BACKGROUND Laparoscopic choledocholithotomy for a large impacted common bile duct(CBD)stone is a challenging procedure because of the technical difficulty and the possibility of postoperative complications,even in thi...BACKGROUND Laparoscopic choledocholithotomy for a large impacted common bile duct(CBD)stone is a challenging procedure because of the technical difficulty and the possibility of postoperative complications,even in this era of minimally invasive surgery.Herein,we present a case of large impacted CBD stones.CASE SUMMARY A 71-year-old man showed a distal CBD stone(45 mm×20 mm)and a middle CBD stone(20 mm×15 mm)on computed tomography.Endoscopic retrograde cholangiopancreatography failed due to the large size of the impacted stone and the presence of a large duodenal diverticulum.Laparoscopic choledocholithotomy was decided,and we used a near-infrared indocyanine green fluorescence scope to detect and expose the supraduodenal CBD more accurately.Then,the location,size,and shape of the stones were detected using a laparoscopic intraoperative ultrasound.The CBD was opened with a 2-cm-sized vertical incision.After irrigating several times,two CBD stones were removed with the Endo BabcockTM.T-tube insertion was done for postoperative cholangiography and delayed the removal of remnant sludge.The patient had no postoperative complications.CONCLUSION Laparoscopic choledocholithotomy by transcholedochal approach and transductal T-tube insertion is a safe and feasible option for large-sized impacted CBD stones.展开更多
BACKGROUND Liver cancer is a malignant tumor with a high incidence.At present,the most effective treatment is laparoscopic hepatectomy(LH).Indocyanine green fluorescence imaging(ICG-FI)has become an important tool in ...BACKGROUND Liver cancer is a malignant tumor with a high incidence.At present,the most effective treatment is laparoscopic hepatectomy(LH).Indocyanine green fluorescence imaging(ICG-FI)has become an important tool in LH,and the most common fluorescent types of tumors are total fluorescence,partial fluorescence,and rim fluorescence.CASE SUMMARY We presented four cases of LH guided by ICG-FI in which we also observed the fourth special fluorescent type.When the tumor or intrahepatic stone compresses the adjacent bile duct to cause local cholestasis,the liver segment or subsegment with obstructed bile drainage will show strong fluorescence.Complete removal of the lesion together with the fluorescent liver parenchyma may help reduce the risk of tumor or stone recurrence.CONCLUSION This type of partial fluorescence can indicate local biliary compression,and the resection method is related to bile drainage,which may be called functional anatomical hepatectomy and ensures radical resection of the lesion.展开更多
BACKGROUND In recent decades,significant advances have been made in protecting the parathyroid glands and recurrent laryngeal nerves during thyroidectomy.However,reliable and convenient technical means are still lacki...BACKGROUND In recent decades,significant advances have been made in protecting the parathyroid glands and recurrent laryngeal nerves during thyroidectomy.However,reliable and convenient technical means are still lacking.In this study,the reliability,safety and feasibility of near-infrared(NIR)laparoscopyassisted thyroid lobectomy with isthmectomy and prophylactic central lymph node dissection(CLND)were reported.CASE SUMMARY A 63-year-old female patient with a free previous medical history,was admitted to our department due to multiple thyroid nodules.Ultrasonic examination suggested diffuse thyroid changes and one thyroid nodule in the right upper lobe with the largest diameter of 1.5 cm adjacent to the trachea and Breast Imaging Reporting and Data System grade 4B.Imaging examination of the neck showed no obvious enlarged lymph nodes.Fine needle aspiration biopsy suggested a papillary thyroid carcinoma.Combined with thyroid function examination,the patient was diagnosed with papillary thyroid carcinoma and Hashimoto's thyroiditis.Considering the risk of invading the capsule and the patient's extreme anxiety,a right thyroid lobectomy with isthmectomy and prophylactic CLND was planned.No significant abnormalities were found during preoperative examinations,except for an increased thyroid stimulating hormone level.The patient underwent NIR laparoscopy-assisted thyroid lobectomy with isthmectomy and prophylactic CLND.During the operation,two right parathyroid glands(PGs)adjacent to the thyroid gland capsule and the right recurrent laryngeal nerve(RLN)were examined by indocyanine green(ICG)fluorescence using a NIR fluorescence camera,and the PGs and RLN were reliably preserved.Considering the ICG-positive PG,prophylactic CLND was performed.The postoperative parathyroid hormone level was in the normal range and no significant hypocalcemia symptoms were observed.CONCLUSION During NIR laparoscopy-assisted thyroidectomy,ICG fluorescence may aid PG identification and protection.展开更多
