BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly dev...BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.展开更多
The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submuc...The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.展开更多
BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for ...BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.展开更多
BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery ...BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.展开更多
Given two ideals I and J of a commutative ring R,there are two extreme connections between I and J:I+J=R and I∩J={0}.For the former case,graphs whose vertices are defined as the proper ideals of R and that two vertic...Given two ideals I and J of a commutative ring R,there are two extreme connections between I and J:I+J=R and I∩J={0}.For the former case,graphs whose vertices are defined as the proper ideals of R and that two vertices are adjacent if and only if their sum is the whole ring R are known as co-maximal ideal graphs.In this paper,we introduce a new kind of graph structure on R,called co-minimal ideal graph,according to the second case:Its vertices are the nonzero ideals of R and two vertices are adjacent if and only if their intersection is zero.Some important graph parameters(including girth,diameter,clique number and chromatic number)and graph structures(including tree and bipartite graph)of co-minimal ideal graphs over finite commutative rings are studied.In particular,we show that the co-maximal ideal graph and the co-minimal ideal graph over R are isomorphic if and only if the number of maximal ideals of R and the number of minimal ideals of R coincide.展开更多
In this paper,we use the solution of the even functional Minkowski problem to show that there is a minimizing affine Minkowski total variation of the function of bounded variation.Moreover,for the Minkowski total vari...In this paper,we use the solution of the even functional Minkowski problem to show that there is a minimizing affine Minkowski total variation of the function of bounded variation.Moreover,for the Minkowski total variation,we use the method of convexation to establish the same conclusion as the convex body space.展开更多
The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the p...The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.展开更多
The underlying molecular changes that result in minimal change disease(ne-phrotic syndrome)require an in-depth analysis.Current molecular studies have shown the involvement of zinc fingers and homeobox transcriptional...The underlying molecular changes that result in minimal change disease(ne-phrotic syndrome)require an in-depth analysis.Current molecular studies have shown the involvement of zinc fingers and homeobox transcriptional factors in its pathogenesis.The application of therapeutic drugs relies on understanding the cascade of molecular events to determine their efficacy in managing the clinical condition.展开更多
Bone injuries induced by accidents or bone-related disease have dramatically increased in the past decades.The application of biomaterials has become an inextricable part of treatment for new bone formation and regene...Bone injuries induced by accidents or bone-related disease have dramatically increased in the past decades.The application of biomaterials has become an inextricable part of treatment for new bone formation and regeneration.Different from traditional bone-regeneration materials,injectable biomaterials—ranging from bioceramics to polymers—have been applied as a means of promoting surgery with a minimal intervention approach.In this review,we summarize the most recent developments in minimally invasive implantable biomaterials for bone reconstruction and different ways to achieve osteogenesis,with a focus on injectable biomaterials for various applications in the orthopedic field.More specifically,bioceramics and polymeric materials,together with their applications in bone fracture healing,vertebral body augmentation,bone implant fixation,bone tumor therapy,and bone-defect-related infection treatment are reviewed in detail.Recent progress in injectable biomaterials with multiple functionalities and bioresponsive properties is also reviewed.Finally,we summarize the challenges in this field and future directions for clinical treatment.展开更多
In this editorial we comment on the article by Jiang et al.We focus on the Ence-phalApp Stroop test which is an innovative,smartphone-based tool specifically designed for screening minimal hepatic encephalopathy(MHE)i...In this editorial we comment on the article by Jiang et al.We focus on the Ence-phalApp Stroop test which is an innovative,smartphone-based tool specifically designed for screening minimal hepatic encephalopathy(MHE)in cirrhosis patients.Traditional MHE screening methods,while highly sensitive and specific,are often complex,time-consuming,and require controlled environmental con-ditions,limiting their widespread clinical use.The EncephalApp Stroop test si-mplifies the screening process,enhances diagnostic efficiency,and is applicable across diverse cultural contexts.However,the combination of additional bio-markers could further improve diagnostic accuracy.Despite its promising po-tential,more multicenter clinical studies are required to validate its effectiveness and applicability on a global scale.展开更多
