Overweight and obesity has been a major public health problem globally.It was estimated that more than 2.1 billion adults were affected by overweight or obese in 2021 worldwide,about one fifth of whom lived in China^(...Overweight and obesity has been a major public health problem globally.It was estimated that more than 2.1 billion adults were affected by overweight or obese in 2021 worldwide,about one fifth of whom lived in China^([1]).By 2050,the country is forecast to remain the one with the largest population of overweight and obese globally^([1]),if no effective strategies were applied on overweight/obesity control.展开更多
Microrobotic systems are emerging as transformative technology for minimally invasive medicine,driven by innovations in actuation mechanisms,advanced fabrication paradigms,and multifunctional system integration.This c...Microrobotic systems are emerging as transformative technology for minimally invasive medicine,driven by innovations in actuation mechanisms,advanced fabrication paradigms,and multifunctional system integration.This comprehensive review analyzes the evolution of microrobotic technologies through three critical dimensions:(1)actuation modalities,including magnetic,optical,acoustic,chemical,and biological actuation,with a focus on the synergistic advantages of hybrid actuation strategies in complex internal physiological environments;(2)Fabrication methods cover technolo-gies such as photolithography,microinjection molding,self-assembly,and 3D printing,emphasizing innovative strategies involving multi-technology integration and collaborative manufacturing of bio/non-bio hybrid materials;(3)Internal phys-iological applications involve disease diagnosis,targeted drug delivery,minimally invasive surgery,tissue engineering,and cell manipulation,highlighting the broad prospects of microrobots in precision medicine.Despite remarkable progress,critical challenges remain,including low actuation efficiency,as seen in acoustic systems,limited biocompatibility,exem-plified by the toxicity of hydrogen peroxide in chemical actuation,delayed clinical translation,and other related challenges that must be addressed to advance the field.展开更多
Background:Minimally invasive distal pancreatectomy(MIDP)is increasingly being used,although its oncologic safety for pancreatic ductal adenocarcinoma(PDAC)remains controversial.In Japan,MIDP for PDAC has limited endo...Background:Minimally invasive distal pancreatectomy(MIDP)is increasingly being used,although its oncologic safety for pancreatic ductal adenocarcinoma(PDAC)remains controversial.In Japan,MIDP for PDAC has limited endorsement due to insufficient data.This study aimed to compare the perioperative and long-term outcomes of open distal pancreatectomy(ODP)and MIDP for PDAC.Methods:We retrospectively analyzed patients with resectable pancreatic body and tail cancer treated with ODP or MIDP(laparoscopic or robotic)between January 2007 and July 2022.The surgical procedures(ODP and MIDP)were compared and the patient characteristics,perioperative outcomes,and long-term outcomes were analyzed.We also compared the outcomes of patients with neoadjuvant chemotherapy(NAC)and without NAC.Results:A total of 72 distal pancreatectomies were performed(37 ODPs and 35 MIDPs).In the upfront group,MIDP resulted in significantly less blood loss than ODP(P<0.01),despite similar operative time.There was no statistically significant difference in the 2-year recurrence-free survival(RFS)rates between ODP and MIDP(39.7%vs.57.8%,P=0.60)or in the overall survival(OS)rates(66.7%vs.74.1%,P=0.43).Similarly,in the NAC group,MIDP resulted in significantly less blood loss than ODP(P=0.01);ODP and MIDP had similar 2-year RFS rates(41.7%and 60.0%,P=0.75)and OS rates(50.0%and 70.0%,P=0.36).The interval from surgery to adjuvant chemotherapy initiation did not significantly differ between the ODP and MIDP subgroups in both the upfront group(P=0.13)and the NAC group(P=0.14).The incidence of recurrence was 64.8%for ODP and 42.8%for MIDP(P=0.06).Both procedures showed similar distributions of local and distant recurrence.Conclusions:MIDP caused less blood loss and had similar oncologic safety compared with ODP.MIDP could become a feasible,minimally invasive option with sufficient oncologic safety for pancreatic body and tail cancers.展开更多
AIM:To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated fourhaptic intraocular lenses(IOLs).METHODS:Thi...AIM:To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated fourhaptic intraocular lenses(IOLs).METHODS:This retrospective consecutive case series included eyes with dislocated Akreos AO60 IOLs underwent scleral refixation using a horizontal mattress doubleneedle suture technique with intralamellar knot burial via Hoffman pockets.Clinical outcomes assessed included pre-and postoperative best-corrected visual acuity(BCVA),intraocular pressure(IOP),spherical equivalent(SE),suture duration,IOL centration,and perioperative complications.RESULTS:A total of 10 eyes from 10 patients(6 males)were included.The mean age at the time of IOL refixation was 53.10±13.07y(range:28-68y).The mean interval between initial IOL implantation and dislocation was 8.44±3.54y.The mean postoperative follow-up duration was 11.45±10.30mo.Surgical time averaged 15.3±1.77min,with no intraoperative complications.The mean axial length was 27.16±4.35 mm,with high myopia(HM)as the leading comorbidity(4/10 eyes).Postoperative BCVA significantly improved compared to preoperative values(P=0.025).Postoperative SE was significantly improved compared with preoperative(P=0.01).All IOLs remained centered throughout follow-up.CONCLUSION:This minimally invasive four-point scleral fixation technique offers a safe and effective refixation strategy for dislocated four-haptic IOLs.The horizontal mattress suture configuration combined with Hoffman pockets facilitates durable centration,avoids conjunctival dissection,and could be adopted into routine surgical practice.展开更多