BACKGROUND Splenic artery aneurysm(SAA)is a rare vascular lesion conventionally treated by resection or interventional therapy.The surgical procedure usually involves splenectomy,and interventional therapy may cause p...BACKGROUND Splenic artery aneurysm(SAA)is a rare vascular lesion conventionally treated by resection or interventional therapy.The surgical procedure usually involves splenectomy,and interventional therapy may cause post-embolization syndromes.Preservation of the spleen and its function is rarely reported during the management of SAA.CASE SUMMARY We report a patient with an asymptomatic SAA(3.5 cm in diameter),which was en-bloc resected laparoscopically using indocyanine green(ICG)fluorescence imaging to preserve the spleen and its function.CONCLUSION ICG fluorescence imaging for spleen preservation in laparoscopic SAA resection is safe and may be beneficial in avoiding splenectomy and maintaining splenic function.展开更多
BACKGROUND Rectal prolapse in young women is rare.Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate,postoperative infertility is a concern.Perineal rectosigmoi...BACKGROUND Rectal prolapse in young women is rare.Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate,postoperative infertility is a concern.Perineal rectosigmoidectomy(Altemeier procedure)is useful for these patients.However,the risk of anastomotic leakage should be considered.Recently,the usefulness of fluorescence imaging with indocyanine green(ICG)to prevent anastomotic leakage was reported.We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.CASE SUMMARY A 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication.The patient also suffered from rectal prolapse,approximately 3 mo before admission.She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder.Approximately 10 cm of complete rectal prolapse was observed.However,the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry.Because she had the desire to bear children in the future,she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility.We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage.Her postoperative course was uneventful,and the rectal prolapse was completely resolved.She continued to do well 18 mo after surgery,without recurrence of the rectal prolapse.CONCLUSION ICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.展开更多
The hotel industry is beginning to implement green design and construction practices,saving energy,water,and resources and thus helping to preserve the environment.In addition,green building practices also can provide...The hotel industry is beginning to implement green design and construction practices,saving energy,water,and resources and thus helping to preserve the environment.In addition,green building practices also can provide healthy and comfortable indoor environments to hotel occupants including guests and employees.However,there is the potential for conflict between green building practices and hotel guests’satisfaction and comfort,as the conservation of resources could detract from the quality of a guest’s visitor experience.This study adopted a case study approach to identify and analyze green design and construction practices that create a green and luxurious environment without damaging the hotels’financial position.An in-depth literature review was conducted to identify green design and construction practices,design features of premium hotels,and major design conflicts between the twin goals of green building and a luxurious hotel environment.Two LEED platinum hotels(the Proximity Hotel and the Bardessono Hotel,both in the United States)were selected and data collected on their green design and construction practices,luxurious design features,and operation and maintenance practices from multiple sources,including the owner,designer,contractor,engineer,and LEED consultant.From the perspective of the entire lifecycle of the building,this data was analyzed to identify green design and construction practices that not only provide a green,luxurious environment but also enhance the hotels’financial strength.展开更多
During the process of construction and maintenance, buildings have had many negativeeffects on the environment, such as destruction of the ecological environment, consumption of naturalresources, air pollution and gen...During the process of construction and maintenance, buildings have had many negativeeffects on the environment, such as destruction of the ecological environment, consumption of naturalresources, air pollution and generation of large amounts of construction waste. The development of greenbuildings has greatly improved the negative impact of buildings on the environment. In the whole life cycleof construction and maintenance of buildings, the consumption of natural resources is reduced, and thedamage to the environment is reduced. In this article, the representative green buildings in Asia are analyzedfrom the aspects of regional humanity, land saving measures, energy-saving measures, behavior-guidedgreen design strategies, building materials, effective greening measures and smart city strategies, and theexcellent design strategies are summarized, in order to provide reference for future architectural practice.展开更多
