The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submuc...The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.展开更多
BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for ...BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.展开更多
BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery ...BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.展开更多
Given two ideals I and J of a commutative ring R,there are two extreme connections between I and J:I+J=R and I∩J={0}.For the former case,graphs whose vertices are defined as the proper ideals of R and that two vertic...Given two ideals I and J of a commutative ring R,there are two extreme connections between I and J:I+J=R and I∩J={0}.For the former case,graphs whose vertices are defined as the proper ideals of R and that two vertices are adjacent if and only if their sum is the whole ring R are known as co-maximal ideal graphs.In this paper,we introduce a new kind of graph structure on R,called co-minimal ideal graph,according to the second case:Its vertices are the nonzero ideals of R and two vertices are adjacent if and only if their intersection is zero.Some important graph parameters(including girth,diameter,clique number and chromatic number)and graph structures(including tree and bipartite graph)of co-minimal ideal graphs over finite commutative rings are studied.In particular,we show that the co-maximal ideal graph and the co-minimal ideal graph over R are isomorphic if and only if the number of maximal ideals of R and the number of minimal ideals of R coincide.展开更多
In this paper,we use the solution of the even functional Minkowski problem to show that there is a minimizing affine Minkowski total variation of the function of bounded variation.Moreover,for the Minkowski total vari...In this paper,we use the solution of the even functional Minkowski problem to show that there is a minimizing affine Minkowski total variation of the function of bounded variation.Moreover,for the Minkowski total variation,we use the method of convexation to establish the same conclusion as the convex body space.展开更多
The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the p...The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.展开更多
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
We construct an infinite family of minimal linear codes over the ring F_(2)+u F_(2).These codes are defined through trace functions and Boolean functions.Their Lee weight distribution is completely computed by Walsh t...We construct an infinite family of minimal linear codes over the ring F_(2)+u F_(2).These codes are defined through trace functions and Boolean functions.Their Lee weight distribution is completely computed by Walsh transformation.By Gray mapping,we obtain a family of minimal binary linear codes from a generic construction,which have prominent applications in secret sharing and secure two-party computation.展开更多
The pore structure of porous scaffolds plays a crucial role in bone repair.The prevalent bone implant structure in clinical practice is the traditional cubic structure.However,the traditional cubic structure exhibits ...The pore structure of porous scaffolds plays a crucial role in bone repair.The prevalent bone implant structure in clinical practice is the traditional cubic structure.However,the traditional cubic structure exhibits sharp edges and junctions that are not conducive to cell adhesion or growth.In this study,a double gyroid(DG)Ti6Al4V scaffold based on a triply periodic minimal surface(TPMS)structure was devised,and the osseointegration performance of DG structural scaffolds with varying porosities was investigated.Compression tests revealed that the elastic modulus and compressive strength of DG structural scaffolds were sufficient for orthopedic implants.In vitro cellular experiments demonstrated that the DG structure significantly enhanced cell proliferation,vascularization,and osteogenic differentiation compared to the cubic structure.The DG structure with 55%porosity exhibited the most favorable outcomes.In vivo experiments in rabbits further demonstrated that DG scaffolds could promote neovascularization and bone regeneration and maturation;those with 55%porosity performed best.Comparing the surface area,specific surface area per unit volume,and internal flow distribution characteristics of gyroid and DG structure scaffolds,the latter are more conducive to cell adhesion and growth within scaffolds.This study underscored the potential of DG scaffolds based on the TPMS structure in optimizing the pore structure design of titanium scaffolds,inducing angiogenesis,and advancing the clinical application of titanium scaffolds for repairing bone defects.展开更多
