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
AIM:To present an overview of the research on global glaucoma treatment in the last decade in terms of publication year,journals,countries/regions,organizations,references,and keywords,to investigate the current resea...AIM:To present an overview of the research on global glaucoma treatment in the last decade in terms of publication year,journals,countries/regions,organizations,references,and keywords,to investigate the current research international trends and hot topics in this area.METHODS:Bibliometric analysis was conducted on 9128 articles in the Web of Science Core Collection(WoSCC;Clarivate)database.Quantitative and qualitative analysis was employed using VOSviewer(v1.6.18),Pajek(v1.0.0.0),and CiteSpace(v6.1.R2)software.RESULTS:The 9128 papers relating to glaucoma treatment were published from April 2013 to April 2023,of which 7482 articles(82%)were original research articles and 1464(18%)were review articles.The United States(2867)and Johns Hopkins University(166)were the most productive country and institution,respectively,but the University College London had the highest h-index(54).The Journal of Glaucoma was the most productive and Ophthalmology had the highest h-index compared with other journals.The Keywords of interest included treatment surgery,cyclophotocoagulation,minimally invasive glaucoma surgery(MIGS),trabeculectomy,baerveldt,epidemiology,medication adherence,nanoparticle,optical coherence tomography(OCT),gene therapy,and artificial intelligence(AI).Glaucoma surgery appeared as a current research hotspot through the analysis of keywords.CONCLUSION:This study provides insights into the research trends and potential research hotspots in the treatment of glaucoma.This will help researchers to evaluate research policies and to promote international cooperation.展开更多
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
BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical perf...BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.展开更多
In this paper,we studyλ-biharmonic hypersurfaces M_(r)^(5) of 6-dimensional pseudo Riemannian space form N_(p)^(6)(c)with the indexs 0≤p≤6,r=p−1 or p,and constant curvature c.It was proved that if the shape operato...In this paper,we studyλ-biharmonic hypersurfaces M_(r)^(5) of 6-dimensional pseudo Riemannian space form N_(p)^(6)(c)with the indexs 0≤p≤6,r=p−1 or p,and constant curvature c.It was proved that if the shape operator of M_(r)^(5) is diagonalizable,then the mean curvature is a constant.As an application,we find some types of biharmonic hypersurfaces of N_(p)^(6)(c)are minimal.展开更多
AIM:To investigate the efficacy and safety of 90°inferonasal sectoral goniotomy with an micro-vitreoretinal(MVR)blade in patients with mild-to-moderate primary open-angle glaucoma(POAG)and pseudoexfoliation glauc...AIM:To investigate the efficacy and safety of 90°inferonasal sectoral goniotomy with an micro-vitreoretinal(MVR)blade in patients with mild-to-moderate primary open-angle glaucoma(POAG)and pseudoexfoliation glaucoma(PEXG).METHODS:This retrospective study included data from 60 patients(60 eyes)who underwent stand-alone goniotomy or goniotomy with phacoemulsification between August 2021 and January 2023,and 45 eyes underwent goniotomy combined with phacoemulsification,and 15 eyes underwent goniotomy as a stand-alone procedure.Postoperatively,intraocular pressure(IOP)and the number of medications were collected at 1,3,6,and 12 mo.The side effects of surgery were recorded 1 d,1 wk,and 1,3,6,and 12 mo postoperatively.The primary outcomes were a reduction in IOP of at least 20%from baseline and a decrease in the number of antiglaucomatous medications in 1 a postoperatively.The