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
Herein,we describe a case of robotic duodenum-preserving pancreatic head resection(DPPHR)performed on a 21-monthold male infant(weight:13 kg;body mass index:18.87 kg/m^(2))with focal nesidioblastosis,expanding the sco...Herein,we describe a case of robotic duodenum-preserving pancreatic head resection(DPPHR)performed on a 21-monthold male infant(weight:13 kg;body mass index:18.87 kg/m^(2))with focal nesidioblastosis,expanding the scope of minimally invasive pediatric hepatobiliary surgery(Fig.1;Video S1).Preoperative positron emission tomography-computed tomography revealed a 23×13 mm neuroendocrine lesion in the pancreatic head,which caused refractory hypoglycemia and necessitated surgical intervention.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
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
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
A Bayesian network reconstruction method based on norm minimization is proposed to address the sparsity and iterative divergence issues in network reconstruction caused by noise and missing values.This method achieves...A Bayesian network reconstruction method based on norm minimization is proposed to address the sparsity and iterative divergence issues in network reconstruction caused by noise and missing values.This method achieves precise adjustment of the network structure by constructing a preliminary random network model and introducing small-world network characteristics and combines L1 norm minimization regularization techniques to control model complexity and optimize the inference process of variable dependencies.In the experiment of game network reconstruction,when the success rate of the L1 norm minimization model’s existence connection reconstruction reaches 100%,the minimum data required is about 40%,while the minimum data required for a sparse Bayesian learning network is about 45%.In terms of operational efficiency,the running time for minimizing the L1 normis basically maintained at 1.0 s,while the success rate of connection reconstruction increases significantly with an increase in data volume,reaching a maximum of 13.2 s.Meanwhile,in the case of a signal-to-noise ratio of 10 dB,the L1 model achieves a 100% success rate in the reconstruction of existing connections,while the sparse Bayesian network had the highest success rate of 90% in the reconstruction of non-existent connections.In the analysis of actual cases,the maximum lift and drop track of the research method is 0.08 m.The mean square error is 5.74 cm^(2).The results indicate that this norm minimization-based method has good performance in data efficiency and model stability,effectively reducing the impact of outliers on the reconstruction results to more accurately reflect the actual situation.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
Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularl...Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularly lumbosacral plexus.The introduction of minimally invasive surgical approaches,such as the lateral rectus approach,not only contributes to preserving lumbar plexus integrity in operated patients but also positively impacts their psychological well-being.Patients treated by surgical reduction of pelvic fractures with lumbosacral plexus injury often experience states of anxiety and depression.The lateral rectus approach is associated with lower levels of anxiety and depression compared to more invasive surgical techniques used for similar fractures.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
Recently,the Fog-Radio Access Network(F-RAN)has gained considerable attention,because of its flexible architecture that allows rapid response to user requirements.In this paper,computational offloading in F-RAN is con...Recently,the Fog-Radio Access Network(F-RAN)has gained considerable attention,because of its flexible architecture that allows rapid response to user requirements.In this paper,computational offloading in F-RAN is considered,where multiple User Equipments(UEs)offload their computational tasks to the F-RAN through fog nodes.Each UE can select one of the fog nodes to offload its task,and each fog node may serve multiple UEs.The tasks are computed by the fog nodes or further offloaded to the cloud via a capacity-limited fronhaul link.In order to compute all UEs'tasks quickly,joint optimization of UE-Fog association,radio and computation resources of F-RAN is proposed to minimize the maximum latency of all UEs.This min-max problem is formulated as a Mixed Integer Nonlinear Program(MINP).To tackle it,first,MINP is reformulated as a continuous optimization problem,and then the Majorization Minimization(MM)method is used to find a solution.The MM approach that we develop is unconventional in that each MM subproblem is solved inexactly with the same provable convergence guarantee as the exact MM,thereby reducing the complexity of MM iteration.In addition,a cooperative offloading model is considered,where the fog nodes compress-and-forward their received signals to the cloud.Under this model,a similar min-max latency optimization problem is formulated and tackled by the inexact MM.Simulation results show that the proposed algorithms outperform some offloading strategies,and that the cooperative offloading can exploit transmission diversity better than noncooperative offloading to achieve better latency performance.展开更多
文摘Overweight and obesity has been a major public health problem globally.It was estimated that more than 2.1 billion adults were affected by overweight or obese in 2021 worldwide,about one fifth of whom lived in China^([1]).By 2050,the country is forecast to remain the one with the largest population of overweight and obese globally^([1]),if no effective strategies were applied on overweight/obesity control.
