Pulmonary embolism after shoulder surgery:Is it a real threat?

Pulmonary embolism(PE)is a rare but devastating complication of shoulder surgery.Apart from increased morbidity and mortality rates,it may significantly impair postoperative recovery and functional outcome.Its frequency accounts for up to 5.7%of all shoulder surgery procedures with a higher occurrence in women and patients older than 70 years.It is most commonly associated with thrombophilia,diabetes mellitus,obesity,smoking,hypertension,and a history of malignancy.PE usually occurs secondary to upper or lower-extremity deep vein thrombosis(DVT).However,in rare cases,the source of the thrombi cannot be determined.Prophylaxis for PE following shoulder surgery remains a topic of debate,and the standard of care does not routinely require prophylactic medication for DVT prophylaxis.Early ambulation and elastic stockings are important preventative measures for DVT of the lower extremity and medical agents such as aspirin,low-molecular-weight heparin,and vitamin K antagonists are indicated for high-risk patients,long-lasting operations,or concomitant severe acute respiratory syndrome coronavirus 2 infection.The most common symptoms of PE include chest pain and shortness of breath,but PE can also be asymptomatic in patients with intrinsic tolerance of hypoxia.Patients with DVT may also present with swelling and pain of the respective extremity.The treatment of PE includes inpatient or outpatient anticoagulant therapy if the patient is hemodynamically unstable or stable,respectively.Hemodynamic instability may require transfer to the intensive care unit,and cardiovascular arrest can be implicated in fatal events.An important issue for patients with PE in the postoperative period after shoulder surgery is residual stiffness due to a delay in rehabilitation and a prolonged hospital stay.Early physiotherapy and range-of-motion exercises do not adversely affect the prognosis of PE and are highly recommended to preserve shoulder mobility and function.

教育5.0时代:内涵、需求和挑战

数字化转型开启了教育5.0时代,为教育带来新的格局、多模态学习的新体验、人机协同的新范式。文章探讨了以学习者为中心、生成式人工智能为技术支撑、智慧教育生态环境建设为依托的教育5.0的内涵、需求及面临的挑战。教育5.0强调学习的主体性、包容性、公平性、可持续性与韧性、主观能动性和团结协作性。文章通过分析教育的演进过程与阶段特征,阐释了教育5.0时代的理念升级、内容更新和方式变革,指出未来教育更应注重人本主义,关注学习者学习体验,满足其个性化和多样化需求,促进其全面发展;将数字技术整合到教育各层面,推动全方位创新与变革,推进教育优质公平与支持终身学习,形成具有开放性、适应性、个性化、自主性等特征的教育新生态。

工业5.0时代中等和低收入国家职业教育转型及启示——对世界银行《创建更优质正规职业教育体系报告》的解读

为加快推进中等和低收入国家职业教育转型发展,适应工业5.0时代对职业人才培养的新需求,世界银行发布了《创建更优质正规职业教育体系报告》,明确了从“身份认同”向“追求卓越”、从“注重输入”向“强调效能”、从“推测决策”到“循证决策”三大转型战略,对我国新质生产力战略下的职业教育转型发展具有重要启示。

日本实现“社会5.0”的科技创新政策梳理及其对中国未来社会发展的启示

在老龄少子化等社会问题凸显、综合国力不断下行的背景下,日本政府于2016年提出“社会5.0”构想。对日本的“社会5.0”先行经验进行分析,有助于更好地理解中国的科技创新政策对中国未来社会发展的影响,并为中国未来发展提供参考借鉴。通过政策研究和对比,对日本“社会5.0”科技创新政策的起源与发展阶段进行梳理和定义,解析日本科技战略框架,结合相关应用案例分析其亮点和意义,并综合比较新加坡、英国、美国等不同国家数智科技政策的异同。研究发现,日本“社会5.0”政策在智能城市与物联网、医疗与健康护理、无人驾驶汽车与自动驾驶、节能和可持续性等领域取得较好的实践应用,推动信息技术与物理社会融合,以实现更智能、更可持续、更人性化的社会。进一步,通过总结中国数智科技创新的现状与挑战,认为中国目前仍需要应对高端技术创新不足、科技成果转化率低等问题,对此,借鉴日本“社会5.0”,提出中国应通过加强国际协同合作和分享、加强关键技术创新进行智能化产业升级,以及加强建设智慧城市、鼓励终身学习、加强相关立法和提供个性化服务等。