Jiang et al explored the diagnostic capabilities of EncephalApp,a smartphone-based Stroop Test,in patients with nonalcoholic liver disease.The study included 160 patients with nonalcoholic cirrhosis and utilized the p...Jiang et al explored the diagnostic capabilities of EncephalApp,a smartphone-based Stroop Test,in patients with nonalcoholic liver disease.The study included 160 patients with nonalcoholic cirrhosis and utilized the psychometric hepatic encephalopathy score as a benchmark for diagnosing minimal encephalopathy.The identified optimal cutoff times were>101.93 seconds for the"off"time and>205.86 seconds for the combined"on+off"time,demonstrating sensitivities of 0.84 and 0.90,and specificities of 0.77 and 0.71,respectively.The findings suggest the necessity of employing different cutoffs for patients with alcoholic vs no-nalcoholic liver cirrhosis,reflecting the distinct pathophysiologies underlying each condition.Additionally,alcohol consumption itself may influence Stroop test outcomes.Therefore,it is reasonable to establish separate benchmarks for alcoholic and nonalcoholic cirrhotic patients.Further validation in larger patient cohorts with clinical outcomes is essential.The demand for noninvasive liver disease assessments remains high in clinical practice.展开更多
Triply periodic minimal surface(TPMS)-based bone implants are an innovative approach in orthopedic implantology,offering customized solutions for bone defect repair and regeneration.This review comprehensively examine...Triply periodic minimal surface(TPMS)-based bone implants are an innovative approach in orthopedic implantology,offering customized solutions for bone defect repair and regeneration.This review comprehensively examines the current research landscape of TPMS-based bone implants,addressing key challenges and proposing future directions.It explores design strategies aimed at optimizing mechanical strength and enhancing biological integration,with a particular emphasis on TPMS structures.These design strategies include graded,hierarchical,and hybrid designs,each contributing to the overall functionality and performance of the implants.This review also highlights state-of-the-art fabrication technologies,particularly advancements in additive manufacturing(AM)techniques for creating metal-based,polymer-based,and ceramic-based bone implants.The ability to precisely control the architecture of TPMS structures using AM techniques is crucial for tailoring the mechanical and biological properties of such implants.Furthermore,this review critically evaluates the biological performance of TPMS implants,focusing on their potential to promote bone ingrowth and regeneration.Key factors,such as mechanical properties,permeability,and biocompatibility,are examined to determine the effectiveness of these implants in clinical applications.By synthesizing existing knowledge and proposing innovative research directions,this review underscores the transformative potential of TPMS-based bone implants in orthopedic surgery.The objective is to improve clinical outcomes and enhance patient care through advanced implant designs and manufacturing techniques.展开更多
Breast cancer mortality is driven predominantly by metastasis,which affects 20-30%of patients with early-stage disease despite guideline-directed therapies.Because conventional imaging modalities currently lack sensit...Breast cancer mortality is driven predominantly by metastasis,which affects 20-30%of patients with early-stage disease despite guideline-directed therapies.Because conventional imaging modalities currently lack sensitivity to identify residual disease,molecular-level monitoring must be developed.Circulating tumor DNA(ctDNA)profiling currently enables transformative minimal residual disease(MRD)detection and can quantify tumor burden at low variant allele frequencies.This review provides a comprehensive overview of MRD in breast cancer,including its definition,detection technologies,positivity thresholds,pathophysiology,clinical applications in adjuvant and neoadjuvant settings,ongoing clinical trials,challenges,and future directions.ctDNA-defined MRD has potential as a precision tool for adaptive therapy,and might facilitate post-adjuvant interception,whereby targeted therapies are administered to eradicate micro-metastases before radiographic recurrence.Persistent challenges include MRD assay standardization,subtype-specific MRD thresholds,tumor heterogeneity,and positioning MRD as a potentially valuable tool for precision management in breast cancer.展开更多
The minimal widths of three bounded subsets of the unit sphere associated to a unit vector in a normed linear space are studied,and three related geometric constants are introduced.New characterizations of inner produ...The minimal widths of three bounded subsets of the unit sphere associated to a unit vector in a normed linear space are studied,and three related geometric constants are introduced.New characterizations of inner product spaces are also presented.From the perspective of minimal width,strongε-symmetry of Birkhoff orthogonality is introduced,and its relation toε-symmetry of Birkhoff orthogonality is shown.Unlike most of the existing parameters of the underlying space,these new constants are full dimensional in nature.展开更多
