The shortage of personal protective equipment and lack of proper nursing training have been endangering health care workers dealing with coronavirus disease 2019(COVID-19).In our treatment center,the implementation of...The shortage of personal protective equipment and lack of proper nursing training have been endangering health care workers dealing with coronavirus disease 2019(COVID-19).In our treatment center,the implementation of a holistic care model of time-sharing management for severe and critical COVID-19 patients has further aggravated the shortage of intensive care unit(ICU)professional nurses.Therefore,we developed a short-term specialized and targeted nursing training program to help ICU nurses to cope with stress and become more efficient,thus reducing the number of nurses required in the ICU.In order to avoid possible human-to-human spread,small teaching classes and remote training were applied.The procedural training mode included four steps:preparation,plan,implementation,and evaluation.An evaluation was conducted throughout the process of nursing training.In this study,we documented and shared experiences in transitioning from traditional face-to-face programs to remote combined with proceduralization nursing training mode from our daily work experiences during the COVID-19 pandemic,which has shown to be helpful for nurses working in the ICU.展开更多
BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints...BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints,and patient safety concerns have constrained its practicality.Simulation-based training has become a reliable,safe,and cost-efficient alternative.Dry lab techniques,especially virtual and augmented reality,make up 78%of current dry lab research,whereas wet labs still set the standard for anatomical realism.AIM To evaluate the effectiveness,limitations,and future directions of wet and dry lab simulation in orthopaedic training.METHODS A scoping review was carried out across four databases-PubMed,Cochrane Library,Web of Science,and EBSCOhost-up to 2025.Medical Subject Headings included:"Orthopaedic Education","Wet Lab","Dry Lab","Simulation Training","Virtual Reality",and"Surgical Procedure".Eligible studies focused on orthopaedic or spinal surgical education,employed wet or dry lab techniques,and assessed training effectiveness.Exclusion criteria consisted of non-English publications,abstracts only,non-orthopaedic research,and studies unrelated to simulation.Two reviewers independently screened titles,abstracts,and full texts,resolving discrepancies with a third reviewer.RESULTS From 1851 records,101 studies met inclusion:78 on dry labs,7 on wet labs,4 on both.Virtual reality(VR)simulations were most common,with AI increasingly used for feedback and assessment.Cadaveric training remains the gold standard for accuracy and tactile feedback,while dry labs-especially VR-offer scalability,lower cost(40%-60%savings in five studies),and accessibility for novices.Senior residents prefer wet labs for complex tasks;juniors favour dry labs for basics.Challenges include limited transferability data,lack of standard outcome metrics,and ethical concerns about cadaver use and AI assessment.CONCLUSION Wet and dry labs each have unique strengths in orthopaedic training.A hybrid approach combining both,supported by standardised assessments and outcome studies,is most effective.Future efforts should aim for uniform reporting,integrating new technologies,and policy support for hybrid curricula to enhance skills and patient care.展开更多
Clear aligner treatment is a novel technique in current orthodontic practice.Distinct from traditional fixed orthodontic appliances,clear aligners have different material features and biomechanical characteristics and...Clear aligner treatment is a novel technique in current orthodontic practice.Distinct from traditional fixed orthodontic appliances,clear aligners have different material features and biomechanical characteristics and treatment efficiencies,presenting new clinical challenges.Therefore,a comprehensive and systematic description of the key clinical aspects of clear aligner treatment is essential to enhance treatment efficacy and facilitate the advancement and wide adoption of this new technique.This expert consensus discusses case selection and grading of treatment difficulty,principle of clear aligner therapy,clinical procedures and potential complications,which are crucial to the clinical success of clear aligner treatment.展开更多
Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and t...Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.展开更多
Non-contact debris removal methods are fuel-efficient in a single operation compared to contact-based strategies as spacecraft don’t need to match debris velocity.To comprehensively analyze this scheme,maneuvering sc...Non-contact debris removal methods are fuel-efficient in a single operation compared to contact-based strategies as spacecraft don’t need to match debris velocity.To comprehensively analyze this scheme,maneuvering schemes for maximum debris removal with minimum fuel consumption,including task assignment,sequence planning,and trajectory planning,must be formulated.The coupling between variables’dimensions and optimization results in task assignment poses challenges,as debris removal is repetitive and uncertain,leading to a vast search space.This paper proposes a novel Greedy Randomized Adaptive Search Procedure with Large Neighborhood and Crossover Mechanisms(GRASP-LNCM)to address this problem.The hybrid dynamic iteration mechanism improves computational efficiency and enhances the optimality of results.The model innovatively considers unsuccessful single removal by using a quantitative method to assess removal percentage.In addition,to improve the efficiency of sequence and trajectory planning,a Suboptimal Search Algorithm(SSA)based on the Lambert property and accelerated Multi-Revolution Lambert Problem(MRLP)solving strategy is established.Finally,a real Iridium-33 debris removal mission is studied.The simulation demonstrates that the proposed algorithm achieves state-of-the-art performance in several typical scenarios.Compared to the contact-based scheme,the new one is simpler,saving more fuel under certain conditions.展开更多