2019年四川威远东两次M_(S)>5.0地震序列活动特征及震源区体波速度结构

自2015年以来,四川威远及邻区的地震活动强度显著增强,其中2019年9月8日和12月18日在威远东发生了M_(S)5.4和M_(S)5.2地震,刷新了威远地区有记录以来历史地震震级上限.本文利用2019年8月至2020年3月期间威远及邻区25个流动台和17个固定台记录到的5638次M_(L)≥1.2地震Pg和Sg波到时以及连续波形资料,采用双差层析成像方法获得了威远东这两次地震序列的重定位结果和震源区浅层地壳高分辨率三维体波速度结构.重定位结果显示震源区地震震源深度主要集中在3~4 km.基于两次M_(S)>5.0地震震后10天余震序列空间展布,本文推测两次地震的发震构造均为NNE走向且倾向SE(倾角40°左右)的盲冲断层.三维体波速度结构反演结果揭示:震源区V_(P)异常变化较V_(S)异常变化显著,V_(P)/V_(S)比背景值普遍低4%~10%.在深度小于5 km的浅层内,地震多分布在V_(P)低速异常和V_(S)弱高速异常以及二者的高低速异常过渡带内;在5~7 km深度范围,地震基本上都发生在V_(P)低速异常区.上述速度结构特征揭示震源区附近可能发育着富含气体的孔隙和裂缝且存在流体活动.此外,2019年11月7日以后的地震活动具有明显的流体扩散驱动地震迁移特征,沿两次地震发震断层走向和倾向的流体扩散系数分别为1.5 m~2·s^(-1)和0.1 m~2·s^(-1).两次地震的发生机理很可能是流体扩散引起的孔隙压力上升.

基于PI方法的华北2019年以来3次M_(S)≥5.0地震回溯性预测研究

本文应用图像信息(PI)方法对2023年山东平原M_(S)5.5地震、2021年江苏大丰海域M_(S)5.0地震和2020年河北古冶M_(S)5.1地震进行了回溯性预测研究。以华北局部(32°N~42°N,114°E~122°E)为研究区域,在网格尺度分别为0.5°×0.5°和1.0°×1.0°且预测窗长为5 a的两组参数模型下,获取2019—2027年逐年滑动的预测窗热点演化图像。结果显示,当网格尺度为1.0°×1.0°时,PI热点效果优于0.5°×0.5°网格,且对平原地震和大丰海域地震的发震位置指示作用较好。当时间窗长和归一化阈值绝对值同时增大,个别窗口存在古冶地震的有效热点,但未找到热点能同时覆盖3个地震震中所在网格的参数模型。不同参数模型下的PI热点显示,未来3~4 a郯庐断裂带渤海段存在发生M_(S)≥5.0地震的风险。本文研究结果对于华北局部地区M_(S)≥5.0地震危险性分析具有一定的参考意义。

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.

2022年云南红河县M_(S)5.0地震震害特征

2022年11月19日云南省红河县(23.37°N,102.26°E)发生M_(S)5.0地震,打破了红河哈尼族彝族自治州21世纪以来未发生5级以上地震的记录。本文结合地震现场灾害损失调查和灾情资料收集整理,详细阐述了灾区的建筑物震害、生命线工程震害、地震地质灾害特征及原因分析,并与云南相近震级历史地震震害特征进行对比,结果表明,本次地震灾区受灾规模小,余震少,灾害损失相对较轻。

Bariatric surgery and diabetes:Current challenges and perspectives

Diabetes mellitus(DM)and obesity have become public issues of global concern.Bariatric surgery for the treatment of obesity combined with type 2 DM has been shown to be a safe and effective approach;however,there are limited studies that have systematically addressed the challenges of surgical treatment of obesity combined with DM.In this review,we summarize and answer the most pressing questions in the field of surgical treatment of obesity-associated DM.I believe that our insights will be of great help to clinicians in their daily practice.