The exchange bias （EB） of the ferromagnetic （FM）/antiferromagnetic （AFM） bilayers in a compensated case is studied by use of the many-body Green＇s function method of quantum statistical theory. The so-called co...The exchange bias （EB） of the ferromagnetic （FM）/antiferromagnetic （AFM） bilayers in a compensated case is studied by use of the many-body Green＇s function method of quantum statistical theory. The so-called compensated case is that there is no net magnetization on the AFM side of the interface. Our conclusion is that the EB in this case is primarily from the asymmetry of the interracial exchange coupling strengths between the FM and the two sublattices of the AFM. The effects of the layer thickness, temperature and the interracial coupling strength oi2 the exchange bias HE are investigated. The dependence of HE on the FM layer thickness and temperature is qualitatively in agreement with experimental results. HE is nearly inversely proportional to FM thickness. When temperature varies, both HE and He decrease with temperature increasing. The anisotropy of the FM layer only slightly influence He, but does not influence HE.展开更多
BACKGROUND Single-port laparoscopy has been used in a variety of abdominal operations.We report the first case of single-port laparoscopic left lateral sectionectomy in pediatric laparoscopic living donor liver transp...BACKGROUND Single-port laparoscopy has been used in a variety of abdominal operations.We report the first case of single-port laparoscopic left lateral sectionectomy in pediatric laparoscopic living donor liver transplantation.CASE SUMMARY A 28-year-old man volunteered for living liver donation to his daughter who was diagnosed with liver cirrhosis and portal hypertension after the Kasai procedure for biliary atresia.His body mass index was 20.5 kg/m2.Liver dynamic computed tomography showed:(1)Left lateral graft volume of 232.76 cm3 with a graft-torecipient weight ratio of 2.59%;and(2)Right hepatic artery derived from the superior mesenteric artery.A single-port access system was placed through a transumbilical incision,including four trocars:two 12-mm ports for a camera and endoscopic stapler and two 5-mm working ports.Liver parenchyma was dissected by a Harmonic and Cavitron Ultrasonic Surgical Aspirator,while bipolar was used for coagulation.The bile duct was transected above the bifurcation by indocyanine green fluorescence cholangiography.The specimen was retrieved from the umbilical incision.The total operation time was 4 h without blood transfusion.The final graft weight was 233.6 g with graft-torecipient weight ratio of 2.60%.The donor was discharged uneventfully on postoperative day 4.CONCLUSION Single-port laparoscopic left lateral sectionectomy is feasible in pediatric laparoscopic living donor liver transplantation in an experienced transplant center.展开更多
The purpose of this work is to present a methodology to provide a solution to a Bi-objective Green Vehicle Routing Problem (BGVRP). The methodology, illustrated using a case study (newspaper distribution problem) and ...The purpose of this work is to present a methodology to provide a solution to a Bi-objective Green Vehicle Routing Problem (BGVRP). The methodology, illustrated using a case study (newspaper distribution problem) and literature Instances, was divided into three stages: Stage 1, data treatment;Stage 2, “metaheuristic approaches” (hybrid or non-hybrid), used comparatively, more specifically: NSGA-II (Non-dominated Sorting Genetic Algorithm II), MOPSO (Multi-Objective Particle Swarm Optimization), which were compared with the new approaches proposed by the authors, CWNSGA-II (Clarke and Wright’s Savings with the Non-dominated Sorting Genetic Algorithm II) and CWTSNSGA-II (Clarke and Wright’s Savings, Tabu Search and Non-dominated Sorting Genetic Algorithm II);Stage 3, analysis of the results, with a comparison of the algorithms. An optimization of 19.9% was achieved for Objective Function 1 (OF<sub>1</sub>;minimization of CO<sub>2</sub> emissions) and consequently the same percentage for the minimization of total distance, and 87.5% for Objective Function 2 (OF<sub>2</sub>;minimization of the difference in demand). Metaheuristic approaches hybrid achieved superior results for case study and instances. In this way, the procedure presented here can bring benefits to society as it considers environmental issues and also balancing work between the routes, ensuring savings and satisfaction for the users.展开更多
基金Supported by the Soonchunhyang University Research Fund,No.2023-0060.