Magnesium(Mg)-based materials are promising for lightweight structural applications.However,their widespread adoption is significantly constrained by inherent limitations in mechanical properties.To address this chall...Magnesium(Mg)-based materials are promising for lightweight structural applications.However,their widespread adoption is significantly constrained by inherent limitations in mechanical properties.To address this challenge,this study introduces a novel Mg-based interpenetratingphase composite reinforced with a nickel-titanium(NiTi)scaffold featuring a triply periodic minimal surface(TPMS)configuration.By combining experimental investigations with finite element simulations,we systematically elucidate the dual impact of the scaffold’s unit cell size(a)on manufacturing viability and mechanical enhancement.To compensate for compromised infiltration dynamics induced by decreasing a,a critical permeability threshold of 1×10^(-8) m^(2) is proposed for achieving successful composite fabrication.Mechanically,reducing a strengthens the interaction between the scaffold and matrix:the TPMS-configured NiTi scaffolds improve stress transfer,deflect crack propagation,and facilitate damage delocalization,whereas the Mg matrix preserves structural integrity and enables load redistribution.Consequently,the composites significantly outperform pure Mg,and lowering a leads to more substantial enhancements in compressive strength,energy dissipation,and deformation recoverability.This study offers valuable insight into the design and fabrication of highperformance Mg-based materials for structural and biomedical applications.展开更多
We construct an infinite family of minimal linear codes over the ring F_(2)+u F_(2).These codes are defined through trace functions and Boolean functions.Their Lee weight distribution is completely computed by Walsh t...We construct an infinite family of minimal linear codes over the ring F_(2)+u F_(2).These codes are defined through trace functions and Boolean functions.Their Lee weight distribution is completely computed by Walsh transformation.By Gray mapping,we obtain a family of minimal binary linear codes from a generic construction,which have prominent applications in secret sharing and secure two-party computation.展开更多
The pore structure of porous scaffolds plays a crucial role in bone repair.The prevalent bone implant structure in clinical practice is the traditional cubic structure.However,the traditional cubic structure exhibits ...The pore structure of porous scaffolds plays a crucial role in bone repair.The prevalent bone implant structure in clinical practice is the traditional cubic structure.However,the traditional cubic structure exhibits sharp edges and junctions that are not conducive to cell adhesion or growth.In this study,a double gyroid(DG)Ti6Al4V scaffold based on a triply periodic minimal surface(TPMS)structure was devised,and the osseointegration performance of DG structural scaffolds with varying porosities was investigated.Compression tests revealed that the elastic modulus and compressive strength of DG structural scaffolds were sufficient for orthopedic implants.In vitro cellular experiments demonstrated that the DG structure significantly enhanced cell proliferation,vascularization,and osteogenic differentiation compared to the cubic structure.The DG structure with 55%porosity exhibited the most favorable outcomes.In vivo experiments in rabbits further demonstrated that DG scaffolds could promote neovascularization and bone regeneration and maturation;those with 55%porosity performed best.Comparing the surface area,specific surface area per unit volume,and internal flow distribution characteristics of gyroid and DG structure scaffolds,the latter are more conducive to cell adhesion and growth within scaffolds.This study underscored the potential of DG scaffolds based on the TPMS structure in optimizing the pore structure design of titanium scaffolds,inducing angiogenesis,and advancing the clinical application of titanium scaffolds for repairing bone defects.展开更多
This study uses numerical and analytical schemes to consider the wave propagation behavior of a triply periodic minimal surface sandwich cylindrical system(TPMS-SCS)for the first time.Although these structures exhibit...This study uses numerical and analytical schemes to consider the wave propagation behavior of a triply periodic minimal surface sandwich cylindrical system(TPMS-SCS)for the first time.Although these structures exhibit outstanding physical and mechanical properties,their dynamic and acoustic features have not been reported yet.This study addresses this gap by calculating the sound transmission loss(STL)coefficient within the framework of the wave approach across various architectures,including the primitive(P),Schoen gyroid(G),and wrapped package-graph(IWP)of a TPMS lattice structure.To determine an analytical STL,a third-order approach is used to precisely capture the stress-strain distribution based on the thickness coordinate,thereby providing a simultaneous solution to the general characteristic relations along with fluid-structure coupling.Given the lack of studies for frequency and STL comparisons,the structure is modeled considering a finite element(FE)design,which is a challenging and time-consuming process because of the complex topological TPMS configurations incorporated within a sandwich cylinder.In fact,achieving convincing computational accuracy requires fine mesh discretization,which significantly increases computational costs during vibroacoustic analysis.Using the numerical results from the COMSOL software Multiphysics,the accuracy of the analytical STL spectrum is verified for different configurations,including P,G,and IWP.The effective acoustic specifications of a TPMS-SCS in the frequency domain are examined by the comparison of the STL with that of a simple cylinder of the same mass.In this context,it would also be beneficial to examine the effect of TPMS thickness,which can demonstrate the importance of the present results.The findings of this approach can be beneficial for scholars working on the numerical and analytical sound insulation characteristics of metamaterial-based cylindrical systems.展开更多