secondary outcome was surgical success,defined as an IOP<18 mmHg with(qualified)or without(complete)antiglaucomatous medication at 1 a postoperatively.RESULTS:At the end of 1 a,78%of patients achieved both a>20%reduction in IOP and a reduction in the number of medications used.Overall success was achieved in 63%of patients.Microhyphaema was the most common complication,none of the patients experienced a complication requiring surgical intervention.CONCLUSION:Sectoral inferonasal goniotomy with an MVR blade significantly reduced IOP and the number of medications required in patients with POAG and PEXG,and 1-year follow-up after goniotomy showed that the need for filtering surgery was either eliminated or delayed in a significant number of patients.展开更多
Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves ...Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves targeting superficial tumors in patients with macronodular cirrhosis and an irregular liver surface.In a minimally invasive setting,the lack of tactile feedback on the hepatic surface makes detecting subcapsular HCC with ultrasound alone challenging.ICG fusion images can mimic the tactile feedback of the hand and act as an ultrasound booster.ICG fluorescence can be used to evaluate tumor residues after minimally invasive thermal ablation.ICG fluorescence imaging can also be used to identify the grade of HCC early on and evaluate the microinvasive component.展开更多
BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparosc...BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.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
Recombinant tissue plasminogen activator is commonly used for hematoma evacuation in minimally invasive surgery following intracerebral hemorrhage.However,during minimally invasive surgery,recombinant tissue plasminog...Recombinant tissue plasminogen activator is commonly used for hematoma evacuation in minimally invasive surgery following intracerebral hemorrhage.However,during minimally invasive surgery,recombinant tissue plasminogen activator may come into contact with brain tissue.Therefore,a thorough assessment of its safety is required.In this study,we established a mouse model of intracerebral hemorrhage induced by type VII collagenase.We observed that the administration of recombinant tissue plasminogen activator without hematoma aspiration significantly improved the neurological function of mice with intracerebral hemorrhage,reduced pathological damage,and lowered the levels of apoptosis and autophagy in the tissue surrounding the hematoma.In an in vitro model of intracerebral hemorrhage using primary cortical neurons induced by hemin,the administration of recombinant tissue plasminogen activator suppressed neuronal apoptosis,autophagy,and endoplasmic reticulum stress.Transcriptome sequencing analysis revealed that recombinant tissue plasminogen activator upregulated the phosphoinositide 3-kinase/RAC-alpha serine/threonine-protein kinase/mammalian target of rapamycin pathway in neurons.Moreover,the phosphoinositide 3-kinase inhibitor LY294002 abrogated the neuroprotective effects of recombinant tissue plasminogen activator in inhibiting excessive apoptosis,autophagy,and endoplasmic reticulum stress.Furthermore,to specify the domain of recombinant tissue plasminogen activator responsible for its neuroprotective effects,various inhibitors were used to target distinct domains.It has been revealed that the epidermal growth factor receptor inhibitor AG-1478 reversed the effect of recombinant tissue plasminogen activator on the phosphoinositide 3-kinase/RAC-alpha serine/threonineprotein kinase/mammalian target of rapamycin pathway.These findings suggest that recombinant tissue plasminogen activator exerts a direct neuroprotective effect on neurons following intracerebral hemorrhage,possibly through activation of the phosphoinositide 3-kinase/RAC-alpha serine/threonine-protein kinase/mammalian target of rapamycin pathway.展开更多