Advances in fetal surgery techniques have enabled the treatment of certain congenital defects before birth.A critical area of focus is the role of perinatal imaging in optimizing prenatal interventions within the prec...Advances in fetal surgery techniques have enabled the treatment of certain congenital defects before birth.A critical area of focus is the role of perinatal imaging in optimizing prenatal interventions within the precision medicine framework.Magnetic resonance imaging(MRI)is emerging as an indispensable tool for guiding these intricate procedures with the potential to significantly enhance the standard of care and outcomes for affected fetuses.This review begins with an overview of the classification and indications for fetal surgical interventions.It then explores the detailed applications of prenatal MRI scanning and diagnostic techniques across various categories of fetal surgery.A key focus is how fetal MRI provides critical insights into specific lesion characteristics and tissue involvement,thereby aiding healthcare professionals in selecting the optimal surgical strategies for prenatal and postnatal interventions.Fetal MRI offers detailed visualizations that complement traditional ultra-sound findings,enhancing the precision of radiological planning for fetal surgery.Finally,the review highlights how integration of fetal MRI into the decision-making process enables healthcare providers to make well-informed choices,ultimately improving the prognosis and outcomes for both the mother and fetus.展开更多
BACKGROUND Fungal balls within the nasal cavity are an exceedingly rare clinical entity,typically presenting with nonspecific symptoms or being identified incidentally.CASE SUMMARY This report presents an incidental d...BACKGROUND Fungal balls within the nasal cavity are an exceedingly rare clinical entity,typically presenting with nonspecific symptoms or being identified incidentally.CASE SUMMARY This report presents an incidental discovery of a fungal ball in the nasal cavity during routine imaging,with no associated clinical symptoms.CONCLUSION This case underscores the importance of considering the possibility of asympto-matic presentations of nasal fungal balls,which may be detected incidentally during imaging evaluations.展开更多
The accuracy of thermal analysis measurements is critical to analyze material properties correctly,making the improvement of measurement precision and proper uncertainty analysis of test results absolutely essential.A...The accuracy of thermal analysis measurements is critical to analyze material properties correctly,making the improvement of measurement precision and proper uncertainty analysis of test results absolutely essential.As a primary thermal analysis instrument,the simultaneous thermal analyzer(STA)has unique advantages,which combines the functionalities of thermogravimetric(TG)analyzersand differential scanning calorimeters(DSC).However,the absence of standard quality control procedures has resulted in poor measurement reproducibility,low accuracy,and inadequate traceability of analytical results.This study utilized a multi-point temperature calibration method based on national certified reference materials to reduce instrument temperature indication errors.On this basis,we innovatively established a comprehensive quality control system encompassing laboratory environmental control,standard method selection,instrument performance verification,reference material traceability,and uncertainty analysis,thereby achieving standardized operational procedures for thermal analysis measurement.Taking the"determination of initial melting temperature of unknown substances"as a representative case study,a component resolution model for thermal analysis test uncertainty was developed.Through systematic analysis of both the reference material-introduced component and measurement repeatability component,complete traceability of test results was achieved.This approach ensures data validity and enhances the accuracy of test results.This provides crucial technical support and practical reference for the standardization of thermal analysis measurement procedure and assessment of result reliability.展开更多
Objective The lack of clarity regarding the application performance of a hybrid operating room(HOR)and the uncertainty of surgical scheduling often lead to its inefficient application.This study aimed to review the cl...Objective The lack of clarity regarding the application performance of a hybrid operating room(HOR)and the uncertainty of surgical scheduling often lead to its inefficient application.This study aimed to review the clinical application of our neurosurgical HOR and propose a scale to score cases clearly.Methods We reviewed the operating procedures and duration of stay in 1865 HOR cases.The actual procedures of each case were summarized into 5 application types,and numerical assignment was used to distinguish the dependence of each type on our HOR:surgical procedures combined with interventional procedures(4 points,the highest dependence),surgical procedures combined with imaging procedures(3 points),interventional procedures(2 points),imaging procedures(1 point),and surgical procedures(0 points,the lowest dependence).Results A novel scale that could score 1865 cases into those 5 grades was developed.The percentages by grade were as follows:4 points,4.24%;3 points,4.88%;2 points,20.75%;1 point,69.38%;and 0 points,0.75%.The cumulative usage time was 4241.9 h,the duration of which was as follows:4 points,16.17%;3 points,15.50%;2 points,31.32%;1 point,35.62%;and 0 points,1.39%.Conclusions The HOR serves as a multifunctional room to treat neurosurgical diseases.The scale helps to quickly prioritize cases that rely more on HOR,providing guidelines for surgical scheduling.Although our HOR is unsuitable for emergency cases,it clearly shows the application performance of our HOR to provide a reference for promoting its efficient application.展开更多