BACKGROUND Acute perforated cholecystitis(APC)is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality,particularly in elderly or high-risk patients.While emergency c...BACKGROUND Acute perforated cholecystitis(APC)is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality,particularly in elderly or high-risk patients.While emergency cholecystectomy is the standard of care,it may not be feasible in unstable patients.Percutaneous transhepatic cholecystostomy(PTC)offers a minimally invasive alternative.AIM To evaluate the safety and effectiveness of PTC as an initial treatment modality for APC.METHODS We conducted a retrospective cohort study of patients diagnosed with APC between January 2017 and October 2022 at a single tertiary medical center.All patients underwent PTC as the initial intervention.Data collected included demographics,comorbidities,laboratory and imaging findings,complications,and clinical outcomes over a 24-month follow-up.Patients were stratified into two groups based on whether they subsequently underwent cholecystectomy.RESULTS Thirty patients underwent PTC for APC.Half of the patients(n=15)were stabilized and later underwent cholecystectomy;the remaining 15 were managed non-operatively.Patients in the non-surgical group were significantly older(87.1±6.2 years vs 76.1±7.4 years;P<0.001).Clinical improvement was observed in 61.4%of non-operated patients,with eventual drain removal or closure.Both groups demonstrated significant reductions in white blood cell count and C-reactive protein levels from admission to discharge.No significant differences were found in hospital stay or complication rates.During follow-up,three deaths occurred due to non-biliary causes.Only one patient required repeat drainage.CONCLUSION PTC is a safe and effective initial treatment for APC,particularly in elderly and comorbid patients for whom surgery poses excessive risk.It provides clinical stabilization and may serve either as a bridge to delayed cholecystectomy or as definitive management in selected patients.These findings support the broader use of PTC in the management of APC,although larger prospective studies are warranted.展开更多
BACKGROUND Return to work(RTW)and resumption of driving(ROD)are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty(THA).However,few studies have focused on the ...BACKGROUND Return to work(RTW)and resumption of driving(ROD)are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty(THA).However,few studies have focused on the minimally invasive(MIS)approach and its effect on these outcomes.AIM To investigate RTW and ROD's timelines and influencing factors following anterior MIS-THA.METHODS A retrospective analysis was conducted on 124 patients who underwent anterior MIS-THA.Data on the demographics,occupational physical demands,and RTW/ROD timelines were also collected.Clinical outcomes were measured using standardised scoring systems.Statistical analyses were performed to evaluate the differences between the groups based on employment status and physical workload.RESULTS Among employed patients,the RTW rate was 94.7%,with an average return time of five weeks.The average ROD time was 3.5 weeks across all patients.Despite similar postoperative clinical scores,RTW time was significantly influenced by occupations'physical workload,with heavier physical demands associated with delayed RTW.CONCLUSION Anterior MIS-THA facilitates early RTW and ROD,particularly in occupations with lower physical demands.These findings highlight the importance of considering occupational and physical workload in postoperative care planning to optimize recovery outcomes.展开更多
In this paper,we investigate the minimization problem e_(s)(p)=_(u∈W_(V)^(1,N))(r^(N)),||u||_(N)^(N)=p>0 inf E(u),where E(u)=1/N∫_(R_(N))|▽_(u)|^(N)dx+1/N∫_(R_(N))V(x)|u|^(N)dx-1/s∫_(R_(N))|u|^(s)dx.Here s>...In this paper,we investigate the minimization problem e_(s)(p)=_(u∈W_(V)^(1,N))(r^(N)),||u||_(N)^(N)=p>0 inf E(u),where E(u)=1/N∫_(R_(N))|▽_(u)|^(N)dx+1/N∫_(R_(N))V(x)|u|^(N)dx-1/s∫_(R_(N))|u|^(s)dx.Here s>N,V is a spherically symmetric increasing function satisfying V(0)=0,|x|→∞lin V(x)=+∞We discuss the problem in three cases.First,for the case s>2N,e_(s)(ρ)=-∞for anyρ>0.Secondly,for the case N<s<2N,for anyρ>0,we prove that it admits a minimizer which is nonnegative,spherically symmetric and decreasing via the N-Laplacian GagliardoNirenberg inequality.When s=2N,the existence and nonexistence of minimizers of e_(s)(ρ)will also be given.During the arguments,we provide the detailed proof of the N-Laplacian Gagliardo-Nirenberg inequality and N-Laplacian Pohozaev identity.展开更多
Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating se...Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating severe obesity,its invasive nature has led to the development of minimally invasive alternatives.Endoscopic sleeve gastroplasty(ESG)is a promising,minimally invasive procedure for weight loss,offering significant weight reduction without the need for surgical incisions.This editorial evaluates the efficacy and safety of ESG,highlighting its weight loss outcomes,safety profile,and comparison with other bariatric procedures,including intragastric balloon,laparoscopic sleeve gastrectomy,and robotic sleeve gastrectomy.ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03%to 17.51%at 12 months and sustained weight reduction over 36 months.The safety profile is favorable,with low rates of serious adverse events and minimal complications compared to surgical alternatives.ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options.However,further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.展开更多
Spleen-preserving distal pancreatectomy(SPDP)has gained increasing attention as a safe and effective alternative to distal pancreatectomy with splenectomy,particularly for benign and low-grade malignant lesions of the...Spleen-preserving distal pancreatectomy(SPDP)has gained increasing attention as a safe and effective alternative to distal pancreatectomy with splenectomy,particularly for benign and low-grade malignant lesions of the pancreatic body and tail.This narrative review evaluates the current evidence,technical considerations,and disease-specific indications for SPDP.Literature was reviewed using up to date scientific evidence and most recent national and international guidelines.Studies addressing SPDP outcomes,splenectomy complications,and disease-specific oncologic principles were included.Spleen preservation has been associated with reduced rates of postoperative infections,thromboembolic events,and longterm immunologic compromise,without compromising oncologic outcomes in selected patients.Indications favoring SPDP include pancreatic neuroendocrine tumors,intraductal papillary mucinous neoplasms,and solid pseudopapillary neoplasms.Although current guidelines generally recommend splenectomy for pancreatic ductal adenocarcinoma,emerging data suggest that spleen preservation may be feasible in highly selected cases.Technical approaches—primarily the Kimura and Warshaw techniques—enable safe dissection and splenic vessel management,particularly with the support of minimally invasive platforms.In conclusion,SPDP should be considered in appropriately selected patients to reduce morbidity while preserving long-term immune function.Future randomized studies are warranted to define oncologic safety and refine indications across tumor types.展开更多
文摘The management of rectal lesions has been significantly enhanced by advancements in endoscopic and minimally invasive surgical techniques.Endoscopic submucosal dissection(ESD),transanal endoscopic microsurgical submucosal dissection(TEM-ESD),and transanal minimally invasive surgery(TAMIS)offer precision and reduced morbidity for treating these conditions.This minireview evaluates the efficacy,safety,and clinical outcomes of ESD,TEM-ESD,and TAMIS,highlighting their roles in the contemporary management of rectal lesions.A desktop research study with a particular focus on ESD,TEM-ESD,and TAMIS for rectal lesions was conducted.Key outcomes assessed include complete resection rates,complication rates,recurrence rates,and functional outcomes following the procedure.ESD is noted for its high rate of en bloc resection with minimal invasiveness,suitable for large or flat lesions.TEM-ESD has demonstrated similar efficacy,with additional benefits including shorter procedure times and a more favorable learning curve,compared to traditional ESD,as evidenced by recent comparative studies.TAMIS offers a less invasive option with enhanced visualization and accessibility,supporting its use in a broader range of rectal lesion cases.ESD,TEM-ESD,and TAMIS are all effective therapeutic options for rectal lesions,each presenting unique advantages depending on lesion characteristics and patient factors.