背景:腰椎退行性疾病是一种中老年人常见疾病,临床表现主要为腰背部疼痛和下肢功能障碍。传统上使用腰椎融合联合双侧椎弓根螺钉固定进行外科干预,但存在创伤大、并发症多等问题。而腰椎融合联合单侧椎弓根螺钉固定是一种新兴的微创治...背景:腰椎退行性疾病是一种中老年人常见疾病,临床表现主要为腰背部疼痛和下肢功能障碍。传统上使用腰椎融合联合双侧椎弓根螺钉固定进行外科干预,但存在创伤大、并发症多等问题。而腰椎融合联合单侧椎弓根螺钉固定是一种新兴的微创治疗方式,具有较小的创伤和较低的并发症风险,已逐渐成为腰椎退行性疾病治疗的新选择。目的:探讨腰椎融合联合单侧椎弓根螺钉固定治疗腰椎退行性疾病的效果及优势。方法:通过检索中国知网和PubMed数据库2010年1月至2025年1月发表的相关文献,总结腰椎融合联合单侧椎弓根螺钉固定的临床研究及生物力学特点,以“腰椎融合术,单侧固定,双侧固定,生物力学,腰椎退行性疾病”为中文检索词,以“lumbar fusion,unilateral fixation,bilateral fixation,biomechanics,degenerative disease of the lumbar spine”为英文检索词,最终纳入70篇文献进行综述。结果与结论:①腰椎融合联合单侧椎弓根螺钉固定能有效减少手术创伤和术中失血量,提供与双侧椎弓根螺钉固定相似的生物力学稳定性,并降低邻近节段退变的风险;②单侧椎弓根螺钉固定在单节段及双节段腰椎退行性疾病治疗中已获得广泛认可,但在多节段腰椎退行性疾病中的应用效果仍需进一步研究;③腰椎融合联合单侧椎弓根螺钉固定为腰椎退行性疾病治疗提供了微创、安全的选择,未来需要更多高质量的研究验证其在复杂病例中的应用和长期疗效,进一步优化临床应用。展开更多
目的探讨微创甲状腺手术对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者术后甲状旁腺功能恢复的影响,明确恢复时间及其相关影响因素。方法采用队列研究,选取2023年1月至2024年1月在新乡医学院第一附属医院接受手术治疗的110例...目的探讨微创甲状腺手术对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者术后甲状旁腺功能恢复的影响,明确恢复时间及其相关影响因素。方法采用队列研究,选取2023年1月至2024年1月在新乡医学院第一附属医院接受手术治疗的110例PTC患者,分为微创手术组(55例)和传统开放手术组(55例)。收集术前甲状腺及甲状旁腺功能指标、术中甲状旁腺保护情况、手术时间、术后血清钙和甲状旁腺激素(parathyroid hormone,PTH)水平、术后恢复时间、低钙血症发生率、住院时间和术后疼痛评分。通过Cox回归模型分析影响恢复的因素,并对两组术后指标进行比较。结果微创手术组的甲状旁腺功能恢复时间显著短于传统组[10(8~12)d vs 17(15~21)d,P<0.001]。术后24和72 h,微创组的血清钙及PTH水平均显著高于传统组(P<0.001),低钙血症发生率明显低于传统组(15.8%vs 32.5%,P=0.005)。Cox回归分析显示,手术方式(HR=0.55,95%CI:0.33~0.91,P=0.021)、甲状旁腺保护(HR=0.58,95%CI:0.35~0.95,P=0.037)、术后早期血清钙(HR=1.32,95%CI:1.10~1.60,P=0.002)及手术时间(HR=1.12,95%CI:1.05~1.20,P=0.001)为独立影响因素。此外,微创组的住院时间(5.2 d vs 7.8 d,P<0.001)和术后疼痛评分(第1 d:2.3 vs 3.7,P<0.001;第3 d:1.5 vs 2.8,P<0.001)均显著低于传统组。结论微创甲状腺手术在甲状腺乳头状癌患者的甲状旁腺功能恢复中具有显著优势,能够缩短恢复时间,减少低钙血症发生率,降低住院时间和术后疼痛。手术方式及甲状旁腺保护是恢复时间的关键因素。展开更多
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.
基金Suppotred by Tianjin Key Medical Discipline Construction Project(No.TJYXZDXK-3-004A-2).
文摘AIM:To present an overview of the research on global glaucoma treatment in the last decade in terms of publication year,journals,countries/regions,organizations,references,and keywords,to investigate the current research international trends and hot topics in this area.METHODS:Bibliometric analysis was conducted on 9128 articles in the Web of Science Core Collection(WoSCC;Clarivate)database.Quantitative and qualitative analysis was employed using VOSviewer(v1.6.18),Pajek(v1.0.0.0),and CiteSpace(v6.1.R2)software.RESULTS:The 9128 papers relating to glaucoma treatment were published from April 2013 to April 2023,of which 7482 articles(82%)were original research articles and 1464(18%)were review articles.The United States(2867)and Johns Hopkins University(166)were the most productive country and institution,respectively,but the University College London had the highest h-index(54).The Journal of Glaucoma was the most productive and Ophthalmology had the highest h-index compared with other journals.The Keywords of interest included treatment surgery,cyclophotocoagulation,minimally invasive glaucoma surgery(MIGS),trabeculectomy,baerveldt,epidemiology,medication adherence,nanoparticle,optical coherence tomography(OCT),gene therapy,and artificial intelligence(AI).Glaucoma surgery appeared as a current research hotspot through the analysis of keywords.CONCLUSION:This study provides insights into the research trends and potential research hotspots in the treatment of glaucoma.This will help researchers to evaluate research policies and to promote international cooperation.
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.