Objective:Prostate cancer is a common malignancy in men over 50 years old,and radical prostatectomy,particularly via laparoscopic and robotic-assisted techniques,significantly impacts quality of life,especially in ter...Objective:Prostate cancer is a common malignancy in men over 50 years old,and radical prostatectomy,particularly via laparoscopic and robotic-assisted techniques,significantly impacts quality of life,especially in terms of erectile dysfunction.This systematic review and meta-analysis aimed to evaluate the preservation of erectile function following robotic-assisted and laparoscopic radical prostatectomy,with a separate analysis of randomized clinical trials and non-randomized studies.Methods:This review was carried out using randomized and non-randomized studies involving adult patients diagnosed with localized prostate cancer undergoing radical prostatectomy,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO.Applicable literature from PubMed,Cochrane,Embase,and the Latin American and Caribbean Health Sciences Literature database was analysed.The bias in randomized clinical trials was assessed using the Cochrane Risk of Bias 2.0 tool,and observational studies were evaluated via the Newcastle-Ottawa Scale.The statistical analysis was performed using Review Manager version 5.4.Results:Our analysis included 13 studies involving 6281 patients.Comparative meta-analysis of non-randomized studies demonstrated that robotic techniques were significantly more effective in preserving erectile function at 3 months(risk difference[RD]0.05,95%confidence interval[CI]0.00-0.11;p=0.040),6 months(RD 0.10,95%CI 0.03-0.17;p=0.006),and 12 months postoperatively(RD 0.06,95%CI 0.02-0.10;p=0.002).Conclusion:Robotic-assisted surgery showed greater preservation of erectile function 3 months,6 months,and 12 months after radical prostatectomy.However,additional studies with meticulous methodological criteria are necessary for future analysis.展开更多
Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedem...Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedema,typically in the limbs,to decompress blocked lymphatic drainage pathways.展开更多
Fluoroscopic imaging is widely utilised for diagnostic and therapeutic procedures and is fundamental to the establishment and maintenance of dialysis vascular access.To optimise outcomes and avoid injury to patients a...Fluoroscopic imaging is widely utilised for diagnostic and therapeutic procedures and is fundamental to the establishment and maintenance of dialysis vascular access.To optimise outcomes and avoid injury to patients and healthcare pro-viders,radiation technology must be applied effectively and safely in clinical practice.Radiation safety may be overlooked by nephrology training curricula.This narrative review discusses the theoretical and practical principles of radiation management in fluoroscopy-guided procedures and is intended as a primer for trainees and nephrologists working in interventional settings.展开更多
This article constructs statistical selection procedures for exponential populations that may differ in only the threshold parameters. The scale parameters of the populations are assumed common and known. The independ...This article constructs statistical selection procedures for exponential populations that may differ in only the threshold parameters. The scale parameters of the populations are assumed common and known. The independent samples drawn from the populations are taken to be of the same size. The best population is defined as the one associated with the largest threshold parameter. In case more than one population share the largest threshold, one of these is tagged at random and denoted the best. Two procedures are developed for choosing a subset of the populations having the property that the chosen subset contains the best population with a prescribed probability. One procedure is based on the sample minimum values drawn from the populations, and another is based on the sample means from the populations. An “Indifference Zone” (IZ) selection procedure is also developed based on the sample minimum values. The IZ procedure asserts that the population with the largest test statistic (e.g., the sample minimum) is the best population. With this approach, the sample size is chosen so as to guarantee that the probability of a correct selection is no less than a prescribed probability in the parameter region where the largest threshold is at least a prescribed amount larger than the remaining thresholds. Numerical examples are given, and the computer R-codes for all calculations are given in the Appendices.展开更多
