Outcomes following minimally invasive dorsal cheilectomy for hallux rigidus:A systematic review

BACKGROUND Cheilectomy of the 1^(st)metatarsophalangeal joint(MTPJ)is one of the most common procedures for the management of hallux rigidus.However,there is no consensus regarding outcomes following minimally invasive dorsal cheilectomy(MIDC)for the management of hallux rigidus.AIM To evaluate outcomes following MIDC for the management of hallux rigidus.METHODS During November 2023,the PubMed,EMBASE and Cochrane Library databases were systematically reviewed to identify clinical studies examining outcomes following MIDC for the management of hallux rigidus.RESULTS Six studies were included.In total,348 patients(370 feet)underwent MIDC for hallux rigidus at a weighted mean follow-up of 37.9±16.5 months.The distribution of patients by Coughlin and Shurna's classification was recorded in 4 studies as follows:Ⅰ(58 patients,27.1%),Ⅱ(112 patients,52.3%),Ⅲ(44 patients,20.6%).Three studies performed an additional 1^(st)MTPJ arthroscopy and debridement following MIDC.Retained intra-articular bone debris was observed in 100%of patients in 1 study.The weighted mean American orthopedic foot and ankle society score improved from a preoperative score of 68.9±3.2 to a postoperative score of 87.1.The complication rate was 8.4%,the most common of which was persistent joint pain and stiffness.Thirty-two failures(8.7%)were observed.Thirty-three secondary procedures(8.9%)were performed at a weighted mean time of 8.6±3.2 months following the index procedure.CONCLUSION This systematic review demonstrated improvements in subjective clinical outcomes together with a moderate complication rate following MIDC for the management of hallux rigidus at short-term follow-up.A moderate reoperation rate at short-term follow-up was recorded.The marked heterogeneity between included studies and paucity of high quality comparative studies limits the generation of any robust conclusions.

Beyond statistical significance:Embracing minimal clinically important difference for better patient care

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.

Multidimensional Multiplicative Large Sets in Totally Minimal Systems

In this paper,it is shown that for a residual set of points in a totally minimal system with finitely many commuting homeomorphisms,the set of return times to any non-empty open set contains a subset with positive multidimensional multiplicative upper Banach density,extending a previous result by Glasscock,Koutsogiannis and Richter.Meanwhile,we give some combinatorial properties of the sets with positive multidimensional multiplicative upper Banach density.

The impact of minimally invasive surgeries for the treatment of symptomatic benign prostatic hyperplasia on male sexual function： a systematic review

A systematic review of randomized controlled trials and cohort studies was conducted to evaluate data for the effects of minimally invasive procedures for treatment of symptomatic benign prostatic hyperplasia （BPH） on male sexual function. The studies searched were trials that enrolled men with symptomatic BPH who were treated with laser surgeries, transurethral microwave therapy （TUMT）, transurethral needle ablation of the prostate （TUNA）, transurethral ethanol ablation of the prostate （TEAP） and high-intensity frequency ultrasound （HIFU）, in comparison with traditional transurethral resection of the prostate （TURP） or sham operations. A total of 72 studies were identified, of which 33 met the inclusion criteria. Of the 33 studies, 21 were concerned with laser surgeries, six with TUMT, four with TUNA and two with TEAP containing information regarding male sexual function. No study is available regarding the effect of HIFU for BPH on male sexual function. Our analysis shows that minimally invasive surgeries for BPH have comparable effects to those of TURP on male erectile function. Collectively, less than 15.4% or 15.2% of patients will have either decrease or increase, respectively, of erectile function after laser procedures, TUMT and TUNA. As observed with TURP, a high incidence of ejaculatory dysfunction （EjD） is common after treatment of BPH with holmium, potassium-titanyl-phosphate and thulium laser therapies （〉 33.6%）. TUMT, TUNA and neodymium：yttrium aluminum garnet visual laser ablation or interstitial laser coagulation for BPH has less incidence of EjD, but these procedures are considered less effective for BPH treatment when compared with TURP.

Sensitivity and regionally proximal relation in minimal systems

A topological dynamical system is n-sensitive,if there is a positive constant such that in each non-empty open subset there are n distinct points whose iterates will be apart from the constant at least for a same moment.The properties of n-sensitivity in minimal systems are investigated.It turns out that a minimal system is n-sensitive if and only if the n-th regionally proximal relation Q_n contains a point whose coordinates are pairwise distinct.Moreover,the structure of a minimal system which is n-sensitive but not(n+1)-sensitive(n≥2)is determined.