Triply periodic minimal surface(TPMS)structures,characterized by special repeating 3D surface periodically with an average curvature of zero in threedimensional directions,have a wide range of applications.Laser powde...Triply periodic minimal surface(TPMS)structures,characterized by special repeating 3D surface periodically with an average curvature of zero in threedimensional directions,have a wide range of applications.Laser powder bed fusion(LPBF)technique,as a type of additive manufacturing techniques,provides the capability to fabricate such complex-shaped porous TPMS structures.In this study,Ti6Al4V G-sheet TPMS structures with various unit cell sizes were fabricated using LPBF to investigate the structural and material anisotropy and their effects on the anisotropy in energy absorption capacity by combining the finite element simulations and experimental analysis.The results showed that the TPMS structures can be successfully fabricated using LPBF,although the sheet thickness exceeds the designed values,with deviation decreasing as the unit cell size increases from 2 to 4 mm.The inherent anisotropy during the LPBF process results in variations in structural dimension,materials characteristics,and energy absorption capacity between directions parallel and perpendicular to the build direction.The anisotropic ratio of the LPBFed Ti6Al4V G-sheet TPMS structures increases from 1.5 to 2.2 in the structural dimension and from 2.8 to 3.3 in specific energy absorption per unit mass(SEA_(m))respectively with decreasing the unit cell size from 4 to 2 mm.The anisotropy of SEA_(m) primarily originates from the coupling effects of anisotropic dimensions and material properties in the LPBFed G-sheet TPMS structure.Among these factors,anisotropic material properties play a more significant role compared to dimensional anisotropy.展开更多
In this paper,the isogeometric analysis(IGA)method is employed to analyze the oscillation characteristics of functionally graded triply periodic minimal surface(FG-TPMS)curved-doubly shells integrated with magneto-ele...In this paper,the isogeometric analysis(IGA)method is employed to analyze the oscillation characteristics of functionally graded triply periodic minimal surface(FG-TPMS)curved-doubly shells integrated with magneto-electric surface layers(referred to as"FG-TPMS-MEE curved-doubly shells")subjected to low-velocity impact loads.This study presents low-velocity impact load model based on a single springmass(S-M)approach.The FG-TPMS-MEE curved-doubly shells are covered with two magneto-electric surface layers,while the core layer consists of three types:I-graph and Wrapped Package-graph(IWP),Gyroid(G),and Primitive(P),with various graded functions.These types are notable for their exceptional stiffness-to-weight ratios,enabling a wide range of potential applications.The Maxwell equations and electromagnetic boundary conditions are applied to compute the change in electric potentials and magnetic potentials.The equilibrium equations of the shell are derived from a refined higher-order shear deformation theory(HSDT),and the transient responses of the FG-TPMS-MEE curveddoubly shells are subsequently determined using Newmark's direct integration method.These results have applications in structural vibration control and the analysis of structures subjected to impact or explosive loads.Furthermore,this study provides a theoretical prediction of the low-velocity impact load and magneto-electric-elastic effects on the free vibration and transient response of FG-TPMS-MEE curved-doubly shells.展开更多
文摘BACKGROUND Repeated application of the Pringle maneuver is a key obstacle to safe minimally invasive repeat liver resection(MISRLR).However,limited technical guidance is available.AIM To study the utility of newly developed Pringle taping method guided by liver surface in MISRLR.METHODS We retrospectively reviewed 72 cases of MISRLR performed by a single surgeon at two centers from August 2015 to July 2024.Beginning in October 2019,a liver surface-guided encirclement of hepatoduodenal ligament(LSEH)was used for repeat Pringle taping.Perioperative outcomes including Pringle taping success,operative time,blood loss,conversion rate,morbidity,and mortality were assessed.RESULTS Laparoscopic and robotic approaches were used in 63 patients and 9 patients,respectively.The median operative time,blood loss,and hospital stay were 331.5 minutes,70 mL,and 8 days,respectively.Open conversion occurred in two cases(2.8%)due to severe adhesions and right renal vein injury.Clavien-Dindo grade≥III complications occurred in 5.6%of cases with no mortality.Anti-adhesion barriers were used in 54 patients(75.0%).LSEH was attempted in 57 cases,improving Pringle taping success from 33.0%to 91.4%(P<0.001).LSEH succeeded in all patients with prior open liver resection(n=11).Among 6 patients in whom LSEH failed,3 patients(50.0%)had undergone a third liver resection,and 1 patient had a history of distal gastrectomy with choledochoduodenostomy.CONCLUSION The newly developed LSEH technique for Pringle taping in MISRLR was feasible,enhancing safety and reproducibility even in patients with a history of open liver resection.