Complete rectal prolapse,characterized by the protrusion of the rectal wall layers through the anal canal,poses significant treatment challenges,particularly due to controversies surrounding surgical approaches and th...Complete rectal prolapse,characterized by the protrusion of the rectal wall layers through the anal canal,poses significant treatment challenges,particularly due to controversies surrounding surgical approaches and the absence of a standardized assessment system.This study comprehensively reviews the main surgical tech-niques for complete rectal prolapse,categorized as transabdominal and transpe-rineal/transanal procedures.Despite various techniques,challenges persist,inclu-ding high recurrence rates and potential complications.Factors influencing the choice of the surgical approach include patient characteristics,symptomatology,and surgical expertise.With advances in medical technology,laparoscopic and robotic surgeries offer promising avenues,albeit with considerations of cost and accessibility.Ultimately,treatment plans tailored to the individual needs of the patient and surgical expertise are essential.Although controversies remain,the continued refinement of surgical techniques holds promise for improving out-comes in complete rectal prolapse surgery.展开更多
1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Nota...1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Notably,robot-assisted surgery(RAS)has led to its extensive adoption in the surgical management of urinary system tumors due to its enhanced maneuverability,precision in suturing,and anastomotic capabilities.展开更多
This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadi...This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.展开更多
The management of gastrointestinal(GI)bleeding patients during endoscopy remains a challenge.Hemorrhage is still one of the significant causes of morbidity and even death.Several therapeutic options have been used ove...The management of gastrointestinal(GI)bleeding patients during endoscopy remains a challenge.Hemorrhage is still one of the significant causes of morbidity and even death.Several therapeutic options have been used over the years depending on the extent,site and cause of bleeding.These include thermal therapy,injection therapy,and mechanical methods of hemostasis(e.g.,endoscopic clips and ligation bands).Patients with refractory bleeding,high-risk ulcer lesions,malignant disease,antiplatelet medications,and chronic kidney disease are at increased risk of upper and lower GI bleeding(LGIB).In this editorial,I commented on the paper by Ballester et al.Their work aimed at evaluating PuraStat^(■)(TDM-621),a novel hemostatic agent,particularly its efficacy,applications,feasibility,and safety in treating GI bleeding lesions.The authors concluded that PuraStat^(■)is an effective therapy for GI bleeding and is usually easy to use.Although the authors recommended its consideration as a frontline therapy in the future,they did not explore the clinical and GI uses of PuraStat®.This editorial focuses on the pharmacology of PuraStat®and how it differs from Hemospray®(TC-325)(hemostatic powder).It also explores the current experience of using PuraStat^(■)in upper and LGIB,its uses and safety,and the need for further research to fully understand its potential.展开更多
BACKGROUND Aortoiliac artery stenting has been accepted as the preferred option for the treatment of aortoiliac artery disease because of lower morbidity and mortality compared with bypass surgery.However,acute stent ...BACKGROUND Aortoiliac artery stenting has been accepted as the preferred option for the treatment of aortoiliac artery disease because of lower morbidity and mortality compared with bypass surgery.However,acute stent occlusion is a troublesome complication due to the need for open surgery or the risk of distal embolization.Herein,we reported a novel approach to treat the acute thrombotic occlusion of an aortoiliac stent using both hemolytic and conventional mechanical thrombectomy coupled with a large diameter sheath.CASE SUMMARY A 64-year-old male patient presented with severe claudication of the right leg.The patient's history included multiple prior interventions for aortoiliac lesions.The preoperative computed tomography(CT)imaging showed a thrombotic occlusion of right aortoiliac stenting.An Angiojet Omni thrombectomy catheter(Boston Scientific,Marlborough,MA,United States)was used to remove the thrombus in a retrograde fashion after the successful placement of the large-diameter sheath in the right common femoral artery for prevention of distal embolization.The remnant organized thrombus was removed with an over-the-wire Fogarty catheter(Edwards Lifesciences,Irvine,CA,United States).Completion angiogram and postoperative CT imaging demonstrated complete removal of thrombus and no evidence of distal embolization.CONCLUSION This novel approach provides successful management of acute thrombotic occlusion of aortoiliac stent without distal embolization.展开更多
基金Supported by The National Natural Science Foundation of China,No.81772045 and No.81902000Teaching project of the First Affiliated Hospital of Harbin Medical University,No.2017014.
文摘The shortage of personal protective equipment and lack of proper nursing training have been endangering health care workers dealing with coronavirus disease 2019(COVID-19).In our treatment center,the implementation of a holistic care model of time-sharing management for severe and critical COVID-19 patients has further aggravated the shortage of intensive care unit(ICU)professional nurses.Therefore,we developed a short-term specialized and targeted nursing training program to help ICU nurses to cope with stress and become more efficient,thus reducing the number of nurses required in the ICU.In order to avoid possible human-to-human spread,small teaching classes and remote training were applied.The procedural training mode included four steps:preparation,plan,implementation,and evaluation.An evaluation was conducted throughout the process of nursing training.In this study,we documented and shared experiences in transitioning from traditional face-to-face programs to remote combined with proceduralization nursing training mode from our daily work experiences during the COVID-19 pandemic,which has shown to be helpful for nurses working in the ICU.