文摘BACKGROUND Robotic assistance is increasingly used for donor and recipient hepatectomy in liver transplantation,yet existing evidence is fragmented and variably indirect.AIM To evaluate clinical outcomes,surgical performance,and economic effects of robotic-assisted donor and recipient hepatectomy in the transplant pathway.METHODS Following Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 and a priori registration,systematic reviews were included with or without meta-analysis.Four databases were searched through July 2025.Methodological quality was appraised with a measurement tool to assess systematic reviews(AMSTAR 2),and certainty was graded with grading of recommendations assessment,development and evaluation(GRADE).Evidence overlap was calculated via a citation-matrix-based corrected covered area(CCA).Effect sizes were prespecified as risk ratios(RR)for dichotomous outcomes and mean differences for continuous outcomes.RESULTS Five reviews met the inclusion criteria,four with meta-analyses and one consensus review used only for context.Donor(direct)findings were more favorable for robotics in terms of estimated blood loss(≈-117 mL)and length of stay(≈-0.6 days),although with longer operative time(≈+105 minutes).Absolute risks for donor complications were not estimable from ratio-only data.Recipient(indirect)meta-analysis indicated robotics to be favorable in terms of conversion(RR≈0.41)and severe morbidity(RR≈0.81),with a trend toward lower overall morbidity(RR≈0.92)and no difference in 30-day mortality.Differences in length of stay and operative time were small and heterogeneous.Economic evidence(indirect,network meta-analysis)suggested higher procedural costs for robotic vs laparoscopic intervention,but lower hospitalization costs vs open intervention,with laparoscopy the least expensive overall.AMSTAR 2 ratings were moderate-to-high across the reviews,GRADE certainty was low for key donor continuous outcomes,and low-to-moderate for recipient and economic outcomes.Overlap was slight(graded-corpus CCA=0.0%;including a contextual non-transplant review increased CCA to≈1.25%).CONCLUSION Robotic donor hepatectomy confers perioperative advantages at the cost of longer operative time.Recipient and economic findings are indirect and considered hypothesis-generating.Transplant-specific,prospective comparisons using a minimum standardized dataset and uniform outcome definitions are needed to resolve remaining uncertainties and to clarify the cost-utility correlation.
基金Supported by National Natural Science Foundation of China(12161078)Foundation for Innovative Fundamental Research Group Project of Gansu Province(24JRRA778)Project of Northwest Normal University(20240010)。
文摘In this paper,we studyλ-biharmonic hypersurfaces M_(r)^(5) of 6-dimensional pseudo Riemannian space form N_(p)^(6)(c)with the indexs 0≤p≤6,r=p−1 or p,and constant curvature c.It was proved that if the shape operator of M_(r)^(5) is diagonalizable,then the mean curvature is a constant.As an application,we find some types of biharmonic hypersurfaces of N_(p)^(6)(c)are minimal.
文摘AIM:To investigate the efficacy and safety of 90°inferonasal sectoral goniotomy with an micro-vitreoretinal(MVR)blade in patients with mild-to-moderate primary open-angle glaucoma(POAG)and pseudoexfoliation glaucoma(PEXG).METHODS:This retrospective study included data from 60 patients(60 eyes)who underwent stand-alone goniotomy or goniotomy with phacoemulsification between August 2021 and January 2023,and 45 eyes underwent goniotomy combined with phacoemulsification,and 15 eyes underwent goniotomy as a stand-alone procedure.Postoperatively,intraocular pressure(IOP)and the number of medications were collected at 1,3,6,and 12 mo.The side effects of surgery were recorded 1 d,1 wk,and 1,3,6,and 12 mo postoperatively.The primary outcomes were a reduction in IOP of at least 20%from baseline and a decrease in the number of antiglaucomatous medications in 1 a postoperatively.The secondary outcome was surgical success,defined as an IOP<18 mmHg with(qualified)or without(complete)antiglaucomatous medication at 1 a postoperatively.RESULTS:At the end of 1 a,78%of patients achieved both a>20%reduction in IOP and a reduction in the number of medications used.Overall success was achieved in 63%of patients.Microhyphaema was the most common complication,none of the patients experienced a complication requiring surgical intervention.CONCLUSION:Sectoral inferonasal goniotomy with an MVR blade significantly reduced IOP and the number of medications required in patients with POAG and PEXG,and 1-year follow-up after goniotomy showed that the need for filtering surgery was either eliminated or delayed in a significant number of patients.