文摘The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.
文摘BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.
基金Supported by Joint Funds for the Innovation of Science and Technology,Fujian Province,No.2023Y9187 and No.2021Y9057.
文摘BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.
基金partially supported by the Open Research Fund of Key Laboratory of Nonlinear Analysis&Applications(Central China Normal University),Ministry of Education,P.R.Chinathe Guiding Science and Technology Plan Project of Suqian City in 2023(No.Z2023130)partially supported by NSFC(No.12271234)。
文摘Given two ideals I and J of a commutative ring R,there are two extreme connections between I and J:I+J=R and I∩J={0}.For the former case,graphs whose vertices are defined as the proper ideals of R and that two vertices are adjacent if and only if their sum is the whole ring R are known as co-maximal ideal graphs.In this paper,we introduce a new kind of graph structure on R,called co-minimal ideal graph,according to the second case:Its vertices are the nonzero ideals of R and two vertices are adjacent if and only if their intersection is zero.Some important graph parameters(including girth,diameter,clique number and chromatic number)and graph structures(including tree and bipartite graph)of co-minimal ideal graphs over finite commutative rings are studied.In particular,we show that the co-maximal ideal graph and the co-minimal ideal graph over R are isomorphic if and only if the number of maximal ideals of R and the number of minimal ideals of R coincide.
基金Supported in part by NSFC(No.11971005)the Fundamental Research Funds for the Central Universities(Nos.GK202101008,GK202102012)。
文摘In this paper,we use the solution of the even functional Minkowski problem to show that there is a minimizing affine Minkowski total variation of the function of bounded variation.Moreover,for the Minkowski total variation,we use the method of convexation to establish the same conclusion as the convex body space.
文摘The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.
文摘The underlying molecular changes that result in minimal change disease(ne-phrotic syndrome)require an in-depth analysis.Current molecular studies have shown the involvement of zinc fingers and homeobox transcriptional factors in its pathogenesis.The application of therapeutic drugs relies on understanding the cascade of molecular events to determine their efficacy in managing the clinical condition.
基金supported by the National Natural Science Foundation of China(81925027,82002275,and 32271421)the Priority Academic Program Development of Jiangsu Higher Education Institutions.
文摘Bone injuries induced by accidents or bone-related disease have dramatically increased in the past decades.The application of biomaterials has become an inextricable part of treatment for new bone formation and regeneration.Different from traditional bone-regeneration materials,injectable biomaterials—ranging from bioceramics to polymers—have been applied as a means of promoting surgery with a minimal intervention approach.In this review,we summarize the most recent developments in minimally invasive implantable biomaterials for bone reconstruction and different ways to achieve osteogenesis,with a focus on injectable biomaterials for various applications in the orthopedic field.More specifically,bioceramics and polymeric materials,together with their applications in bone fracture healing,vertebral body augmentation,bone implant fixation,bone tumor therapy,and bone-defect-related infection treatment are reviewed in detail.Recent progress in injectable biomaterials with multiple functionalities and bioresponsive properties is also reviewed.Finally,we summarize the challenges in this field and future directions for clinical treatment.
基金Supported by The Basic and Clinical Integration Project of Xi'an Jiaotong University,No.YXJLRH2022067.
文摘In this editorial we comment on the article by Jiang et al.We focus on the Ence-phalApp Stroop test which is an innovative,smartphone-based tool specifically designed for screening minimal hepatic encephalopathy(MHE)in cirrhosis patients.Traditional MHE screening methods,while highly sensitive and specific,are often complex,time-consuming,and require controlled environmental con-ditions,limiting their widespread clinical use.The EncephalApp Stroop test si-mplifies the screening process,enhances diagnostic efficiency,and is applicable across diverse cultural contexts.However,the combination of additional bio-markers could further improve diagnostic accuracy.Despite its promising po-tential,more multicenter clinical studies are required to validate its effectiveness and applicability on a global scale.