文摘BACKGROUND Currently,very few studies have examined the analgesic effectiveness and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.AIM To investigate the analgesic effect and safety of dexmedetomidine-assisted intravenous-inhalation combined general anesthesia in laparoscopic minimally invasive surgery for inguinal hernia.METHODS In this retrospective study,94 patients scheduled for laparoscopic minimally invasive surgery for inguinal hernia,admitted to Yiwu Central Hospital between May 2022 and May 2023,were divided into a control group(inhalation combined general anesthesia)and a treatment group(dexmedetomidine-assisted intrave-nous-inhalation combined general anesthesia).Perioperative indicators,analgesic effect,preoperative and postoperative 24-hours blood pressure(BP)and heart rate(HR),stress indicators,immune function levels,and adverse reactions were com-pared between the two groups.RESULTS Baseline data,including age,hernia location,place of residence,weight,monthly income,education level,and underlying diseases,were not significantly different between the two groups,indicating comparability(P>0.05).No significant difference was found in operation time and anesthesia time between the two groups(P>0.05).However,the treatment group exhibited a shorter postoperative urinary catheter removal time and hospital stay than the control group(P<0.05).Preoperatively,no significant differences were found in the visual analog scale(VAS)scores between the two groups(P>0.05).However,at 12,18,and 24 hours postoper-atively,the treatment group had significantly lower VAS scores than the control group(P<0.05).Although no significant differences in preoperative hemodynamic indicators were found between the two groups(P>0.05),both groups experienced some extent of changes in postoperative HR,diastolic BP(DBP),and systolic BP(SBP).Nevertheless,the treatment group showed smaller changes in HR,DBP,and SBP than the control group(P<0.05).Preoperative immune function indicators showed no significant differences between the two groups(P>0.05).However,postoperatively,the treatment group demonstrated higher levels of CD3+,CD4+,and CD4+/CD8+and lower levels of CD8+than the control group(P<0.05).The rates of adverse reactions were 6.38%and 23.40%in the treatment and control groups,respectively,revealing a significant difference(χ2=5.371,P=0.020).CONCLUSION Dexmedetomidine-assisted intravenous-inhalation combined general anesthesia can promote early recovery of patients undergoing laparoscopic minimally invasive surgery for inguinal hernia.It ensures stable blood flow,improves postoperative analgesic effects,reduces postoperative pain intensity,alleviates stress response,improves immune function,facilitates anesthesia recovery,and enhances safety.
基金Supported by Joint Funds for the Innovation of Science and Technology,Fujian Province,No.2023Y9187 and No.2021Y9057.
文摘BACKGROUND Minimally invasive esophagectomy(MIE)is a widely accepted treatment for esophageal cancer,yet it is associated with a significant risk of surgical adverse events(SAEs),which can compromise patient recovery and long-term survival.Accurate preoperative identification of high-risk patients is critical for improving outcomes.AIM To establish and validate a risk prediction and stratification model for the risk of SAEs in patients with MIE.METHODS This retrospective study included 747 patients who underwent MIE at two centers from January 2019 to February 2024.Patients were separated into a train set(n=549)and a validation set(n=198).After screening by least absolute shrinkage and selection operator regression,multivariate logistic regression analyzed clinical and intraoperative variables to identify independent risk factors for SAEs.A risk stratification model was constructed and validated to predict the probability of SAEs.RESULTS SAEs occurred in 10.2%of patients in train set and 13.6%in the validation set.Patients with SAE had significantly higher complication rate and a longer hospital stay after surgery.The key independent risk factors identified included chronic obstructive pulmonary disease,a history of alcohol consumption,low forced expiratory volume in the first second,and low albumin levels.The stratification model has excellent prediction accuracy,with an area under the curve of 0.889 for the training set and an area under the curve of 0.793 for the validation set.CONCLUSION The developed risk stratification model effectively predicts the risk of SAEs in patients undergoing MIE,facilitating targeted preoperative interventions and improving perioperative management.