文摘BACKGROUND Orthopaedic surgical education has traditionally depended on the apprenticeship model of“see one,do one,teach one”.However,reduced operative exposure,stricter work-hour regulations,medicolegal constraints,and patient safety concerns have constrained its practicality.Simulation-based training has become a reliable,safe,and cost-efficient alternative.Dry lab techniques,especially virtual and augmented reality,make up 78%of current dry lab research,whereas wet labs still set the standard for anatomical realism.AIM To evaluate the effectiveness,limitations,and future directions of wet and dry lab simulation in orthopaedic training.METHODS A scoping review was carried out across four databases-PubMed,Cochrane Library,Web of Science,and EBSCOhost-up to 2025.Medical Subject Headings included:"Orthopaedic Education","Wet Lab","Dry Lab","Simulation Training","Virtual Reality",and"Surgical Procedure".Eligible studies focused on orthopaedic or spinal surgical education,employed wet or dry lab techniques,and assessed training effectiveness.Exclusion criteria consisted of non-English publications,abstracts only,non-orthopaedic research,and studies unrelated to simulation.Two reviewers independently screened titles,abstracts,and full texts,resolving discrepancies with a third reviewer.RESULTS From 1851 records,101 studies met inclusion:78 on dry labs,7 on wet labs,4 on both.Virtual reality(VR)simulations were most common,with AI increasingly used for feedback and assessment.Cadaveric training remains the gold standard for accuracy and tactile feedback,while dry labs-especially VR-offer scalability,lower cost(40%-60%savings in five studies),and accessibility for novices.Senior residents prefer wet labs for complex tasks;juniors favour dry labs for basics.Challenges include limited transferability data,lack of standard outcome metrics,and ethical concerns about cadaver use and AI assessment.CONCLUSION Wet and dry labs each have unique strengths in orthopaedic training.A hybrid approach combining both,supported by standardised assessments and outcome studies,is most effective.Future efforts should aim for uniform reporting,integrating new technologies,and policy support for hybrid curricula to enhance skills and patient care.
文摘Clear aligner treatment is a novel technique in current orthodontic practice.Distinct from traditional fixed orthodontic appliances,clear aligners have different material features and biomechanical characteristics and treatment efficiencies,presenting new clinical challenges.Therefore,a comprehensive and systematic description of the key clinical aspects of clear aligner treatment is essential to enhance treatment efficacy and facilitate the advancement and wide adoption of this new technique.This expert consensus discusses case selection and grading of treatment difficulty,principle of clear aligner therapy,clinical procedures and potential complications,which are crucial to the clinical success of clear aligner treatment.
文摘Background:We aimed to study physician attitudes toward ultrasound-guided procedures and possible improvements.We hypothesized that the usage of ultrasound in procedures may be limited by a high barrier of entry and that most physicians would choose to adopt software that provides real-time image guidance if accessible.Methods:A voluntary,cross-sectional survey of physicians at a single site was conducted using a five-point Likert scale.Data analysis included both descriptive and inferential statistical analyses and stratified by categorical descriptors,including variables of formal training,years of experience,and specialty of practice.Results:One hundred sixteen physicians responded to the survey.The majority disagreed that there was a steep learning curve(57.5%)and that they need more time to identify structures under ultrasound(85.0%).Overall attitudes were mixed about the use of additional software to improve ease of use,but most(55.4%)had positive opinions toward the addition of real-time 3D reconstruction.Respondents without formal training were significantly more likely to agree that additional software would improve ease of ultrasound-guided procedures(p=0.0389).Radiologists were significantly more likely to perceive a steeper learning curve and less likely to advocate for supplemental software compared to emergency medicine physicians,surgeons,or anesthesiologists.Conclusions:Surveyed physicians demonstrated comfort with ultrasound-guided procedures and a mixed stance toward the use of additional software to assist with procedures.Those without formal training had significantly more positive attitudes toward the use of additional technology to augment ultrasound-guided procedures,suggesting a knowledge gap that may benefit from such technology.
基金co-supported by the National Natural Science Foundation of China(Nos.U23B6001,62273118,12150008)the Fundamental Research Funds for the Central Universities,China(No.2023FRFK02043)+1 种基金the Natural Science Foundation of Heilongjiang Province,China(No.LH2022F023)China Aerospace Science and Technology Corporation Youth Talent Support Program.
文摘Non-contact debris removal methods are fuel-efficient in a single operation compared to contact-based strategies as spacecraft don’t need to match debris velocity.To comprehensively analyze this scheme,maneuvering schemes for maximum debris removal with minimum fuel consumption,including task assignment,sequence planning,and trajectory planning,must be formulated.The coupling between variables’dimensions and optimization results in task assignment poses challenges,as debris removal is repetitive and uncertain,leading to a vast search space.This paper proposes a novel Greedy Randomized Adaptive Search Procedure with Large Neighborhood and Crossover Mechanisms(GRASP-LNCM)to address this problem.The hybrid dynamic iteration mechanism improves computational efficiency and enhances the optimality of results.The model innovatively considers unsuccessful single removal by using a quantitative method to assess removal percentage.In addition,to improve the efficiency of sequence and trajectory planning,a Suboptimal Search Algorithm(SSA)based on the Lambert property and accelerated Multi-Revolution Lambert Problem(MRLP)solving strategy is established.Finally,a real Iridium-33 debris removal mission is studied.The simulation demonstrates that the proposed algorithm achieves state-of-the-art performance in several typical scenarios.Compared to the contact-based scheme,the new one is simpler,saving more fuel under certain conditions.