文摘Jiang et al explored the diagnostic capabilities of EncephalApp,a smartphone-based Stroop Test,in patients with nonalcoholic liver disease.The study included 160 patients with nonalcoholic cirrhosis and utilized the psychometric hepatic encephalopathy score as a benchmark for diagnosing minimal encephalopathy.The identified optimal cutoff times were>101.93 seconds for the"off"time and>205.86 seconds for the combined"on+off"time,demonstrating sensitivities of 0.84 and 0.90,and specificities of 0.77 and 0.71,respectively.The findings suggest the necessity of employing different cutoffs for patients with alcoholic vs no-nalcoholic liver cirrhosis,reflecting the distinct pathophysiologies underlying each condition.Additionally,alcohol consumption itself may influence Stroop test outcomes.Therefore,it is reasonable to establish separate benchmarks for alcoholic and nonalcoholic cirrhotic patients.Further validation in larger patient cohorts with clinical outcomes is essential.The demand for noninvasive liver disease assessments remains high in clinical practice.
基金funded by the National Natural Science Foundation of China(No.52275343)the Natural Science Foundation of Zhejiang Province(No.LY23E050003)+1 种基金Ningbo Youth Science and Technology Innovation Leading Talent Project(No.2023QL021)Smart Medicine and Engineering Interdisciplinary Innovation Project of Ningbo University(No.ZHYG001).
文摘Triply periodic minimal surface(TPMS)-based bone implants are an innovative approach in orthopedic implantology,offering customized solutions for bone defect repair and regeneration.This review comprehensively examines the current research landscape of TPMS-based bone implants,addressing key challenges and proposing future directions.It explores design strategies aimed at optimizing mechanical strength and enhancing biological integration,with a particular emphasis on TPMS structures.These design strategies include graded,hierarchical,and hybrid designs,each contributing to the overall functionality and performance of the implants.This review also highlights state-of-the-art fabrication technologies,particularly advancements in additive manufacturing(AM)techniques for creating metal-based,polymer-based,and ceramic-based bone implants.The ability to precisely control the architecture of TPMS structures using AM techniques is crucial for tailoring the mechanical and biological properties of such implants.Furthermore,this review critically evaluates the biological performance of TPMS implants,focusing on their potential to promote bone ingrowth and regeneration.Key factors,such as mechanical properties,permeability,and biocompatibility,are examined to determine the effectiveness of these implants in clinical applications.By synthesizing existing knowledge and proposing innovative research directions,this review underscores the transformative potential of TPMS-based bone implants in orthopedic surgery.The objective is to improve clinical outcomes and enhance patient care through advanced implant designs and manufacturing techniques.
基金supported by the National Natural Science Foundation of China(Grant No.82373113,XJ)Shenyang Breast Cancer Clinical Medical Research Center(Grant No.2020-48-3-1,ST)+1 种基金Shenyang Public Health R&D Special Project(Grant No.22-321-31-04,ST)Liaoning Revitalization Talents Program(Grant No.XLYC1907160,XJ).
文摘Breast cancer mortality is driven predominantly by metastasis,which affects 20-30%of patients with early-stage disease despite guideline-directed therapies.Because conventional imaging modalities currently lack sensitivity to identify residual disease,molecular-level monitoring must be developed.Circulating tumor DNA(ctDNA)profiling currently enables transformative minimal residual disease(MRD)detection and can quantify tumor burden at low variant allele frequencies.This review provides a comprehensive overview of MRD in breast cancer,including its definition,detection technologies,positivity thresholds,pathophysiology,clinical applications in adjuvant and neoadjuvant settings,ongoing clinical trials,challenges,and future directions.ctDNA-defined MRD has potential as a precision tool for adaptive therapy,and might facilitate post-adjuvant interception,whereby targeted therapies are administered to eradicate micro-metastases before radiographic recurrence.Persistent challenges include MRD assay standardization,subtype-specific MRD thresholds,tumor heterogeneity,and positioning MRD as a potentially valuable tool for precision management in breast cancer.
基金supported by the National Natural Science Foundation of China(12071444,12201581)the Fundamental Research Program of Shanxi Province of China(202103021223191).