Comparison of the modified Wiltse’s approach with spinal minimally invasive system and traditional approach for the therapy of thoracolumbar fracture

Thoracolumbar fractures are usually treated by open posterior pedicle screw fixation.However,this procedure involves massive paraspinal muscle stripping,inflicting surgical trauma,and prolonged X-ray exposure.In this study,we observed 127 patients with single-segment injury thoracolumbar fractures.Thirty-six patients were treated by the modified Wiltse’s paraspinal approach with minimally invasive channel system,while 91 patients were treated via traditional posterior approach.Operation time,intraoperative blood loss,intraoperative fluoroscopy frequency,screw placement accuracy,visual analogue scale score,and Cobb’s angle of two groups were compared.The X-ray exposure times were notably reduced(4.2±1.6) in the new approach group(P<0.05).The pedicle screw placement accuracy and Cobb’s angle after surgery were similar in the two groups.We conclude that modified Wiltse’s paraspinal approach w ith spinal minimally invasive channel system surgery can significantly reduce the X-ray exposure times and is an alternative therapy for the thoracolumbar fracture.

Innovative Design and Additive Manufacturing of Regenerative Cooling Thermal Protection System Based on the Triply Periodic Minimal Surface Porous Structure

The new regenerative cooling thermal protection system exhibits the multifunctional characteristics of load-carrying and heat exchange cooling,which are fundamental for the lightweight design and thermal protection of hypersonic vehicles.Triply periodic minimal surface(TPMS)is especially suitable for the structural design of the internal cavity of regenerative cooling structures owing to its excellent structural characteristics.In this study,test pieces were manufactured using Ti6Al4V lightweight material.We designed three types of porous test pieces,and the interior was filled with a TPMS lattice(Gyroid,Primitive,I-WP)with a porosity of 30%.All porous test pieces were manufactured via selective laser melting technology.A combination of experiments and finite element simulations were performed to study the selection of the internal cavity structure of the regenerative cooling thermal protection system.Hence,the relationship between the geometry and mechanical properties of a unit cell is established,and the deformation mechanism of the porous unit cell is clarified.Among the three types of porous test pieces,the weight of the test piece filled with the Gyroid unit cell was reduced by 8.21%,the average tensile strength was reduced by 17.7%compared to the solid test piece,while the average tensile strength of the Primitive and I-WP porous test pieces were decreased by 30.5%and 33.3%,respectively.Compared with the other two types of unit cells,Gyroid exhibited better mechanical conductivity characteristics.Its deformation process was characterised by stretching,shearing,and twisting,while the Primitive and I-WP unit cells underwent tensile deformation and tensile and shear deformation,respectively.The finite element predictions in the study agree well with the experimental results.The results can provide a basis for the design of regenerative cooling thermal protection system.

Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma:A systematic review

BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver cancer and is characterized by an aggressive behavior and a dismal prognosis.Radical surgical resection represents the only potentially curative treatment.Despite the increasing acceptance of laparoscopic liver resection for surgical treatment of malignant liver diseases,its use for ICC is not commonly performed.In fact,to achieve surgical free margins a major resection and/or vascular and/or biliary reconstructions is often needed,as well as an associated lymph node dissection.AIM To review and summarize the current evidences on the minimally invasive resection of ICC.METHODS A systematic review of the literature based on the criteria predetermined by the investigators was performed from the 1st of January 2009 up to the 1st of January2021 in 4 databases(PubMed,Scopus,Google Scholar,and Cochrane databases).All retrospective and prospective studies reporting on the comparative outcomes of open vs minimally invasive treatment of ICC were included.An evaluation of manuscripts quality was achieved using Methodological Index for Non-Randomized Studies criteria and Newcastle-Ottawa Scale.RESULTS After a systematic search 9 studies fulfilled the inclusion criteria.Among the all 3012 included patients,2450 were operated by an open approach and 562 by a minimally invasive(laparoscopic)approach.Baseline characteristics,tumor characteristics,surgical outcomes and oncological outcomes were collected and analyzed,highlighting values with a statistical significant difference between patients treated with open or laparoscopic approach.Shorter hospital stay and lower intraoperative blood losses were reported by some Authors in minimally invasive surgery,on the contrary,in the open group there was a higher number of lymphadenectomies and a higher percentage of major hepatectomies.CONCLUSION Minimally invasive resection of ICC has some short-term benefits and it is safe and feasible only in selected centers with a high experience in laparoscopic approach for liver surgery.Minimally invasive surgery,actually,was considered mainly in patients with a tumor with a diameter<5 cm,without invasion of main biliary duct or main vessel and no vascular or biliary reconstructions were planned.Further studies are needed to elucidate its impact on long term oncologic outcomes.