基金National Natural Science Foundation of China(Grant No.61903157)the Foundation of State Key Laboratory of Robotics(Grand No.2024-O08).
文摘Microrobotic systems are emerging as transformative technology for minimally invasive medicine,driven by innovations in actuation mechanisms,advanced fabrication paradigms,and multifunctional system integration.This comprehensive review analyzes the evolution of microrobotic technologies through three critical dimensions:(1)actuation modalities,including magnetic,optical,acoustic,chemical,and biological actuation,with a focus on the synergistic advantages of hybrid actuation strategies in complex internal physiological environments;(2)Fabrication methods cover technolo-gies such as photolithography,microinjection molding,self-assembly,and 3D printing,emphasizing innovative strategies involving multi-technology integration and collaborative manufacturing of bio/non-bio hybrid materials;(3)Internal phys-iological applications involve disease diagnosis,targeted drug delivery,minimally invasive surgery,tissue engineering,and cell manipulation,highlighting the broad prospects of microrobots in precision medicine.Despite remarkable progress,critical challenges remain,including low actuation efficiency,as seen in acoustic systems,limited biocompatibility,exem-plified by the toxicity of hydrogen peroxide in chemical actuation,delayed clinical translation,and other related challenges that must be addressed to advance the field.
文摘Background:Minimally invasive distal pancreatectomy(MIDP)is increasingly being used,although its oncologic safety for pancreatic ductal adenocarcinoma(PDAC)remains controversial.In Japan,MIDP for PDAC has limited endorsement due to insufficient data.This study aimed to compare the perioperative and long-term outcomes of open distal pancreatectomy(ODP)and MIDP for PDAC.Methods:We retrospectively analyzed patients with resectable pancreatic body and tail cancer treated with ODP or MIDP(laparoscopic or robotic)between January 2007 and July 2022.The surgical procedures(ODP and MIDP)were compared and the patient characteristics,perioperative outcomes,and long-term outcomes were analyzed.We also compared the outcomes of patients with neoadjuvant chemotherapy(NAC)and without NAC.Results:A total of 72 distal pancreatectomies were performed(37 ODPs and 35 MIDPs).In the upfront group,MIDP resulted in significantly less blood loss than ODP(P<0.01),despite similar operative time.There was no statistically significant difference in the 2-year recurrence-free survival(RFS)rates between ODP and MIDP(39.7%vs.57.8%,P=0.60)or in the overall survival(OS)rates(66.7%vs.74.1%,P=0.43).Similarly,in the NAC group,MIDP resulted in significantly less blood loss than ODP(P=0.01);ODP and MIDP had similar 2-year RFS rates(41.7%and 60.0%,P=0.75)and OS rates(50.0%and 70.0%,P=0.36).The interval from surgery to adjuvant chemotherapy initiation did not significantly differ between the ODP and MIDP subgroups in both the upfront group(P=0.13)and the NAC group(P=0.14).The incidence of recurrence was 64.8%for ODP and 42.8%for MIDP(P=0.06).Both procedures showed similar distributions of local and distant recurrence.Conclusions:MIDP caused less blood loss and had similar oncologic safety compared with ODP.MIDP could become a feasible,minimally invasive option with sufficient oncologic safety for pancreatic body and tail cancers.
文摘AIM:To evaluate the clinical outcomes of a new minimally invasive technique using horizontal mattress sutures and Hoffman pockets for four-point refixation of dislocated fourhaptic intraocular lenses(IOLs).METHODS:This retrospective consecutive case series included eyes with dislocated Akreos AO60 IOLs underwent scleral refixation using a horizontal mattress doubleneedle suture technique with intralamellar knot burial via Hoffman pockets.Clinical outcomes assessed included pre-and postoperative best-corrected visual acuity(BCVA),intraocular pressure(IOP),spherical equivalent(SE),suture duration,IOL centration,and perioperative complications.RESULTS:A total of 10 eyes from 10 patients(6 males)were included.The mean age at the time of IOL refixation was 53.10±13.07y(range:28-68y).The mean interval between initial IOL implantation and dislocation was 8.44±3.54y.The mean postoperative follow-up duration was 11.45±10.30mo.Surgical time averaged 15.3±1.77min,with no intraoperative complications.The mean axial length was 27.16±4.35 mm,with high myopia(HM)as the leading comorbidity(4/10 eyes).Postoperative BCVA significantly improved compared to preoperative values(P=0.025).Postoperative SE was significantly improved compared with preoperative(P=0.01).All IOLs remained centered throughout follow-up.CONCLUSION:This minimally invasive four-point scleral fixation technique offers a safe and effective refixation strategy for dislocated four-haptic IOLs.The horizontal mattress suture configuration combined with Hoffman pockets facilitates durable centration,avoids conjunctival dissection,and could be adopted into routine surgical practice.