基于数据挖掘分析《中华医典5.0》对中风病气虚证的用药特点及处方配伍规律

目的基于《中华医典5.0》探讨中风病气虚证的用药特点和处方配伍规律。方法收集《中华医典5.0》中治疗中风病气虚证的古代及近代处方,通过Microsoft Office Excel 2013软件建立规范化数据库,并利用SPSS Statistics 25和SPSS Modeler 18.0软件对数据库中处方进行频数、关联规则、聚类分析等数据挖掘方法的研究。结果本研究共得到频率>15%的中药16味,使用频次前5位的中药分别是:甘草70次、人参64次、白术50次、当归43次、茯苓41次。药性多为温、寒、平之品,药味以甘、辛、苦为主,主要归脾、肺、心经。药类频次前6位的中药类别为:补虚药、解表药、理气药、化痰止咳平喘药、温里药及活血化瘀药。关联分析得到强关联配对方式50种(置信度>0.8、支持度>0.1),支持度前5位的药对为白术—茯苓、甘草—陈皮、茯苓—半夏、人参—半夏、甘草—半夏。聚类分析得到聚类组5类,复杂网络分析得到中风病气虚证的核心处方,共包含26味中药:人参、半夏、天麻、川芎、当归、木香、桔梗、熟地黄、独活、甘草、生姜、白术、白芍、白芷、竹沥、细辛、羌活、肉桂、茯苓、防风、附子、陈皮、麻黄、黄芩、黄芪、乌药,为六君子汤、四物汤、九味羌活汤合方。结论《中华医典5.0》中记载治疗中风病气虚证的处方呈现以益气养血、祛风解表、理气祛痰为主的处方规律,治疗以补气为核心,兼以祛风、化痰、祛湿之品。需要注意的是,气虚证贯穿中风病发病始终,在中风病气虚证的治疗中,调补后天之气是治疗的关键,运用毒性药物或可成为治疗中风病气虚证的新思路。

Artificial Intelligence and Computer Vision during Surgery: Discussing Laparoscopic Images with ChatGPT4—Preliminary Results

Introduction: Ultrafast latest developments in artificial intelligence (ΑΙ) have recently multiplied concerns regarding the future of robotic autonomy in surgery. However, the literature on the topic is still scarce. Aim: To test a novel AI commercially available tool for image analysis on a series of laparoscopic scenes. Methods: The research tools included OPENAI CHATGPT 4.0 with its corresponding image recognition plugin which was fed with a list of 100 laparoscopic selected snapshots from common surgical procedures. In order to score reliability of received responses from image-recognition bot, two corresponding scales were developed ranging from 0 - 5. The set of images was divided into two groups: unlabeled (Group A) and labeled (Group B), and according to the type of surgical procedure or image resolution. Results: AI was able to recognize correctly the context of surgical-related images in 97% of its reports. For the labeled surgical pictures, the image-processing bot scored 3.95/5 (79%), whilst for the unlabeled, it scored 2.905/5 (58.1%). Phases of the procedure were commented in detail, after all successful interpretations. With rates 4 - 5/5, the chatbot was able to talk in detail about the indications, contraindications, stages, instrumentation, complications and outcome rates of the operation discussed. Conclusion: Interaction between surgeon and chatbot appears to be an interesting frontend for further research by clinicians in parallel with evolution of its complex underlying infrastructure. In this early phase of using artificial intelligence for image recognition in surgery, no safe conclusions can be drawn by small cohorts with commercially available software. Further development of medically-oriented AI software and clinical world awareness are expected to bring fruitful information on the topic in the years to come.