文摘BACKGROUND Laparoscopic choledocholithotomy for a large impacted common bile duct(CBD)stone is a challenging procedure because of the technical difficulty and the possibility of postoperative complications,even in this era of minimally invasive surgery.Herein,we present a case of large impacted CBD stones.CASE SUMMARY A 71-year-old man showed a distal CBD stone(45 mm×20 mm)and a middle CBD stone(20 mm×15 mm)on computed tomography.Endoscopic retrograde cholangiopancreatography failed due to the large size of the impacted stone and the presence of a large duodenal diverticulum.Laparoscopic choledocholithotomy was decided,and we used a near-infrared indocyanine green fluorescence scope to detect and expose the supraduodenal CBD more accurately.Then,the location,size,and shape of the stones were detected using a laparoscopic intraoperative ultrasound.The CBD was opened with a 2-cm-sized vertical incision.After irrigating several times,two CBD stones were removed with the Endo BabcockTM.T-tube insertion was done for postoperative cholangiography and delayed the removal of remnant sludge.The patient had no postoperative complications.CONCLUSION Laparoscopic choledocholithotomy by transcholedochal approach and transductal T-tube insertion is a safe and feasible option for large-sized impacted CBD stones.
基金Supported by National Natural Science Foundation of China,No.81972792.
文摘BACKGROUND Liver cancer is a malignant tumor with a high incidence.At present,the most effective treatment is laparoscopic hepatectomy(LH).Indocyanine green fluorescence imaging(ICG-FI)has become an important tool in LH,and the most common fluorescent types of tumors are total fluorescence,partial fluorescence,and rim fluorescence.CASE SUMMARY We presented four cases of LH guided by ICG-FI in which we also observed the fourth special fluorescent type.When the tumor or intrahepatic stone compresses the adjacent bile duct to cause local cholestasis,the liver segment or subsegment with obstructed bile drainage will show strong fluorescence.Complete removal of the lesion together with the fluorescent liver parenchyma may help reduce the risk of tumor or stone recurrence.CONCLUSION This type of partial fluorescence can indicate local biliary compression,and the resection method is related to bile drainage,which may be called functional anatomical hepatectomy and ensures radical resection of the lesion.
文摘BACKGROUND In recent decades,significant advances have been made in protecting the parathyroid glands and recurrent laryngeal nerves during thyroidectomy.However,reliable and convenient technical means are still lacking.In this study,the reliability,safety and feasibility of near-infrared(NIR)laparoscopyassisted thyroid lobectomy with isthmectomy and prophylactic central lymph node dissection(CLND)were reported.CASE SUMMARY A 63-year-old female patient with a free previous medical history,was admitted to our department due to multiple thyroid nodules.Ultrasonic examination suggested diffuse thyroid changes and one thyroid nodule in the right upper lobe with the largest diameter of 1.5 cm adjacent to the trachea and Breast Imaging Reporting and Data System grade 4B.Imaging examination of the neck showed no obvious enlarged lymph nodes.Fine needle aspiration biopsy suggested a papillary thyroid carcinoma.Combined with thyroid function examination,the patient was diagnosed with papillary thyroid carcinoma and Hashimoto's thyroiditis.Considering the risk of invading the capsule and the patient's extreme anxiety,a right thyroid lobectomy with isthmectomy and prophylactic CLND was planned.No significant abnormalities were found during preoperative examinations,except for an increased thyroid stimulating hormone level.The patient underwent NIR laparoscopy-assisted thyroid lobectomy with isthmectomy and prophylactic CLND.During the operation,two right parathyroid glands(PGs)adjacent to the thyroid gland capsule and the right recurrent laryngeal nerve(RLN)were examined by indocyanine green(ICG)fluorescence using a NIR fluorescence camera,and the PGs and RLN were reliably preserved.Considering the ICG-positive PG,prophylactic CLND was performed.The postoperative parathyroid hormone level was in the normal range and no significant hypocalcemia symptoms were observed.CONCLUSION During NIR laparoscopy-assisted thyroidectomy,ICG fluorescence may aid PG identification and protection.
