Single-incision laparoscopic surgery(SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecyste...Single-incision laparoscopic surgery(SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecystectomy(SILC) has been the most frequently studied SILS to date. Hundreds of studies on SILC have failed to present conclusive results. Most randomized controlled trials(RCTs) have been small in scale and have been conducted under ideal operative conditions. The role of SILC in complicated scenarios remains uncertain. As common bile duct exploration(CBDE) methods have been used for more than one hundred years, laparoscopic CBDE(LCBDE) has emerged as an effective, demanding, and infrequent technique employed during the laparoscopic era. Likewise, laparoscopic biliary-enteric anastomosis is difficult to carry out, with only a few studies have been published on the approach. The application of SILS to CBDE and biliary-enteric anastomosis is extremely rare, and such innovative procedures are only carried out by a number of specialized groups across the globe. Herein we present a thorough and detailed analysis of SILC in terms of operative techniques, training and learning curves, safety and efficacy levels, recovery trends, and costs by reviewing RCTs conducted over the past three years and two recently updated meta-analyses. All existing literature on single-incision LCBDE and singleincision laparoscopic hepaticojejunostomy has been reviewed to describe these two demanding techniques.展开更多
This paper presents a single-site positioning method based on the joint estimation of propagation time-of-arrival(TOA) and direction-of-arrival(DOA), with the assist of virtual stations in the typical non-line-of-sigh...This paper presents a single-site positioning method based on the joint estimation of propagation time-of-arrival(TOA) and direction-of-arrival(DOA), with the assist of virtual stations in the typical non-line-of-sight(NLOS) environment. Consider the influence of multipath noise on the positioning performance, the proposed method firstly presents a modified high-resolution estimation technique called Multipath noise Limiting Matrix Pencil(MLMP) algorithm to achieve the TOA/DOA estimations, in which the matrix pencil and matrix enhancement process are implemented to deal with the measurements from the uniform linear array(ULA) receiver. Meanwhile, the subspace dimension estimation is improved via an adaptive threshold, for enhancing the performance of high-resolution techniques in low signal-noise-ration(SNR) situation. Next the proposed method generates virtual stations utilizing the known floor plan of surrounding reflectors, and adopts a weighted Least Square(WLS) position estimator to calculate the required position, combining the TOA/DOA estimations with the location of virtual stations. Simulations are conducted to evaluate the proposed method under NLOSconditions, and the results show that comparing with the multipath fingerprinting scheme, the proposed method has better performance in various simulation scenarios.展开更多
The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy （LESSV） and conventional laparoscopic varicocelectomy. The candidate stud...The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy （LESSV） and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design （RCT and non-RCT）. The odds ratio （OR） or standardized mean difference （SMD） and their 95% confidence intervals （95% CIs） were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work （overall： SMD = -1.454, 95% Ch -2.502m0.405, P= 0.007; non-RCT： SMD = -2.906, 95% Ch -3.796-2.017, P= 0.000; and RCT： SMD = -0.841, 95% Ch -1.393-0.289, P = 0.003） and less pain experience at 3 h or 6 h （SMD = -0.447, 95% Ch -0.754-0.139, P = 0.004）, day 1 （SMD = -0.477, 95% Ch -0.905-0.05, P = 0.029）, and day 2 （SMD = -0.612, 95% Ch -1.099-0.125, P= 0.014） postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect （improvement of semen quality and scrotal pain relief）, and complications （hydrocele and recurrence） yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.展开更多
Objective:To assess the feasibility of single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy(spRALP)and discuss its surgical technique.Methods:A 60-year-old male was admitted with an elevated...Objective:To assess the feasibility of single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy(spRALP)and discuss its surgical technique.Methods:A 60-year-old male was admitted with an elevated prostate-specific antigen(PSA)level of 13.89 ng/mL and confirmed with prostate cancer on biopsy showing three of 22 positive cores with a Gleason score of 3þ4=7.Multiparametric magnetic resonance(MR)and bone scintigraphy showed organ-confined disease.spRALP was performed using da Vinci Si HD surgical system,with access of a quadri-channel laparoscopic port placed supraumbilically.Two drainage tubes were placed before wound closure.The surgical procedure was largely in consistence with a conventional robotic-assisted laparoscopic radical prostatectomy.Results:The surgery was successfully carried out with a duration of 152 min and an estimated blood loss of 100 mL.The patient was discharged on postoperative Day 4 after removal of both pelvic drainage tubes.Foley catheter was removed on postoperative Day 14.No major complications were encountered.Postoperative pathology showed a Gleason score of 3þ4=7 with no extraprostatic extension and negative surgical margins.Conclusion:Single-port robotic prostatectomy is feasible using the currently available robotic instruments in most Chinese robotic urological centers.Meticulous preoperative planning and careful patient selection are mandatory.Further studies concerning perioperative complications and pentafecta outcome compared with the conventional multi-port robotic prostatectomy is required.展开更多
