved significantly,with a mean logMAR value of-0.07±0.06 at the final follow-up visit.Measurements of posterior corneal elevation showed no significant changes in most points,hemispheres,and meridians at 6mo postoperatively.Notably,only two points,ΔE_(2mm-45°)andΔE_(2mm-90°),exhibited statistically significant elevation changes:the elevation ofΔE_(2mm-45°)increased from-2.3±4.99 to-1.0±5.9μm(P=0.0037),and that ofΔE_(2mm-90°)increased from-16±7.53 to-15±7.4μm(P=0.016).However,these changes were within the measurement error range of the Pentacam HR(±5μm in a 5 mm area).CONCLUSION:SMILE surgery is a safe and stable procedure for correcting myopia or myopic astigmatism in patients with thin corneas,as evidenced by the stability of posterior corneal elevation.
基金supported by the Applied Research Grant Program of the Academy of Social Sciences of Zhejiang University(No.2020XZA108)Medical Science and Technology Project of Zhejiang Province(No.2023KY798)Key Project in the Agricultural and Social Development Sector of the Science and Technology Bureau of Hangzhou(No.20231203A09).
文摘Objective Enhanced recovery after surgery(ERAS)protocols have revolutionized postoperative care by integrating minimally invasive techniques and patient-centered strategies to reduce physical and psychological trauma.However,the cognitive and experiential dimensions of surgical incisions under ERAS remain underexplored,particularly in non-Western populations.This study aims to explore patients’perceptions and preferences regarding laparoscopic incisions under ERAS,providing evidence to optimize incision planning and perioperative education.Methods A qualitative descriptive study was conducted at the Department of Surgery,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,between November 2022 and February 2023.The participants were adults(≥18 years)who underwent elective laparoscopic abdominal surgery under ERAS,excluding those with cognitive impairments,language barriers,or emergency procedures.Semi-structured interviews,covering physical function,social function,emotional function,self and others’acceptance,and confidence in the nature and treatment of the disease,were audio-recorded and transcribed verbatim and guided by a thematic framework co-developed by surgeons,nurses,and psychologists.The data were analyzed via the framework method to identify themes related to incision experiences.Results This qualitative study included 16 participants,8(50%)females and 6(37.5%)cancer patients,with a mean age of 41.5±12.2 years.Qualitative analysis revealed that the participants experienced minimal psychological distress and great emphasis on pain management and expressed specific concerns regarding the location,size,and cosmetic appearance of the incision.They also voiced high expectations for preventing incision complications and sought information regarding postoperative care.There was notable variation in preferences regarding the choice of incision site before surgery.Participants with cancer focused on disease cure rather than aesthetics.Conclusion Personalized preoperative discussions,incision site selection,and postoperative education are critical for increasing patient satisfaction.Laparoscopic incisions under ERAS minimally impact psychological well-being,but location-specific discomfort and aesthetic preferences require attention.
基金Supported by Scientific Research Fund of China-Japan Friendship Hospital,No.2019-1-QN-53.
文摘BACKGROUND Circumferential prolapsed hemorrhoids(CPHs)necessitate surgical intervention.While Milligan-Morgan hemorrhoidectomy(MMH)remains widely used,it compromises functional preservation and associates with significant post-operative pain,edema,and delayed healing in severe CPH cases.To address these limitations,our research team innovatively proposed the transverse incision with longitudinal ligation procedure(TILL).This novel technique utilizes targeted transverse incisions and longitudinal pedicle ligation to optimize complete resection while preserving anal anatomy and function.METHODS A total of 180 patients were retrospectively reviewed in China.The patients were divided into two groups of 90 based on the surgical methods.The treatment group underwent the TILL procedure,while the control group underwent MMH.The main observation index was the evaluation of clinical efficacy after wound healing.Secondary outcomes included the recurrence rate and wound healing time.Safety measurements were also evaluated.RESULTS The TILL group showed a significant difference compared to the MMH group(P=0.022),indicating better overall treatment effects.The time for wound healing in the TILL group was shorter than that in the MMH group(P=0.001).Compared to those who underwent MMH,those who underwent TILL experienced significantly reduced postoperative pain,with lower average scores for anal edema and anal stenosis(both P<0.05).CONCLUSION TILL demonstrates superior efficacy to MMH for advanced CPH,reducing recovery times and postoperative pain,edema,and stenosis while preserving anal function.
文摘AIM:To assess early visual outcomes and corneal stability following small incision lenticule extraction(SMILE)in eyes with a pre-planned residual stromal thickness(RST)ranging from 280 to 300μm.METHODS:This retrospective study was designed to evaluate 82 eyes from 82 patients,all of whom had a pre-planned RST of 280 to 300μm and normal corneal topography prior to undergoing SMILE surgery.The mean preoperative spherical equivalent(SE)was-4.82±1.30 D.A standard follow-up protocol was conducted between 1 to 6mo postoperatively.Visual outcomes were recorded using uncorrected visual acuity(UCVA)and subjective refraction.The curvature of the anterior and posterior corneal surfaces,as well as the posterior elevation at the thinnest point(PTE)were derived from the Pentacam system.RESULTS:At the final follow-up,the efficacy index was 1.14±0.15,the safety index was 1.20±0.13.The mean preoperative UDVA was 0.78±0.16 logMAR,which improved significantly to-0.07±0.06 logMAR postoperatively(P<0.001).The preoperative mean SE was-4.82±1.30 D,which decreased to-0.14±0.30 D by the last visit.The curvature of the anterior cornea at the flat meridian(AK1)were 42.62±1.02 D preoperatively,38.56±1.37 D and 38.59±1.39 D at 1 and 6mo after operation,respectively.Corresponding measurements at the steep meridian(AK2)were 43.55±1.14 D preoperatively,39.18±1.46 D and 39.22±1.50 D at 1 and 6mo after operation,respectively.Both AK1 and AK2 remained stable at 1 and 6-mo postoperative intervals(P=0.126 and 0.082,respectively).There were no observed changes in the curvature of the posterior cornea at the flat meridian or at the steep meridian,or the PTE before and after surgery.CONCLUSION:SMILE represents a safe and effective procedure for the correction of myopia and astigmatism in eyes featuring a pre-planned RST ranging from 280 to 300μm accompanied by normal corneal topography,on the premise of strict control of surgical indications.
基金supported by the National Key R&D Program of China(No.2022YFC2702701)Shanghai Scientific and Technological Project(No.20Y11907600)Clinical Research Innovation Plan of Shanghai General Hospital(No.CTCCR-2021C17).
文摘Dear Editor,Inguinal hernia repair(IHR)performed during childhood is a prevalent etiological factor for obstructive azoospermia(OA)attributed to vasal injury.OA couples can achieve pregnancy through intracytoplasmic sperm injection or natural pregnancy after microsurgical anastomosis.Recent advancements have highlighted the potential utility of laparoscopy-assisted vasovasostomy for treating OA caused by childhood herniorrhaphy.