文摘The minimal widths of three bounded subsets of the unit sphere associated to a unit vector in a normed linear space are studied,and three related geometric constants are introduced.New characterizations of inner product spaces are also presented.From the perspective of minimal width,strongε-symmetry of Birkhoff orthogonality is introduced,and its relation toε-symmetry of Birkhoff orthogonality is shown.Unlike most of the existing parameters of the underlying space,these new constants are full dimensional in nature.
基金supported by the Mainland-Hong Kong Joint Funding Scheme(MHKJFS)(Project No:MHP/040/22)RGC Theme-based Research Scheme AoE/M-402/20+1 种基金National Natural Science Foundation of China/Hong Kong Research Grants Council Joint Research Scheme(Project No:N_CityU151/23)Hong Kong Innovation and Technology Commission via the Hong Kong Branch of National Precious Metals Materials Engineering Research Center.
文摘Magnesium(Mg)-based materials are promising for lightweight structural applications.However,their widespread adoption is significantly constrained by inherent limitations in mechanical properties.To address this challenge,this study introduces a novel Mg-based interpenetratingphase composite reinforced with a nickel-titanium(NiTi)scaffold featuring a triply periodic minimal surface(TPMS)configuration.By combining experimental investigations with finite element simulations,we systematically elucidate the dual impact of the scaffold’s unit cell size(a)on manufacturing viability and mechanical enhancement.To compensate for compromised infiltration dynamics induced by decreasing a,a critical permeability threshold of 1×10^(-8) m^(2) is proposed for achieving successful composite fabrication.Mechanically,reducing a strengthens the interaction between the scaffold and matrix:the TPMS-configured NiTi scaffolds improve stress transfer,deflect crack propagation,and facilitate damage delocalization,whereas the Mg matrix preserves structural integrity and enables load redistribution.Consequently,the composites significantly outperform pure Mg,and lowering a leads to more substantial enhancements in compressive strength,energy dissipation,and deformation recoverability.This study offers valuable insight into the design and fabrication of highperformance Mg-based materials for structural and biomedical applications.
基金National Natural Science Foundation of China(12201171)。
文摘We construct an infinite family of minimal linear codes over the ring F_(2)+u F_(2).These codes are defined through trace functions and Boolean functions.Their Lee weight distribution is completely computed by Walsh transformation.By Gray mapping,we obtain a family of minimal binary linear codes from a generic construction,which have prominent applications in secret sharing and secure two-party computation.
基金supported bythe National Natural Science Foundation of China(Nos.U23A20523,82272504,and 82072456)the Department of Science and Technology of Jilin Province,China(Nos.20210101439JC,20210101321JC,20220204119YY,202201ZYTS131,202201ZYTS129,20230204114YY,YDZJ202201ZYTS505,and YDZJ202301ZYTS076)+4 种基金the Special Program for Science and Technology Personnel of Changchun(No.ZKICKJJ2023015)the Key Training Plan for Outstanding Youth of Jilin University(No.419070623036)the Research Fund of the First Hospital of Jilin University(No.2021-zl-01)the Graduate Innovation Fund of Jilin University(No.2024CX125)the Foun-dation of National Center for Translational Medicine(Shanghai)SHU Branch,China(No.SUITM-202405).
文摘The pore structure of porous scaffolds plays a crucial role in bone repair.The prevalent bone implant structure in clinical practice is the traditional cubic structure.However,the traditional cubic structure exhibits sharp edges and junctions that are not conducive to cell adhesion or growth.In this study,a double gyroid(DG)Ti6Al4V scaffold based on a triply periodic minimal surface(TPMS)structure was devised,and the osseointegration performance of DG structural scaffolds with varying porosities was investigated.Compression tests revealed that the elastic modulus and compressive strength of DG structural scaffolds were sufficient for orthopedic implants.In vitro cellular experiments demonstrated that the DG structure significantly enhanced cell proliferation,vascularization,and osteogenic differentiation compared to the cubic structure.The DG structure with 55%porosity exhibited the most favorable outcomes.In vivo experiments in rabbits further demonstrated that DG scaffolds could promote neovascularization and bone regeneration and maturation;those with 55%porosity performed best.Comparing the surface area,specific surface area per unit volume,and internal flow distribution characteristics of gyroid and DG structure scaffolds,the latter are more conducive to cell adhesion and growth within scaffolds.This study underscored the potential of DG scaffolds based on the TPMS structure in optimizing the pore structure design of titanium scaffolds,inducing angiogenesis,and advancing the clinical application of titanium scaffolds for repairing bone defects.