The key challenge for scalable production of hydrogen from water lies in the rational design and preparation of high-performance and earth-abundant electrocatalysts to replace precious metal Pt and IrO_(2) for hydroge...The key challenge for scalable production of hydrogen from water lies in the rational design and preparation of high-performance and earth-abundant electrocatalysts to replace precious metal Pt and IrO_(2) for hydrogen evolution reaction(HER)and oxygen evolution reaction(OER).Although atomic M-N-C materials have been extensively studied in heterogeneous catalysis field,the insufficient antioxidant capacity of carbonous substrates hinders their practical application in OER.Developing highly active and stable OER electrocatalysts is the key for electrochemical water splitting.This review presents feasible design strategies for fabricating carbon-free single-site catalysts and their applications in HER/OER and overall water splitting.The constitutive relationships between structure,composition,and catalytic performance for HER and OER are detailly discussed,providing ponderable insights into rationally constructing high-performance HER and OER electrocatalysts.The perspectives on the challenges and future research orientations in single-site catalysts for electrochemical water splitting are suggested.展开更多
文摘Single-incision laparoscopic surgery(SILS), or laparoendoscopic single-site surgery, has been employed in various fields to minimize traumatic effects over the last two decades. Single-incision laparoscopic cholecystectomy(SILC) has been the most frequently studied SILS to date. Hundreds of studies on SILC have failed to present conclusive results. Most randomized controlled trials(RCTs) have been small in scale and have been conducted under ideal operative conditions. The role of SILC in complicated scenarios remains uncertain. As common bile duct exploration(CBDE) methods have been used for more than one hundred years, laparoscopic CBDE(LCBDE) has emerged as an effective, demanding, and infrequent technique employed during the laparoscopic era. Likewise, laparoscopic biliary-enteric anastomosis is difficult to carry out, with only a few studies have been published on the approach. The application of SILS to CBDE and biliary-enteric anastomosis is extremely rare, and such innovative procedures are only carried out by a number of specialized groups across the globe. Herein we present a thorough and detailed analysis of SILC in terms of operative techniques, training and learning curves, safety and efficacy levels, recovery trends, and costs by reviewing RCTs conducted over the past three years and two recently updated meta-analyses. All existing literature on single-incision LCBDE and singleincision laparoscopic hepaticojejunostomy has been reviewed to describe these two demanding techniques.
基金supported in part by the National Natural Science Foundation of China under Grants numbers 61471164, 61601122, 61741102 and 61571128
文摘This paper presents a single-site positioning method based on the joint estimation of propagation time-of-arrival(TOA) and direction-of-arrival(DOA), with the assist of virtual stations in the typical non-line-of-sight(NLOS) environment. Consider the influence of multipath noise on the positioning performance, the proposed method firstly presents a modified high-resolution estimation technique called Multipath noise Limiting Matrix Pencil(MLMP) algorithm to achieve the TOA/DOA estimations, in which the matrix pencil and matrix enhancement process are implemented to deal with the measurements from the uniform linear array(ULA) receiver. Meanwhile, the subspace dimension estimation is improved via an adaptive threshold, for enhancing the performance of high-resolution techniques in low signal-noise-ration(SNR) situation. Next the proposed method generates virtual stations utilizing the known floor plan of surrounding reflectors, and adopts a weighted Least Square(WLS) position estimator to calculate the required position, combining the TOA/DOA estimations with the location of virtual stations. Simulations are conducted to evaluate the proposed method under NLOSconditions, and the results show that comparing with the multipath fingerprinting scheme, the proposed method has better performance in various simulation scenarios.