基金supported by Zhejiang Provincial Natural Science Foundation of China(Grant No.ZCLTGY24H0401)Technology Program of Jiaxing(Grant No.2024AD30125).
文摘Advances in fetal surgery techniques have enabled the treatment of certain congenital defects before birth.A critical area of focus is the role of perinatal imaging in optimizing prenatal interventions within the precision medicine framework.Magnetic resonance imaging(MRI)is emerging as an indispensable tool for guiding these intricate procedures with the potential to significantly enhance the standard of care and outcomes for affected fetuses.This review begins with an overview of the classification and indications for fetal surgical interventions.It then explores the detailed applications of prenatal MRI scanning and diagnostic techniques across various categories of fetal surgery.A key focus is how fetal MRI provides critical insights into specific lesion characteristics and tissue involvement,thereby aiding healthcare professionals in selecting the optimal surgical strategies for prenatal and postnatal interventions.Fetal MRI offers detailed visualizations that complement traditional ultra-sound findings,enhancing the precision of radiological planning for fetal surgery.Finally,the review highlights how integration of fetal MRI into the decision-making process enables healthcare providers to make well-informed choices,ultimately improving the prognosis and outcomes for both the mother and fetus.
文摘BACKGROUND Fungal balls within the nasal cavity are an exceedingly rare clinical entity,typically presenting with nonspecific symptoms or being identified incidentally.CASE SUMMARY This report presents an incidental discovery of a fungal ball in the nasal cavity during routine imaging,with no associated clinical symptoms.CONCLUSION This case underscores the importance of considering the possibility of asympto-matic presentations of nasal fungal balls,which may be detected incidentally during imaging evaluations.
文摘The accuracy of thermal analysis measurements is critical to analyze material properties correctly,making the improvement of measurement precision and proper uncertainty analysis of test results absolutely essential.As a primary thermal analysis instrument,the simultaneous thermal analyzer(STA)has unique advantages,which combines the functionalities of thermogravimetric(TG)analyzersand differential scanning calorimeters(DSC).However,the absence of standard quality control procedures has resulted in poor measurement reproducibility,low accuracy,and inadequate traceability of analytical results.This study utilized a multi-point temperature calibration method based on national certified reference materials to reduce instrument temperature indication errors.On this basis,we innovatively established a comprehensive quality control system encompassing laboratory environmental control,standard method selection,instrument performance verification,reference material traceability,and uncertainty analysis,thereby achieving standardized operational procedures for thermal analysis measurement.Taking the"determination of initial melting temperature of unknown substances"as a representative case study,a component resolution model for thermal analysis test uncertainty was developed.Through systematic analysis of both the reference material-introduced component and measurement repeatability component,complete traceability of test results was achieved.This approach ensures data validity and enhances the accuracy of test results.This provides crucial technical support and practical reference for the standardization of thermal analysis measurement procedure and assessment of result reliability.
基金supported by the Technology Innovation Special Major Project of Hubei Province(grant number 2022BCA003).
文摘Objective The lack of clarity regarding the application performance of a hybrid operating room(HOR)and the uncertainty of surgical scheduling often lead to its inefficient application.This study aimed to review the clinical application of our neurosurgical HOR and propose a scale to score cases clearly.Methods We reviewed the operating procedures and duration of stay in 1865 HOR cases.The actual procedures of each case were summarized into 5 application types,and numerical assignment was used to distinguish the dependence of each type on our HOR:surgical procedures combined with interventional procedures(4 points,the highest dependence),surgical procedures combined with imaging procedures(3 points),interventional procedures(2 points),imaging procedures(1 point),and surgical procedures(0 points,the lowest dependence).Results A novel scale that could score 1865 cases into those 5 grades was developed.The percentages by grade were as follows:4 points,4.24%;3 points,4.88%;2 points,20.75%;1 point,69.38%;and 0 points,0.75%.The cumulative usage time was 4241.9 h,the duration of which was as follows:4 points,16.17%;3 points,15.50%;2 points,31.32%;1 point,35.62%;and 0 points,1.39%.Conclusions The HOR serves as a multifunctional room to treat neurosurgical diseases.The scale helps to quickly prioritize cases that rely more on HOR,providing guidelines for surgical scheduling.Although our HOR is unsuitable for emergency cases,it clearly shows the application performance of our HOR to provide a reference for promoting its efficient application.