文摘This study uses numerical and analytical schemes to consider the wave propagation behavior of a triply periodic minimal surface sandwich cylindrical system(TPMS-SCS)for the first time.Although these structures exhibit outstanding physical and mechanical properties,their dynamic and acoustic features have not been reported yet.This study addresses this gap by calculating the sound transmission loss(STL)coefficient within the framework of the wave approach across various architectures,including the primitive(P),Schoen gyroid(G),and wrapped package-graph(IWP)of a TPMS lattice structure.To determine an analytical STL,a third-order approach is used to precisely capture the stress-strain distribution based on the thickness coordinate,thereby providing a simultaneous solution to the general characteristic relations along with fluid-structure coupling.Given the lack of studies for frequency and STL comparisons,the structure is modeled considering a finite element(FE)design,which is a challenging and time-consuming process because of the complex topological TPMS configurations incorporated within a sandwich cylinder.In fact,achieving convincing computational accuracy requires fine mesh discretization,which significantly increases computational costs during vibroacoustic analysis.Using the numerical results from the COMSOL software Multiphysics,the accuracy of the analytical STL spectrum is verified for different configurations,including P,G,and IWP.The effective acoustic specifications of a TPMS-SCS in the frequency domain are examined by the comparison of the STL with that of a simple cylinder of the same mass.In this context,it would also be beneficial to examine the effect of TPMS thickness,which can demonstrate the importance of the present results.The findings of this approach can be beneficial for scholars working on the numerical and analytical sound insulation characteristics of metamaterial-based cylindrical systems.
基金financially supported by the Open Project Program of Chinese Scholar Tree Ridge State Key Laboratory(No.AF20240023)
文摘Triply periodic minimal surface(TPMS)structures,characterized by special repeating 3D surface periodically with an average curvature of zero in threedimensional directions,have a wide range of applications.Laser powder bed fusion(LPBF)technique,as a type of additive manufacturing techniques,provides the capability to fabricate such complex-shaped porous TPMS structures.In this study,Ti6Al4V G-sheet TPMS structures with various unit cell sizes were fabricated using LPBF to investigate the structural and material anisotropy and their effects on the anisotropy in energy absorption capacity by combining the finite element simulations and experimental analysis.The results showed that the TPMS structures can be successfully fabricated using LPBF,although the sheet thickness exceeds the designed values,with deviation decreasing as the unit cell size increases from 2 to 4 mm.The inherent anisotropy during the LPBF process results in variations in structural dimension,materials characteristics,and energy absorption capacity between directions parallel and perpendicular to the build direction.The anisotropic ratio of the LPBFed Ti6Al4V G-sheet TPMS structures increases from 1.5 to 2.2 in the structural dimension and from 2.8 to 3.3 in specific energy absorption per unit mass(SEA_(m))respectively with decreasing the unit cell size from 4 to 2 mm.The anisotropy of SEA_(m) primarily originates from the coupling effects of anisotropic dimensions and material properties in the LPBFed G-sheet TPMS structure.Among these factors,anisotropic material properties play a more significant role compared to dimensional anisotropy.
文摘In this paper,the isogeometric analysis(IGA)method is employed to analyze the oscillation characteristics of functionally graded triply periodic minimal surface(FG-TPMS)curved-doubly shells integrated with magneto-electric surface layers(referred to as"FG-TPMS-MEE curved-doubly shells")subjected to low-velocity impact loads.This study presents low-velocity impact load model based on a single springmass(S-M)approach.The FG-TPMS-MEE curved-doubly shells are covered with two magneto-electric surface layers,while the core layer consists of three types:I-graph and Wrapped Package-graph(IWP),Gyroid(G),and Primitive(P),with various graded functions.These types are notable for their exceptional stiffness-to-weight ratios,enabling a wide range of potential applications.The Maxwell equations and electromagnetic boundary conditions are applied to compute the change in electric potentials and magnetic potentials.The equilibrium equations of the shell are derived from a refined higher-order shear deformation theory(HSDT),and the transient responses of the FG-TPMS-MEE curveddoubly shells are subsequently determined using Newmark's direct integration method.These results have applications in structural vibration control and the analysis of structures subjected to impact or explosive loads.Furthermore,this study provides a theoretical prediction of the low-velocity impact load and magneto-electric-elastic effects on the free vibration and transient response of FG-TPMS-MEE curved-doubly shells.