文摘The present meta-analysis was conducted to compare the clinical effect and patient experience of laparoendoscopic single-site varicocelectomy （LESSV） and conventional laparoscopic varicocelectomy. The candidate studies were included after literature search of database Cochrane Library, PubMed, EMBASE, and MEDLINE. Related information on essential data and outcome measures was extracted from the eligible studies by two independent authors, and a meta-analysis was conducted using STATA 12.0 software. Subgroup analyses were conducted by study design （RCT and non-RCT）. The odds ratio （OR） or standardized mean difference （SMD） and their 95% confidence intervals （95% CIs） were used to estimate the outcome measures. Seven articles were included in our meta-analysis. The results indicated that patient who had undergone LESSV had a shorter duration of back to work （overall： SMD = -1.454, 95% Ch -2.502m0.405, P= 0.007; non-RCT： SMD = -2.906, 95% Ch -3.796-2.017, P= 0.000; and RCT： SMD = -0.841, 95% Ch -1.393-0.289, P = 0.003） and less pain experience at 3 h or 6 h （SMD = -0.447, 95% Ch -0.754-0.139, P = 0.004）, day 1 （SMD = -0.477, 95% Ch -0.905-0.05, P = 0.029）, and day 2 （SMD = -0.612, 95% Ch -1.099-0.125, P= 0.014） postoperatively based on RCT studies. However, the meta-analyses based on operation time, clinical effect （improvement of semen quality and scrotal pain relief）, and complications （hydrocele and recurrence） yielded nonsignificant results. In conclusion, LESSV had a rapid recovery and less pain experience over conventional laparoscopic varicocelectomy. However, there was no statistically significant difference between the two varicocelectomy techniques in terms of the clinical effect and the incidence of hydrocele and varicocele recurrence. More high-quality studies are warranted for a comprehensive conclusion.
基金This study is supported by the Shanghai“Top Priority”Medical Center Project(No.2017ZZ01005)the National Natural Science Foundation of China(Youth Grant,No.81502198)the Shanghai Pujiang Talent Project(No.15PJD001).
文摘Objective:To assess the feasibility of single-port transperitoneal robotic-assisted laparoscopic radical prostatectomy(spRALP)and discuss its surgical technique.Methods:A 60-year-old male was admitted with an elevated prostate-specific antigen(PSA)level of 13.89 ng/mL and confirmed with prostate cancer on biopsy showing three of 22 positive cores with a Gleason score of 3þ4=7.Multiparametric magnetic resonance(MR)and bone scintigraphy showed organ-confined disease.spRALP was performed using da Vinci Si HD surgical system,with access of a quadri-channel laparoscopic port placed supraumbilically.Two drainage tubes were placed before wound closure.The surgical procedure was largely in consistence with a conventional robotic-assisted laparoscopic radical prostatectomy.Results:The surgery was successfully carried out with a duration of 152 min and an estimated blood loss of 100 mL.The patient was discharged on postoperative Day 4 after removal of both pelvic drainage tubes.Foley catheter was removed on postoperative Day 14.No major complications were encountered.Postoperative pathology showed a Gleason score of 3þ4=7 with no extraprostatic extension and negative surgical margins.Conclusion:Single-port robotic prostatectomy is feasible using the currently available robotic instruments in most Chinese robotic urological centers.Meticulous preoperative planning and careful patient selection are mandatory.Further studies concerning perioperative complications and pentafecta outcome compared with the conventional multi-port robotic prostatectomy is required.
基金supported by the National Natural Science Foundation of China(No.22075099)Natural Science Foundation of Jilin Province(No.20180101291JC).
文摘The key challenge for scalable production of hydrogen from water lies in the rational design and preparation of high-performance and earth-abundant electrocatalysts to replace precious metal Pt and IrO_(2) for hydrogen evolution reaction(HER)and oxygen evolution reaction(OER).Although atomic M-N-C materials have been extensively studied in heterogeneous catalysis field,the insufficient antioxidant capacity of carbonous substrates hinders their practical application in OER.Developing highly active and stable OER electrocatalysts is the key for electrochemical water splitting.This review presents feasible design strategies for fabricating carbon-free single-site catalysts and their applications in HER/OER and overall water splitting.The constitutive relationships between structure,composition,and catalytic performance for HER and OER are detailly discussed,providing ponderable insights into rationally constructing high-performance HER and OER electrocatalysts.The perspectives on the challenges and future research orientations in single-site catalysts for electrochemical water splitting are suggested.