Generation of minimally persistent circle formation for a multi-agent system

In this paper, two methods of generating minimally persistent circle formation are presented. The proposed methods adopt a leader-follower strategy and all followers are firstly motivated to move into the leader＇s interaction range. Based on the information about relative angle and relative distance, two numbering schemes are proposed to generate minimally persistent circle formation. Distributed control laws are also designed to maintain the desired relative distance between agents. The distinctive features of the proposed methods are as follows. First, only 2n - 3 unilateral communication links for n agents are needed during the circle formation process and thus the communication complexity can be reduced. In addition, the formation topology is kept fixed for the whole motion and achieves a self-stability property. Finally, each follower keeps a regualr interval with its neighbors and the formation converges to a uniform circle formation. Simulation results are also provided to demonstrate the effectiveness of the proposed methods.

Perioperative outcomes in minimally invasive lumbar spine surgery: A systematic review

AIM: To compare minimally invasive(MIS) and open techniques for MIS lumbar laminectomy, direct lateral and transforaminal lumbar interbody fusion(TLIF) surgeries with respect to length of surgery, estimated blood loss(EBL), neurologic complications, perioperative transfusion, postoperative pain, postoperative narcotic use, and length of stay(LOS).METHODS: A systematic review of previously published studies accessible through Pub Med was performed. Only articles in English journals or published with English language translations were included. Level of evidence of the selected articles was assessed. Statistical data was calculated with analysis of variance with P < 0.05 considered statistically significant.RESULTS: A total of 11 pertinent laminectomy studies, 20 direct lateral studies, and 27 TLIF studies were found. For laminectomy, MIS techniques resulted in a significantly longer length of surgery(177.5 min vs 129.0 min, P = 0.04), shorter LOS(4.3 d vs 5.3 d, P = 0.01) and less perioperative pain(visual analog scale: 16 ± 17 vs 34 ± 31, P = 0.04). There is evidence of decreased narcotic use for MIS patients(postoperative intravenous morphine use: 9.3 mg vs 42.8 mg), however this difference is of unknown significance. Direct lateral approaches have insufficient comparative data to establish relative perioperative outcomes. MIS TLIF had superior EBL(352 mL vs 580 mL, P < 0.0001) and LOS(7.7 d vs 10.4 d, P < 0.0001) and limited data to suggest lower perioperative pain.CONCLUSION: Based on perioperative outcomes data, MIS approach is superior to open approach for TLIF. For laminectomy, MIS and open approaches can be chosen based on surgeon preference. For lateral approaches, there is insufficient evidence to find noninferior perioperative outcomes at this time.

Operation and Force Analysis of the Guide Wire in a Minimally Invasive Vascular Interventional Surgery Robot System

To develop a robot system for minimally invasive surgery is significant,however the existing minimally invasive surgery robots are not applicable in practical operations,due to their limited functioning and weaker perception.A novel wire feeder is proposed for minimally invasive vascular interventional surgery.It is used for assisting surgeons in delivering a guide wire,balloon and stenting into a specific lesion location.By contrasting those existing wire feeders,the motion methods for delivering and rotating the guide wire in blood vessel are described,and their mechanical realization is presented.A new resistant force detecting method is given in details.The change of the resistance force can help the operator feel the block or embolism existing in front of the guide wire.The driving torque for rotating the guide wire is developed at different positions.Using the CT reconstruction image and extracted vessel paths,the path equation of the blood vessel is obtained.Combining the shapes of the guide wire outside the blood vessel,the whole bending equation of the guide wire is obtained.That is a risk criterion in the delivering process.This process can make operations safer and man-machine interaction more reliable.A novel surgery robot for feeding guide wire is designed,and a risk criterion for the system is given.

Improvement of the minimal residual method for solving nonsymmetric linear systems

In this paper, the minimal residual （MRES） method for solving nonsymmetric equation systems was improved, the recurrence relation was deduced between the approximate solutions of the linear equation system Ax = b, and a more effective method was presented, which can reduce the operational count and the storage.