文摘Over the past ten years,numerous papers have been published on the use of indocyanine green(ICG)fluorescence in liver surgery for hepatocellular carcinoma(HCC).There are many different applications.The first involves targeting superficial tumors in patients with macronodular cirrhosis and an irregular liver surface.In a minimally invasive setting,the lack of tactile feedback on the hepatic surface makes detecting subcapsular HCC with ultrasound alone challenging.ICG fusion images can mimic the tactile feedback of the hand and act as an ultrasound booster.ICG fluorescence can be used to evaluate tumor residues after minimally invasive thermal ablation.ICG fluorescence imaging can also be used to identify the grade of HCC early on and evaluate the microinvasive component.
文摘BACKGROUND Living donor kidney transplantation is the optimal method of long-term renal replacement therapy.Minimally invasive donor nephrectomy techniques,such as robot-assisted(RALDN)and hand-assisted(HALDN)laparoscopic procedures,are well-established in high-income countries and are being increasingly adopted worldwide.Nevertheless,no studies have reported surgical outcomes of RALDN donor nephrectomy from a United Kingdom center to date.AIM To compare surgical outcomes between RALDN and HALDN laparoscopic donor nephrectomy in a United Kingdom high-volume living kidney donor transplant program.METHODS A case-control matching analysis was performed based on the following parameters:Sex,age,body mass index,procedure laterality,number of renal arteries,and previous abdominal surgeries.Key surgical outcomes,including primary warm ischemia time,operative duration,and post-operative recovery,were evaluated.RESULTS In this cohort of 140 living donors(70 RALDN vs 70 HALDN),donor and recipient outcomes were equivalent across key metrics:Pain scores,overall complication rates,readmissions,reoperations,and creatinine levels at 30 days and 1 year.Recipient long-term renal function did not differ between groups.Operative time for RALDN decreased significantly over the study period,indicating progressive improvement along the learning curve.Although RALDN was associated with a modestly longer mean warm ischaemia time(3.53 minutes vs 2.76 minutes,P<0.001)and extended hospital stay(4.21 days vs 3.17 days,P<0.001),these did not translate into any disadvantage in clinical outcomes.CONCLUSION In this first United Kingdom comparative cohort,RALDN demonstrated excellent safety and efficacy,even in the early phase of our programme,matching the outcomes of the well-established,gold-standard HALDN approach.Moreover,the pronounced learning-curve trajectory suggests considerable potential for further improvements in robotic surgical outcomes as the programme matures.
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.
基金supported by the National Natural Science Foundation of China,Nos.92148206,82071330(both to ZT)a grant from the Major Program of Hubei Province,No.2023BAA005(to ZT)+1 种基金a grant from the Key Research and Discovery Program of Hubei Province,No.2021BCA109(to ZT)the Research Foundation of Tongji Hospital,No.2022B37(to PZ)。
文摘Recombinant tissue plasminogen activator is commonly used for hematoma evacuation in minimally invasive surgery following intracerebral hemorrhage.However,during minimally invasive surgery,recombinant tissue plasminogen activator may come into contact with brain tissue.Therefore,a thorough assessment of its safety is required.In this study,we established a mouse model of intracerebral hemorrhage induced by type VII collagenase.We observed that the administration of recombinant tissue plasminogen activator without hematoma aspiration significantly improved the neurological function of mice with intracerebral hemorrhage,reduced pathological damage,and lowered the levels of apoptosis and autophagy in the tissue surrounding the hematoma.In an in vitro model of intracerebral hemorrhage using primary cortical neurons induced by hemin,the administration of recombinant tissue plasminogen activator suppressed neuronal apoptosis,autophagy,and endoplasmic reticulum stress.Transcriptome sequencing analysis revealed that recombinant tissue plasminogen activator upregulated the phosphoinositide 3-kinase/RAC-alpha serine/threonine-protein kinase/mammalian target of rapamycin pathway in neurons.Moreover,the phosphoinositide 3-kinase inhibitor LY294002 abrogated the neuroprotective effects of recombinant tissue plasminogen activator in inhibiting excessive apoptosis,autophagy,and endoplasmic reticulum stress.Furthermore,to specify the domain of recombinant tissue plasminogen activator responsible for its neuroprotective effects,various inhibitors were used to target distinct domains.It has been revealed that the epidermal growth factor receptor inhibitor AG-1478 reversed the effect of recombinant tissue plasminogen activator on the phosphoinositide 3-kinase/RAC-alpha serine/threonineprotein kinase/mammalian target of rapamycin pathway.These findings suggest that recombinant tissue plasminogen activator exerts a direct neuroprotective effect on neurons following intracerebral hemorrhage,possibly through activation of the phosphoinositide 3-kinase/RAC-alpha serine/threonine-protein kinase/mammalian target of rapamycin pathway.