基金partially supported by the Open Research Fund of Key Laboratory of Nonlinear Analysis&Applications(Central China Normal University),Ministry of Education,P.R.Chinathe Guiding Science and Technology Plan Project of Suqian City in 2023(No.Z2023130)partially supported by NSFC(No.12271234)。
文摘Given two ideals I and J of a commutative ring R,there are two extreme connections between I and J:I+J=R and I∩J={0}.For the former case,graphs whose vertices are defined as the proper ideals of R and that two vertices are adjacent if and only if their sum is the whole ring R are known as co-maximal ideal graphs.In this paper,we introduce a new kind of graph structure on R,called co-minimal ideal graph,according to the second case:Its vertices are the nonzero ideals of R and two vertices are adjacent if and only if their intersection is zero.Some important graph parameters(including girth,diameter,clique number and chromatic number)and graph structures(including tree and bipartite graph)of co-minimal ideal graphs over finite commutative rings are studied.In particular,we show that the co-maximal ideal graph and the co-minimal ideal graph over R are isomorphic if and only if the number of maximal ideals of R and the number of minimal ideals of R coincide.
基金Supported in part by NSFC(No.11971005)the Fundamental Research Funds for the Central Universities(Nos.GK202101008,GK202102012)。
文摘In this paper,we use the solution of the even functional Minkowski problem to show that there is a minimizing affine Minkowski total variation of the function of bounded variation.Moreover,for the Minkowski total variation,we use the method of convexation to establish the same conclusion as the convex body space.
文摘The minimal clinically important difference(MCID)represents a pivotal metric in bridging the gap between statistical significance and clinical relevance,addressing the direct impact of medical interventions from the patient's perspective.This comprehensive review analyzes the evolution,applications,and challenges of MCID across medical specialties,emphasizing its necessity in ensuring that clinical outcomes not only demonstrate statistical significance but also offer genuine clinical utility that aligns with patient expectations and needs.We discuss the evolution of MCID since its inception in the 1980s,its current applications across various medical specialties,and the methodologies used in its calculation,highlighting both anchor-based and distribution-based approaches.Furthermore,the paper delves into the challenges associated with the application of MCID,such as methodological variability and the interpretation difficulties that arise in clinical settings.Recommendations for the future include standardizing MCID calculation methods,enhancing patient involvement in setting MCID thresholds,and extending research to incorporate diverse global perspectives.These steps are critical to refining the role of MCID in patient-centered healthcare,addressing existing gaps in methodology and interpretation,and ensuring that medical interventions lead to significant,patient-perceived improvements.
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.
基金National Natural Science Foundation of China(12201171)。
文摘We construct an infinite family of minimal linear codes over the ring F_(2)+u F_(2).These codes are defined through trace functions and Boolean functions.Their Lee weight distribution is completely computed by Walsh transformation.By Gray mapping,we obtain a family of minimal binary linear codes from a generic construction,which have prominent applications in secret sharing and secure two-party computation.
基金supported bythe National Natural Science Foundation of China(Nos.U23A20523,82272504,and 82072456)the Department of Science and Technology of Jilin Province,China(Nos.20210101439JC,20210101321JC,20220204119YY,202201ZYTS131,202201ZYTS129,20230204114YY,YDZJ202201ZYTS505,and YDZJ202301ZYTS076)+4 种基金the Special Program for Science and Technology Personnel of Changchun(No.ZKICKJJ2023015)the Key Training Plan for Outstanding Youth of Jilin University(No.419070623036)the Research Fund of the First Hospital of Jilin University(No.2021-zl-01)the Graduate Innovation Fund of Jilin University(No.2024CX125)the Foun-dation of National Center for Translational Medicine(Shanghai)SHU Branch,China(No.SUITM-202405).