文摘Objective:Prostate cancer is a common malignancy in men over 50 years old,and radical prostatectomy,particularly via laparoscopic and robotic-assisted techniques,significantly impacts quality of life,especially in terms of erectile dysfunction.This systematic review and meta-analysis aimed to evaluate the preservation of erectile function following robotic-assisted and laparoscopic radical prostatectomy,with a separate analysis of randomized clinical trials and non-randomized studies.Methods:This review was carried out using randomized and non-randomized studies involving adult patients diagnosed with localized prostate cancer undergoing radical prostatectomy,according to Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines and registered in PROSPERO.Applicable literature from PubMed,Cochrane,Embase,and the Latin American and Caribbean Health Sciences Literature database was analysed.The bias in randomized clinical trials was assessed using the Cochrane Risk of Bias 2.0 tool,and observational studies were evaluated via the Newcastle-Ottawa Scale.The statistical analysis was performed using Review Manager version 5.4.Results:Our analysis included 13 studies involving 6281 patients.Comparative meta-analysis of non-randomized studies demonstrated that robotic techniques were significantly more effective in preserving erectile function at 3 months(risk difference[RD]0.05,95%confidence interval[CI]0.00-0.11;p=0.040),6 months(RD 0.10,95%CI 0.03-0.17;p=0.006),and 12 months postoperatively(RD 0.06,95%CI 0.02-0.10;p=0.002).Conclusion:Robotic-assisted surgery showed greater preservation of erectile function 3 months,6 months,and 12 months after radical prostatectomy.However,additional studies with meticulous methodological criteria are necessary for future analysis.
基金the Ministry of Science and Technology of the People's Republic of China(2021ZD0201804,GW)the National Natural Science Foundation of China(82371416,HW).
文摘Lymphatic-venous anastomosis(LVA)surgery has recently emerged as a potential treatment for Alzheimer’s disease(AD)in China.This minimally invasive microsurgical procedure has been used for decades to treat lymphoedema,typically in the limbs,to decompress blocked lymphatic drainage pathways.
文摘Fluoroscopic imaging is widely utilised for diagnostic and therapeutic procedures and is fundamental to the establishment and maintenance of dialysis vascular access.To optimise outcomes and avoid injury to patients and healthcare pro-viders,radiation technology must be applied effectively and safely in clinical practice.Radiation safety may be overlooked by nephrology training curricula.This narrative review discusses the theoretical and practical principles of radiation management in fluoroscopy-guided procedures and is intended as a primer for trainees and nephrologists working in interventional settings.
文摘This article constructs statistical selection procedures for exponential populations that may differ in only the threshold parameters. The scale parameters of the populations are assumed common and known. The independent samples drawn from the populations are taken to be of the same size. The best population is defined as the one associated with the largest threshold parameter. In case more than one population share the largest threshold, one of these is tagged at random and denoted the best. Two procedures are developed for choosing a subset of the populations having the property that the chosen subset contains the best population with a prescribed probability. One procedure is based on the sample minimum values drawn from the populations, and another is based on the sample means from the populations. An “Indifference Zone” (IZ) selection procedure is also developed based on the sample minimum values. The IZ procedure asserts that the population with the largest test statistic (e.g., the sample minimum) is the best population. With this approach, the sample size is chosen so as to guarantee that the probability of a correct selection is no less than a prescribed probability in the parameter region where the largest threshold is at least a prescribed amount larger than the remaining thresholds. Numerical examples are given, and the computer R-codes for all calculations are given in the Appendices.
基金Supported by Science and Technology Fund Project of Guizhou Health Commission,No.gzwkj2023-042 and No.gzwkj2024-010National Natural Science Foundation of China,No.82060440+2 种基金Guizhou Provincial Science and Technology Projects,No.QKHJC ZK[2024]-210Cultivation Program for General Projects of the National Natural Science Foundation of China,No.gyfynsfc[2023]-01Cultivation Program for Regional Projects of the National Natural Science Foundation of China,No.gyfynsfc[2024]-19.
文摘Complete rectal prolapse,characterized by the protrusion of the rectal wall layers through the anal canal,poses significant treatment challenges,particularly due to controversies surrounding surgical approaches and the absence of a standardized assessment system.This study comprehensively reviews the main surgical tech-niques for complete rectal prolapse,categorized as transabdominal and transpe-rineal/transanal procedures.Despite various techniques,challenges persist,inclu-ding high recurrence rates and potential complications.Factors influencing the choice of the surgical approach include patient characteristics,symptomatology,and surgical expertise.With advances in medical technology,laparoscopic and robotic surgeries offer promising avenues,albeit with considerations of cost and accessibility.Ultimately,treatment plans tailored to the individual needs of the patient and surgical expertise are essential.Although controversies remain,the continued refinement of surgical techniques holds promise for improving out-comes in complete rectal prolapse surgery.