New direction for surgery:Super minimally invasive surgery

The top goal of modern medicine is treating disease without destroying organ structures and making patients as healthy as they were before their sickness.Minimally invasive surgery(MIS)has dominated the surgical realm because of its lesser invasiveness.However,changes in anatomical structures of the body and reconstruction of internal organs or different organs are common after traditional surgery or MIS,decreasing the quality of life of patients post-operation.Thus,I propose a new treatment mode,super MIS(SMIS),which is defined as“curing a disease or lesion which used to be treated by MIS while preserving the integrity of the organs”.In this study,I describe the origin,definition,operative channels,advantages,and future perspectives of SMIS.

Feasibility and safety of minimally invasive multivisceral resection for T4b rectal cancer:A 9-year review

BACKGROUND Colorectal cancer is the third most common cancer and the second highest cause of cancer-related mortality worldwide.About 5%-10%of patients are diagnosed with locally advanced rectal cancer(LARC)on presentation.For LARC invading into other structures(i.e.T4b),multivisceral resection(MVR)and/or pelvic ex-enteration(PE)remains the only potential curative surgical treatment.MVR and/or PE is a major and complex surgery with high post-operative morbidity.Minimally invasive surgery(MIS)has been shown to improve short-term post-operative outcomes in other gastrointestinal malignancies,but there is little evi-dence on its use in MVR,especially so for robotic MVR.This is a single-center retrospective cohort study from 1st January 2015 to 31st March 2023.Inclusion criteria were patients diagnosed with cT4b rectal cancer and underwent MVR,or stage 4 disease with resectable systemic metastases.Pa-tients who underwent curative MVR for locally recurrent rectal cancer,or me-tachronous rectal cancer were also included.Exclusion criteria were patients with systemic metastases with non-resectable disease.All patients planned for elective surgery were enrolled into the standard enhanced recovery after surgery pathway with standard peri-operative management for colorectal surgery.Complex sur-gery was defined based on technical difficulty of surgery(i.e.total PE,bladder-sparing prostatectomy,pelvic lymph node dissection or need for flap creation).Our primary outcomes were the margin status,and complication rates.Cate-gorical values were described as percentages and analysed by the chi-square test.Continuous variables were expressed as median(range)and analysed by Mann-Whitney U test.Cumulative overall survival(OS)and recurrence-free survival(RFS)were analysed using Kaplan-Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.Meier estimates with life table analysis.Log-rank test was performed to determine statistical significance between cumulative estimates.Statistical significance was defined as P<0.05.RESULTS A total of 46 patients were included in this study[open MVR(oMVR):12(26.1%),miMVR:36(73.9%)].Patients’American Society of Anesthesiologists score,body mass index and co-morbidities were comparable between oMVR and miMVR.There is an increasing trend towards robotic MVR from 2015 to 2023.MiMVR was associated with lower estimated blood loss(EBL)(median 450 vs 1200 mL,P=0.008),major morbidity(14.7%vs 50.0%,P=0.014),post-operative intra-abdominal collections(11.8%vs 50.0%,P=0.006),post-operative ileus(32.4%vs 66.7%,P=0.04)and surgical site infection(11.8%vs 50.0%,P=0.006)compared with oMVR.Length of stay was also shorter for miMVR compared with oMVR(median 10 vs 30 d,P=0.001).Oncological outcomes-R0 resection,recurrence,OS and RFS were comparable between miMVR and oMVR.There was no 30-d mortality.More patients underwent robotic compared with laparoscopic MVR for complex cases(robotic 57.1%vs laparoscopic 7.7%,P=0.004).The operating time was longer for robotic compared with laparoscopic MVR[robotic:602(400-900)min,laparoscopic:Median 455(275-675)min,P<0.001].Incidence of R0 resection was similar(laparoscopic:84.6%vs robotic:76.2%,P=0.555).Overall complication rates,major morbidity rates and 30-d readmission rates were similar between la-paroscopic and robotic MVR.Interestingly,3-year OS(robotic 83.1%vs 58.6%,P=0.008)and RFS(robotic 72.9%vs 34.3%,P=0.002)was superior for robotic compared with laparoscopic MVR.CONCLUSION MiMVR had lower post-operative complications compared to oMVR.Robotic MVR was also safe,with acceptable post-operative complication rates.Prospective studies should be conducted to compare short-term and long-term outcomes between robotic vs laparoscopic MVR.

MINIMAL PERIOD SYMMETRIC SOLUTIONS FOR SOME HAMILTONIAN SYSTEMS VIA THE NEHARI MANIFOLD METHOD

For a given T>0,we prove,under the global ARS-condition and using the Nehari manifold method,the existence of a T-periodic solution having the W-symmetry introduced in[21],for the hamiltonian system z+V'(z)=0,z∈R^N,N∈N^*.Moreover,such a solution is shown to have T as a minimal period without relaying to any index theory.A multiplicity result is also proved under the same condition.