Fully automatic AI segmentation of oral surgery-related tissues based on cone beam computed tomography images

Accurate segmentation of oral surgery-related tissues from cone beam computed tomography(CBCT)images can significantly accelerate treatment planning and improve surgical accuracy.In this paper,we propose a fully automated tissue segmentation system for dental implant surgery.Specifically,we propose an image preprocessing method based on data distribution histograms,which can adaptively process CBCT images with different parameters.Based on this,we use the bone segmentation network to obtain the segmentation results of alveolar bone,teeth,and maxillary sinus.We use the tooth and mandibular regions as the ROI regions of tooth segmentation and mandibular nerve tube segmentation to achieve the corresponding tasks.The tooth segmentation results can obtain the order information of the dentition.The corresponding experimental results show that our method can achieve higher segmentation accuracy and efficiency compared to existing methods.Its average Dice scores on the tooth,alveolar bone,maxillary sinus,and mandibular canal segmentation tasks were 96.5%,95.4%,93.6%,and 94.8%,respectively.These results demonstrate that it can accelerate the development of digital dentistry.

Is recovery enhancement after gastric cancer surgery really a safe approach for elderly patients?

BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery(ERAS)in elderly patients with gastric cancer(GC).AIM To evaluate the safety of ERAS in elderly patients with GC.METHODS The PubMed,EMBASE,and Cochrane Library databases were used to search for eligible studies from inception to April 1,2023.The mean difference(MD),odds ratio(OR)and 95%confidence interval(95%CI)were pooled for analysis.The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores.We used Stata(V.16.0)software for data analysis.RESULTS This study consists of six studies involving 878 elderly patients.By analyzing the clinical outcomes,we found that the ERAS group had shorter postoperative hospital stays(MD=-0.51,I2=0.00%,95%CI=-0.72 to-0.30,P=0.00);earlier times to first flatus(defecation;MD=-0.30,I²=0.00%,95%CI=-0.55 to-0.06,P=0.02);less intestinal obstruction(OR=3.24,I2=0.00%,95%CI=1.07 to 9.78,P=0.04);less nausea and vomiting(OR=4.07,I2=0.00%,95%CI=1.29 to 12.84,P=0.02);and less gastric retention(OR=5.69,I2=2.46%,95%CI=2.00 to 16.20,P=0.00).Our results showed that the conventional group had a greater mortality rate than the ERAS group(OR=0.24,I2=0.00%,95%CI=0.07 to 0.84,P=0.03).However,there was no statistically significant difference in major complications between the ERAS group and the conventional group(OR=0.67,I2=0.00%,95%CI=0.38 to 1.18,P=0.16).CONCLUSION Compared to those with conventional recovery,elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.

Enhanced recovery after surgery in elderly patients with non-small cell lung cancer who underwent video-assisted thoracic surgery

BACKGROUND This study was designed to investigate the clinical outcomes of enhanced recovery after surgery(ERAS)in the perioperative period in elderly patients with nonsmall cell lung cancer(NSCLC).AIM To investigate the potential enhancement of video-assisted thoracic surgery(VATS)in postoperative recovery in elderly patients with NSCLC.METHODS We retrospectively analysed the clinical data of 85 elderly NSCLC patients who underwent ERAS(the ERAS group)and 327 elderly NSCLC patients who received routine care(the control group)after VATS at the Department of Thoracic Surgery of Peking University Shenzhen Hospital between May 2015 and April 2017.After propensity score matching of baseline data,we analysed the postoperative stay,total hospital expenses,postoperative 48-h pain score,and postoperative complication rate for the 2 groups of patients who underwent lobectomy or sublobar resection.RESULTS After propensity score matching,ERAS significantly reduced the postoperative hospital stay(6.96±4.16 vs 8.48±4.18 d,P=0.001)and total hospital expenses(48875.27±18437.5 vs 55497.64±21168.63 CNY,P=0.014)and improved the satisfaction score(79.8±7.55 vs 77.35±7.72,P=0.029)relative to those for routine care.No significant between-group difference was observed in postoperative 48-h pain score(4.68±1.69 vs 5.28±2.1,P=0.090)or postoperative complication rate(21.2%vs 27.1%,P=0.371).Subgroup analysis showed that ERAS significantly reduced the postoperative hospital stay and total hospital expenses and increased the satisfaction score of patients who underwent lobectomy but not of patients who underwent sublobar resection.CONCLUSION ERAS effectively reduced the postoperative hospital stay and total hospital expenses and improved the satisfaction score in the perioperative period for elderly NSCLC patients who underwent lobectomy but not for patients who underwent sublobar resection.