基金supported by grants from the National Natural Science Foundation of China(No.82172741 to Ye D)Shanghai Municipal Health Bureau(No.2020CXJQ03 to Ye D)Xuhui District Hospital Local Cooperation Project(No.23XHYD-14 to Ye D).
文摘1.Introduction Due to the continuous progress in surgical methodologies and the swift evolution of surgical tools,minimally invasive procedures have emerged as the dominant approach in urologic oncology surgeries.Notably,robot-assisted surgery(RAS)has led to its extensive adoption in the surgical management of urinary system tumors due to its enhanced maneuverability,precision in suturing,and anastomotic capabilities.
基金supported by funding from the Medical Research Funding of Guangdong(No.A2022499 to QGX)the National Natural Science Foundation of China(No.82301796 to PL)the Guangdong Province Regional Joint Fund-Youth Fund Project of China(No.2022A1515111201 to PL).
文摘This study aimed to introduce a modified Byars staged procedure and investigate its application value in patients with severe hypospadias.We retrospectively analyzed the clinical data of patients with severe hypospadias admitted to the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between October 2012 and October 2022.In total,31 patients underwent the conventional Byars procedure(conventional group),and 45 patients underwent the modified Byars staged procedure(modified group).Our modified strategy was built upon the standard Byars procedure by incorporating glansplasty during the first stage and employing a Y-shaped flap in conjunction with a glandular tunnel for urethroplasty during the second stage.Notably,there were no statistically significant differences in the preoperative baseline characteristics,duration of surgery,amount of blood loss,or occurrence of postoperative complications,including urethral fistula,stricture and diverticulum,or penile curvature,between the conventional and modified groups.However,there was a significantly lower incidence of coronal sulcus fistula(0 vs 16.1%,P=0.02)and glans dehiscence(0 vs 12.9%,P=0.02)in the surgical group than that in the conventional group.In addition,the modified group exhibited a notably greater rate of normotopic urethral opening(100.0%vs 83.9%,P=0.01)and a higher mean score on the Hypospadias Objective Penile Evaluation(HOPE;mean±standard error of mean:8.6±0.2 vs 7.9±0.3,P=0.02)than did the conventional group.In conclusion,the modified Byars staged procedure significantly reduced the risks of glans dehiscence and coronal sulcus fistula.Consequently,it offers a promising approach for achieving favorable penile esthetics,thereby providing a reliable therapeutic option for severe hypospadias.
文摘The management of gastrointestinal(GI)bleeding patients during endoscopy remains a challenge.Hemorrhage is still one of the significant causes of morbidity and even death.Several therapeutic options have been used over the years depending on the extent,site and cause of bleeding.These include thermal therapy,injection therapy,and mechanical methods of hemostasis(e.g.,endoscopic clips and ligation bands).Patients with refractory bleeding,high-risk ulcer lesions,malignant disease,antiplatelet medications,and chronic kidney disease are at increased risk of upper and lower GI bleeding(LGIB).In this editorial,I commented on the paper by Ballester et al.Their work aimed at evaluating PuraStat^(■)(TDM-621),a novel hemostatic agent,particularly its efficacy,applications,feasibility,and safety in treating GI bleeding lesions.The authors concluded that PuraStat^(■)is an effective therapy for GI bleeding and is usually easy to use.Although the authors recommended its consideration as a frontline therapy in the future,they did not explore the clinical and GI uses of PuraStat®.This editorial focuses on the pharmacology of PuraStat®and how it differs from Hemospray®(TC-325)(hemostatic powder).It also explores the current experience of using PuraStat^(■)in upper and LGIB,its uses and safety,and the need for further research to fully understand its potential.
文摘BACKGROUND Aortoiliac artery stenting has been accepted as the preferred option for the treatment of aortoiliac artery disease because of lower morbidity and mortality compared with bypass surgery.However,acute stent occlusion is a troublesome complication due to the need for open surgery or the risk of distal embolization.Herein,we reported a novel approach to treat the acute thrombotic occlusion of an aortoiliac stent using both hemolytic and conventional mechanical thrombectomy coupled with a large diameter sheath.CASE SUMMARY A 64-year-old male patient presented with severe claudication of the right leg.The patient's history included multiple prior interventions for aortoiliac lesions.The preoperative computed tomography(CT)imaging showed a thrombotic occlusion of right aortoiliac stenting.An Angiojet Omni thrombectomy catheter(Boston Scientific,Marlborough,MA,United States)was used to remove the thrombus in a retrograde fashion after the successful placement of the large-diameter sheath in the right common femoral artery for prevention of distal embolization.The remnant organized thrombus was removed with an over-the-wire Fogarty catheter(Edwards Lifesciences,Irvine,CA,United States).Completion angiogram and postoperative CT imaging demonstrated complete removal of thrombus and no evidence of distal embolization.CONCLUSION This novel approach provides successful management of acute thrombotic occlusion of aortoiliac stent without distal embolization.