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Herein,we describe a case of robotic duodenum-preserving pancreatic head resection(DPPHR)performed on a 21-monthold male infant(weight:13 kg;body mass index:18.87 kg/m^(2))with focal nesidioblastosis,expanding the scope of minimally invasive pediatric hepatobiliary surgery(Fig.1;Video S1).Preoperative positron emission tomography-computed tomography revealed a 23×13 mm neuroendocrine lesion in the pancreatic head,which caused refractory hypoglycemia and necessitated surgical intervention.
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 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.
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.
基金supported by the Scientific and Technological Developing Scheme of Jilin Province,China(No.20240101371JC)the National Natural Science Foundation of China(No.62107008).
文摘A Bayesian network reconstruction method based on norm minimization is proposed to address the sparsity and iterative divergence issues in network reconstruction caused by noise and missing values.This method achieves precise adjustment of the network structure by constructing a preliminary random network model and introducing small-world network characteristics and combines L1 norm minimization regularization techniques to control model complexity and optimize the inference process of variable dependencies.In the experiment of game network reconstruction,when the success rate of the L1 norm minimization model’s existence connection reconstruction reaches 100%,the minimum data required is about 40%,while the minimum data required for a sparse Bayesian learning network is about 45%.In terms of operational efficiency,the running time for minimizing the L1 normis basically maintained at 1.0 s,while the success rate of connection reconstruction increases significantly with an increase in data volume,reaching a maximum of 13.2 s.Meanwhile,in the case of a signal-to-noise ratio of 10 dB,the L1 model achieves a 100% success rate in the reconstruction of existing connections,while the sparse Bayesian network had the highest success rate of 90% in the reconstruction of non-existent connections.In the analysis of actual cases,the maximum lift and drop track of the research method is 0.08 m.The mean square error is 5.74 cm^(2).The results indicate that this norm minimization-based method has good performance in data efficiency and model stability,effectively reducing the impact of outliers on the reconstruction results to more accurately reflect the actual situation.
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.
文摘Pelvic fractures are rare but severe injuries that severely affect patients’quality of life.Treatment of these fractures often involves invasive approaches with high risk of injuries to nervous structures,particularly lumbosacral plexus.The introduction of minimally invasive surgical approaches,such as the lateral rectus approach,not only contributes to preserving lumbar plexus integrity in operated patients but also positively impacts their psychological well-being.Patients treated by surgical reduction of pelvic fractures with lumbosacral plexus injury often experience states of anxiety and depression.The lateral rectus approach is associated with lower levels of anxiety and depression compared to more invasive surgical techniques used for similar fractures.
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.
基金supported in part by the Natural Science Foundation of China (62171110,U19B2028 and U20B2070)。
文摘Recently,the Fog-Radio Access Network(F-RAN)has gained considerable attention,because of its flexible architecture that allows rapid response to user requirements.In this paper,computational offloading in F-RAN is considered,where multiple User Equipments(UEs)offload their computational tasks to the F-RAN through fog nodes.Each UE can select one of the fog nodes to offload its task,and each fog node may serve multiple UEs.The tasks are computed by the fog nodes or further offloaded to the cloud via a capacity-limited fronhaul link.In order to compute all UEs'tasks quickly,joint optimization of UE-Fog association,radio and computation resources of F-RAN is proposed to minimize the maximum latency of all UEs.This min-max problem is formulated as a Mixed Integer Nonlinear Program(MINP).To tackle it,first,MINP is reformulated as a continuous optimization problem,and then the Majorization Minimization(MM)method is used to find a solution.The MM approach that we develop is unconventional in that each MM subproblem is solved inexactly with the same provable convergence guarantee as the exact MM,thereby reducing the complexity of MM iteration.In addition,a cooperative offloading model is considered,where the fog nodes compress-and-forward their received signals to the cloud.Under this model,a similar min-max latency optimization problem is formulated and tackled by the inexact MM.Simulation results show that the proposed algorithms outperform some offloading strategies,and that the cooperative offloading can exploit transmission diversity better than noncooperative offloading to achieve better latency performance.