Uterine artery pseudoaneurysm caused by hysteroscopic surgery: A case report

BACKGROUND We report a case of uterine artery pseudoaneurysm(UAP)occurrence during hysteroscopic endometrial polypectomy and its treatment via uterine artery embolization(UAE).CASE SUMMARY A 48-year-old primigravid,primiparous patient was incidentally found to have an endometrial polyp during a health checkup,and underwent a hysteroscopic polypectomy at another hospital.Her cervix was dilated with a Laminken-R®device.After the Laminken-R®was withdrawn,a large amount of genital bleeding was observed.This bleeding persisted after the hysteroscopic polypectomy,and,as hemostasis became impossible,the patient was transferred to our hospital by ambulance.On arrival,transvaginal ultrasonography revealed a 3-cm hypoechoic mass with a swirling internal pulse on the right side of the uterus,and color Doppler ultrasonography showed feeder vessels penetrating the mass.Pelvic contrast-enhanced computed tomography(CT)confirmed the presence of a mass at this site,and vascular proliferation was observed within the uterine cavity.Consequently,UAP was diagnosed,and UAE was performed.The patient’s postoperative course was uneventful,and 6 mo post-UAE,no recurrence of blood flow to the UAP was observed.CONCLUSION When abnormal genital bleeding occurs during hysteroscopic surgery,ultrasonography and contrast-enhanced CT can assist in the detection of early UAPs.

Glaucoma surgery experiments using digital microscope-integrated optical coherence tomography and OCT-compatible instruments

There is a certain failure rate in traditional glaucoma surgery because of the lack of depth information in microscope images.In this work,we present a digital microscope-integrated optical coherence tomography(MIOCT)system and several custom-made OCT-compatible instruments for glaucoma surgery.Sixteen ophthalmologists were asked to perform trabeculectomy and canaloplasty on live porcine eyes using the system and instruments.After surgery,a subjective feedback survey about the user experience was taken.The experiment results showed that our system can help surgeons easily locate important tissue structures during surgery.The custom-made instruments also solved the shadowing problem in OCT imaging.Surgeons preferred to use the system in their future practice.

Effect of bariatric surgery on metabolism in diabetes and obesity comorbidity:Insight from recent research

Obesity is a prevalent cause of diabetes mellitus(DM)and is a serious danger to human health.Type 2 DM(T2DM)mostly occurs along with obesity.Foodborne obesity-induced DM is caused by an excessive long-term diet and surplus energy.Bariatric surgery can improve the symptoms of T2DM in some obese patients.But different types of bariatric surgery may have different effects.There are some models built by researchers to discuss the surgical procedures’effects on me-tabolism in diabetes animal models and diabetes patients.It is high time to conclude all this effects and recommend procedures that can better improve metabolism.

Treatment of hemolymphangioma by robotic surgery: A case report

BACKGROUND Hemolymphangioma of the jejunum is rare and lacks clinical specificity,and can manifest as gastrointestinal bleeding,abdominal pain,and intestinal obstruction.Computed tomography,magnetic resonance imaging,and other examinations show certain characteristics of the disease,but lack accuracy.Although capsule endoscopy and enteroscopy make up for this deficiency,the diagnosis also still re-quires pathology.CASE SUMMARY A male patient was admitted to the hospital due to abdominal distension and abdominal pain,but a specific diagnosis by computed tomography examination was not obtained.Partial resection of the small intestine was performed by robotic surgery,and postoperative pathological biopsy confirmed the diagnosis of hemo-lymphangioma.No recurrence in the follow-up examination was observed.CONCLUSION Robotic surgery is an effective way to treat hemolymphangioma through minima-lly invasive techniques under the concept of rapid rehabilitation.

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.

Effect of ankle versus thigh tourniquets on post-operative pain in foot and ankle surgery

BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical time.There is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of use.There is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle surgery.AIM To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle surgery.METHODS Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was undertaken.Intraoperative tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h post-op.Scatter plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation coefficient.RESULTS All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for thigh.There was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 h.There was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h post-operatively.CONCLUSION This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle surgery.The choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.