基金Zhejiang Medical and Health Science and Technology Plan,No. 2022RC096Basic Public Welfare Research Project of Zhejiang Province of China,No. LGF20H030011
文摘BACKGROUND Splenic artery aneurysm(SAA)is a rare vascular lesion conventionally treated by resection or interventional therapy.The surgical procedure usually involves splenectomy,and interventional therapy may cause post-embolization syndromes.Preservation of the spleen and its function is rarely reported during the management of SAA.CASE SUMMARY We report a patient with an asymptomatic SAA(3.5 cm in diameter),which was en-bloc resected laparoscopically using indocyanine green(ICG)fluorescence imaging to preserve the spleen and its function.CONCLUSION ICG fluorescence imaging for spleen preservation in laparoscopic SAA resection is safe and may be beneficial in avoiding splenectomy and maintaining splenic function.
文摘BACKGROUND Rectal prolapse in young women is rare.Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate,postoperative infertility is a concern.Perineal rectosigmoidectomy(Altemeier procedure)is useful for these patients.However,the risk of anastomotic leakage should be considered.Recently,the usefulness of fluorescence imaging with indocyanine green(ICG)to prevent anastomotic leakage was reported.We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy.CASE SUMMARY A 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication.The patient also suffered from rectal prolapse,approximately 3 mo before admission.She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder.Approximately 10 cm of complete rectal prolapse was observed.However,the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry.Because she had the desire to bear children in the future,she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility.We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage.Her postoperative course was uneventful,and the rectal prolapse was completely resolved.She continued to do well 18 mo after surgery,without recurrence of the rectal prolapse.CONCLUSION ICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.
文摘The hotel industry is beginning to implement green design and construction practices,saving energy,water,and resources and thus helping to preserve the environment.In addition,green building practices also can provide healthy and comfortable indoor environments to hotel occupants including guests and employees.However,there is the potential for conflict between green building practices and hotel guests’satisfaction and comfort,as the conservation of resources could detract from the quality of a guest’s visitor experience.This study adopted a case study approach to identify and analyze green design and construction practices that create a green and luxurious environment without damaging the hotels’financial position.An in-depth literature review was conducted to identify green design and construction practices,design features of premium hotels,and major design conflicts between the twin goals of green building and a luxurious hotel environment.Two LEED platinum hotels(the Proximity Hotel and the Bardessono Hotel,both in the United States)were selected and data collected on their green design and construction practices,luxurious design features,and operation and maintenance practices from multiple sources,including the owner,designer,contractor,engineer,and LEED consultant.From the perspective of the entire lifecycle of the building,this data was analyzed to identify green design and construction practices that not only provide a green,luxurious environment but also enhance the hotels’financial strength.
基金Sponsored by Interdisciplinary Research Projects of the Fundamental Research Funds for the Central Universities(DUT19JC55)High-level Talents Innovation Support Project of Dalian City(2017RQ076).
文摘During the process of construction and maintenance, buildings have had many negativeeffects on the environment, such as destruction of the ecological environment, consumption of naturalresources, air pollution and generation of large amounts of construction waste. The development of greenbuildings has greatly improved the negative impact of buildings on the environment. In the whole life cycleof construction and maintenance of buildings, the consumption of natural resources is reduced, and thedamage to the environment is reduced. In this article, the representative green buildings in Asia are analyzedfrom the aspects of regional humanity, land saving measures, energy-saving measures, behavior-guidedgreen design strategies, building materials, effective greening measures and smart city strategies, and theexcellent design strategies are summarized, in order to provide reference for future architectural practice.