Efficacy and safety of minimally invasive laparoscopic surgery under general anesthesia for ovarian cancer

BACKGROUND Ovarian cancer is one of the most common malignant tumors in female reproductive system in the world,and the choice of its treatment is very important for the survival rate and prognosis of patients.Traditional open surgery is the main treatment for ovarian cancer,but it has the disadvantages of big trauma and slow recovery.With the continuous development of minimally invasive technology,minimally invasive laparoscopic surgery under general anesthesia has been gradually applied to the treatment of ovarian cancer because of its advantages of less trauma and quick recovery.However,the efficacy and safety of minimally invasive laparoscopic surgery under general anesthesia in the treatment of ovarian cancer are still controversial.AIM To explore the efficacy and safety of general anesthesia minimally invasive surgery in the treatment of ovarian cancer.METHODS The clinical data of 90 patients with early ovarian cancer in our hospital were analyzed retrospectively.According to the different surgical treatment methods,patients were divided into study group and control group(45 cases in each group).The study group received minimally invasive laparoscopic surgery under general anesthesia for ovarian cancer,while the control group received traditional open surgery for ovarian cancer.The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire(EORTC QLQ-C30),clinical efficacy and safety of the two groups were compared.RESULTS The intraoperative blood loss,length of hospital stay,postoperative gas evacuation time,and postoperative EORTC QLQ-C30 score of the study group were significantly better than those of the control group(P<0.05).The incidence of postoperative complications in the study group was significantly lower than in the control group(P<0.05).The two groups had no significant differences in the preoperative adrenocorticotropic hormone(ACTH),androstenedione(AD),cortisol(Cor),cluster of differentiation 3 positive(CD3+),and cluster of differentiation 4 positive(CD4+)indexes(P>0.05).In contrast,postoperatively,the study group's ACTH,AD,and Cor indexes were lower,and the CD3+and CD4+indexes were higher than those in the control group(P<0.05).CONCLUSION Minimally invasive laparoscopic surgery under general anesthesia in patients with early ovarian cancer can significantly improve the efficacy and safety,improve the short-term prognosis and quality of life of patients,and is worth popularizing.

A constructive approach to minimal realization problem of 2D systems

Unlike in the 1D case, it is not always possible to find a minimal state-space realization for a 2D system except for some particular categories. The purpose of this paper is to explore a constructive approach to the minimal Roesser model realization problem for a class of 2D systems which does not belong to the clarified categories. As one of the main results, a constructive realization procedure is first proposed. Based on the proposed procedure, sufficient conditions and explicit construction for minimal realizations of the considered 2D systems are shown. In addition, possible variations and applications of the obtained results are discussed and illustrative examples are presented.

Optimum Maintenance Policy for a One-Shot System with Series Structure Considering Minimal Repair

One-shot systems such as missiles and extinguishers are placed in storage for a long time and used only once during their lives. Their reliability deteriorates with time even when they are in storage, and their failures are detected only through inspections for their characteristics. Thus, we need to decide an appropriate inspection policy for such systems. In this paper, we deal with a system comprising non-identical units in series, where only minimal repairs are performed when unit failures are detected by periodic inspections. The system is replaced and becomes “as good as new” when the nth failure of the system is detected. Our objective is to find the optimal inspection interval and number of failures before replacement that minimize the expected total system cost per unit of time.

GEOMETRIC FRAMEWORK AND MINIMAL REALIZATIONS OF NONLINEAR SYSTEMS ON FIBRE BUNDLE

The definition of nonlinear control sysms on fibre bundles proposed by Brockett and Willems is incomplete from the mathematical view geometric framework is proposed and a minimal realization theory is developed for nonlinear control systems on fibre bundles which is elaborated as a natural generalization of Sussmann's theory and differs essentially from Van der Schaft's approach. Limitations of realization theory given by Van der Schaft are also discussed.

Analysis of Stochastic Reliability Characteristics of a Repairable 2-out-of-3 System with Minimal Repair at Failure

In this paper, we study the reliability and availability characteristics of a repairable 2-out-of-3 system. Failure and repair times are assumed exponential. The explicit expressions of reliability and availability characteristics such as mean time to system failure (MTSF), steady-state availability, busy period and profit function are derived using Kolmogorov’s forward equations method. Various cases are analyzed graphically to investigate the impact of system parameters on MTSF, availability, busy period and profit function.