文摘背景:腰椎退行性疾病是一种中老年人常见疾病,临床表现主要为腰背部疼痛和下肢功能障碍。传统上使用腰椎融合联合双侧椎弓根螺钉固定进行外科干预,但存在创伤大、并发症多等问题。而腰椎融合联合单侧椎弓根螺钉固定是一种新兴的微创治疗方式,具有较小的创伤和较低的并发症风险,已逐渐成为腰椎退行性疾病治疗的新选择。目的:探讨腰椎融合联合单侧椎弓根螺钉固定治疗腰椎退行性疾病的效果及优势。方法:通过检索中国知网和PubMed数据库2010年1月至2025年1月发表的相关文献,总结腰椎融合联合单侧椎弓根螺钉固定的临床研究及生物力学特点,以“腰椎融合术,单侧固定,双侧固定,生物力学,腰椎退行性疾病”为中文检索词,以“lumbar fusion,unilateral fixation,bilateral fixation,biomechanics,degenerative disease of the lumbar spine”为英文检索词,最终纳入70篇文献进行综述。结果与结论:①腰椎融合联合单侧椎弓根螺钉固定能有效减少手术创伤和术中失血量,提供与双侧椎弓根螺钉固定相似的生物力学稳定性,并降低邻近节段退变的风险;②单侧椎弓根螺钉固定在单节段及双节段腰椎退行性疾病治疗中已获得广泛认可,但在多节段腰椎退行性疾病中的应用效果仍需进一步研究;③腰椎融合联合单侧椎弓根螺钉固定为腰椎退行性疾病治疗提供了微创、安全的选择,未来需要更多高质量的研究验证其在复杂病例中的应用和长期疗效,进一步优化临床应用。
文摘目的探讨微创甲状腺手术对甲状腺乳头状癌(papillary thyroid carcinoma,PTC)患者术后甲状旁腺功能恢复的影响,明确恢复时间及其相关影响因素。方法采用队列研究,选取2023年1月至2024年1月在新乡医学院第一附属医院接受手术治疗的110例PTC患者,分为微创手术组(55例)和传统开放手术组(55例)。收集术前甲状腺及甲状旁腺功能指标、术中甲状旁腺保护情况、手术时间、术后血清钙和甲状旁腺激素(parathyroid hormone,PTH)水平、术后恢复时间、低钙血症发生率、住院时间和术后疼痛评分。通过Cox回归模型分析影响恢复的因素,并对两组术后指标进行比较。结果微创手术组的甲状旁腺功能恢复时间显著短于传统组[10(8~12)d vs 17(15~21)d,P<0.001]。术后24和72 h,微创组的血清钙及PTH水平均显著高于传统组(P<0.001),低钙血症发生率明显低于传统组(15.8%vs 32.5%,P=0.005)。Cox回归分析显示,手术方式(HR=0.55,95%CI:0.33~0.91,P=0.021)、甲状旁腺保护(HR=0.58,95%CI:0.35~0.95,P=0.037)、术后早期血清钙(HR=1.32,95%CI:1.10~1.60,P=0.002)及手术时间(HR=1.12,95%CI:1.05~1.20,P=0.001)为独立影响因素。此外,微创组的住院时间(5.2 d vs 7.8 d,P<0.001)和术后疼痛评分(第1 d:2.3 vs 3.7,P<0.001;第3 d:1.5 vs 2.8,P<0.001)均显著低于传统组。结论微创甲状腺手术在甲状腺乳头状癌患者的甲状旁腺功能恢复中具有显著优势,能够缩短恢复时间,减少低钙血症发生率,降低住院时间和术后疼痛。手术方式及甲状旁腺保护是恢复时间的关键因素。