文摘The pore structure of porous scaffolds plays a crucial role in bone repair.The prevalent bone implant structure in clinical practice is the traditional cubic structure.However,the traditional cubic structure exhibits sharp edges and junctions that are not conducive to cell adhesion or growth.In this study,a double gyroid(DG)Ti6Al4V scaffold based on a triply periodic minimal surface(TPMS)structure was devised,and the osseointegration performance of DG structural scaffolds with varying porosities was investigated.Compression tests revealed that the elastic modulus and compressive strength of DG structural scaffolds were sufficient for orthopedic implants.In vitro cellular experiments demonstrated that the DG structure significantly enhanced cell proliferation,vascularization,and osteogenic differentiation compared to the cubic structure.The DG structure with 55%porosity exhibited the most favorable outcomes.In vivo experiments in rabbits further demonstrated that DG scaffolds could promote neovascularization and bone regeneration and maturation;those with 55%porosity performed best.Comparing the surface area,specific surface area per unit volume,and internal flow distribution characteristics of gyroid and DG structure scaffolds,the latter are more conducive to cell adhesion and growth within scaffolds.This study underscored the potential of DG scaffolds based on the TPMS structure in optimizing the pore structure design of titanium scaffolds,inducing angiogenesis,and advancing the clinical application of titanium scaffolds for repairing bone defects.
文摘BACKGROUND Acute perforated cholecystitis(APC)is a serious complication of acute cholecystitis and is associated with significant morbidity and mortality,particularly in elderly or high-risk patients.While emergency cholecystectomy is the standard of care,it may not be feasible in unstable patients.Percutaneous transhepatic cholecystostomy(PTC)offers a minimally invasive alternative.AIM To evaluate the safety and effectiveness of PTC as an initial treatment modality for APC.METHODS We conducted a retrospective cohort study of patients diagnosed with APC between January 2017 and October 2022 at a single tertiary medical center.All patients underwent PTC as the initial intervention.Data collected included demographics,comorbidities,laboratory and imaging findings,complications,and clinical outcomes over a 24-month follow-up.Patients were stratified into two groups based on whether they subsequently underwent cholecystectomy.RESULTS Thirty patients underwent PTC for APC.Half of the patients(n=15)were stabilized and later underwent cholecystectomy;the remaining 15 were managed non-operatively.Patients in the non-surgical group were significantly older(87.1±6.2 years vs 76.1±7.4 years;P<0.001).Clinical improvement was observed in 61.4%of non-operated patients,with eventual drain removal or closure.Both groups demonstrated significant reductions in white blood cell count and C-reactive protein levels from admission to discharge.No significant differences were found in hospital stay or complication rates.During follow-up,three deaths occurred due to non-biliary causes.Only one patient required repeat drainage.CONCLUSION PTC is a safe and effective initial treatment for APC,particularly in elderly and comorbid patients for whom surgery poses excessive risk.It provides clinical stabilization and may serve either as a bridge to delayed cholecystectomy or as definitive management in selected patients.These findings support the broader use of PTC in the management of APC,although larger prospective studies are warranted.
基金approved by the Institutional Ethics Committee of Shizuoka Red Cross Hospital(No.2023-36,approval date:January 12,2024).
文摘BACKGROUND Return to work(RTW)and resumption of driving(ROD)are critical factors that influence postoperative quality of life in patients undergoing total hip arthroplasty(THA).However,few studies have focused on the minimally invasive(MIS)approach and its effect on these outcomes.AIM To investigate RTW and ROD's timelines and influencing factors following anterior MIS-THA.METHODS A retrospective analysis was conducted on 124 patients who underwent anterior MIS-THA.Data on the demographics,occupational physical demands,and RTW/ROD timelines were also collected.Clinical outcomes were measured using standardised scoring systems.Statistical analyses were performed to evaluate the differences between the groups based on employment status and physical workload.RESULTS Among employed patients,the RTW rate was 94.7%,with an average return time of five weeks.The average ROD time was 3.5 weeks across all patients.Despite similar postoperative clinical scores,RTW time was significantly influenced by occupations'physical workload,with heavier physical demands associated with delayed RTW.CONCLUSION Anterior MIS-THA facilitates early RTW and ROD,particularly in occupations with lower physical demands.These findings highlight the importance of considering occupational and physical workload in postoperative care planning to optimize recovery outcomes.