基金supported by National Natural Science Foundation of China under Grant Nos.10574121,10874160,and 10025420the‘111’Project of the Ministry of Education and the Chinese Academy of Sciences
文摘The exchange bias （EB） of the ferromagnetic （FM）/antiferromagnetic （AFM） bilayers in a compensated case is studied by use of the many-body Green＇s function method of quantum statistical theory. The so-called compensated case is that there is no net magnetization on the AFM side of the interface. Our conclusion is that the EB in this case is primarily from the asymmetry of the interracial exchange coupling strengths between the FM and the two sublattices of the AFM. The effects of the layer thickness, temperature and the interracial coupling strength oi2 the exchange bias HE are investigated. The dependence of HE on the FM layer thickness and temperature is qualitatively in agreement with experimental results. HE is nearly inversely proportional to FM thickness. When temperature varies, both HE and He decrease with temperature increasing. The anisotropy of the FM layer only slightly influence He, but does not influence HE.
基金Supported by Capital Research Project for Specialty Clinical Application,No.Z181100001718220.
文摘BACKGROUND Single-port laparoscopy has been used in a variety of abdominal operations.We report the first case of single-port laparoscopic left lateral sectionectomy in pediatric laparoscopic living donor liver transplantation.CASE SUMMARY A 28-year-old man volunteered for living liver donation to his daughter who was diagnosed with liver cirrhosis and portal hypertension after the Kasai procedure for biliary atresia.His body mass index was 20.5 kg/m2.Liver dynamic computed tomography showed:(1)Left lateral graft volume of 232.76 cm3 with a graft-torecipient weight ratio of 2.59%;and(2)Right hepatic artery derived from the superior mesenteric artery.A single-port access system was placed through a transumbilical incision,including four trocars:two 12-mm ports for a camera and endoscopic stapler and two 5-mm working ports.Liver parenchyma was dissected by a Harmonic and Cavitron Ultrasonic Surgical Aspirator,while bipolar was used for coagulation.The bile duct was transected above the bifurcation by indocyanine green fluorescence cholangiography.The specimen was retrieved from the umbilical incision.The total operation time was 4 h without blood transfusion.The final graft weight was 233.6 g with graft-torecipient weight ratio of 2.60%.The donor was discharged uneventfully on postoperative day 4.CONCLUSION Single-port laparoscopic left lateral sectionectomy is feasible in pediatric laparoscopic living donor liver transplantation in an experienced transplant center.
文摘The purpose of this work is to present a methodology to provide a solution to a Bi-objective Green Vehicle Routing Problem (BGVRP). The methodology, illustrated using a case study (newspaper distribution problem) and literature Instances, was divided into three stages: Stage 1, data treatment;Stage 2, “metaheuristic approaches” (hybrid or non-hybrid), used comparatively, more specifically: NSGA-II (Non-dominated Sorting Genetic Algorithm II), MOPSO (Multi-Objective Particle Swarm Optimization), which were compared with the new approaches proposed by the authors, CWNSGA-II (Clarke and Wright’s Savings with the Non-dominated Sorting Genetic Algorithm II) and CWTSNSGA-II (Clarke and Wright’s Savings, Tabu Search and Non-dominated Sorting Genetic Algorithm II);Stage 3, analysis of the results, with a comparison of the algorithms. An optimization of 19.9% was achieved for Objective Function 1 (OF<sub>1</sub>;minimization of CO<sub>2</sub> emissions) and consequently the same percentage for the minimization of total distance, and 87.5% for Objective Function 2 (OF<sub>2</sub>;minimization of the difference in demand). Metaheuristic approaches hybrid achieved superior results for case study and instances. In this way, the procedure presented here can bring benefits to society as it considers environmental issues and also balancing work between the routes, ensuring savings and satisfaction for the users.