基金supported by the Xingdian Talents Support Program of Yunnan Province of Youthsthe Yunnan Province Basic Research Project for General Program(202401AT070441)+5 种基金the Yunnan Key Laboratory of Modern Analytical Mathematics and Applications(202302AN360007)supported by the NNSF(12261031)supported by the NNSF(12401145)supported by the NNSF(12371120)the Yunnan Province Basic Research Project for Key Program(202401AS070024)the General Program(202301AT070141)。
文摘In this paper,we investigate the minimization problem e_(s)(p)=_(u∈W_(V)^(1,N))(r^(N)),||u||_(N)^(N)=p>0 inf E(u),where E(u)=1/N∫_(R_(N))|▽_(u)|^(N)dx+1/N∫_(R_(N))V(x)|u|^(N)dx-1/s∫_(R_(N))|u|^(s)dx.Here s>N,V is a spherically symmetric increasing function satisfying V(0)=0,|x|→∞lin V(x)=+∞We discuss the problem in three cases.First,for the case s>2N,e_(s)(ρ)=-∞for anyρ>0.Secondly,for the case N<s<2N,for anyρ>0,we prove that it admits a minimizer which is nonnegative,spherically symmetric and decreasing via the N-Laplacian GagliardoNirenberg inequality.When s=2N,the existence and nonexistence of minimizers of e_(s)(ρ)will also be given.During the arguments,we provide the detailed proof of the N-Laplacian Gagliardo-Nirenberg inequality and N-Laplacian Pohozaev identity.
文摘Obesity is a major global health issue,contributing to numerous comorbidities such as type 2 diabetes mellitus,hypertension,and cardiovascular diseases.While bariatric surgery remains the gold standard for treating severe obesity,its invasive nature has led to the development of minimally invasive alternatives.Endoscopic sleeve gastroplasty(ESG)is a promising,minimally invasive procedure for weight loss,offering significant weight reduction without the need for surgical incisions.This editorial evaluates the efficacy and safety of ESG,highlighting its weight loss outcomes,safety profile,and comparison with other bariatric procedures,including intragastric balloon,laparoscopic sleeve gastrectomy,and robotic sleeve gastrectomy.ESG has shown substantial weight loss with a mean total weight loss ranging from 15.03%to 17.51%at 12 months and sustained weight reduction over 36 months.The safety profile is favorable,with low rates of serious adverse events and minimal complications compared to surgical alternatives.ESG is particularly suited for patients with mild to moderate obesity or those not eligible for surgical options.However,further long-term studies and standardized protocols are needed to refine patient selection and optimize treatment outcomes.
文摘Spleen-preserving distal pancreatectomy(SPDP)has gained increasing attention as a safe and effective alternative to distal pancreatectomy with splenectomy,particularly for benign and low-grade malignant lesions of the pancreatic body and tail.This narrative review evaluates the current evidence,technical considerations,and disease-specific indications for SPDP.Literature was reviewed using up to date scientific evidence and most recent national and international guidelines.Studies addressing SPDP outcomes,splenectomy complications,and disease-specific oncologic principles were included.Spleen preservation has been associated with reduced rates of postoperative infections,thromboembolic events,and longterm immunologic compromise,without compromising oncologic outcomes in selected patients.Indications favoring SPDP include pancreatic neuroendocrine tumors,intraductal papillary mucinous neoplasms,and solid pseudopapillary neoplasms.Although current guidelines generally recommend splenectomy for pancreatic ductal adenocarcinoma,emerging data suggest that spleen preservation may be feasible in highly selected cases.Technical approaches—primarily the Kimura and Warshaw techniques—enable safe dissection and splenic vessel management,particularly with the support of minimally invasive platforms.In conclusion,SPDP should be considered in appropriately selected patients to reduce morbidity while preserving long-term immune function.Future randomized studies are warranted to define oncologic safety and refine indications across tumor types.
