Despite the prevailing emphasis in the medical literature on establishing evidence,many changes in the practice of surgery have not been achieved using proper evidence-based assessment.This paper examines the adoption...Despite the prevailing emphasis in the medical literature on establishing evidence,many changes in the practice of surgery have not been achieved using proper evidence-based assessment.This paper examines the adoption of laparoscopic cholecystectomy(LC)into regular use for the treatment of cholecystitis and the process of its acceptance,focusing on the limited role of technology assessment in its appraisal.A review of the published medical literature concerning LC was performed.Approximately 3000 studies of LC have been conducted since 1985,and there have been nearly 8500 publications to date.As LC was adopted enthusiastically into practice,the results of outcome studies generally showed that it compared favorably with the traditional,open cholecystectomy with regard to mortality,complications,and length of hospital stay.However,despite the rapid general agreement on surgical technique,efficacy,and appropriateness,there remained lingering doubts about safety,outcomes,and cost of the procedure that suggested that essential research questions were ignored even as the procedure became standard.Using LC as a case study,there are important lessons to be learned about the need for important guidelines for surgical innovation and the adoption of minimally invasive surgical techniques into current clinical and surgical practice.We highlight one recent example,natural orifice transluminal endoscopic surgery and how necessary it is to properly evaluate this new technology before it is accepted as a safe and effective surgical option.展开更多
A microsphere biosorbent with uniform size （CV = 1.52%）, controllable morphology and component, and high mechanical strength was synthesized from chitosan by microfluidic technology combining with chemical crosslink...A microsphere biosorbent with uniform size （CV = 1.52%）, controllable morphology and component, and high mechanical strength was synthesized from chitosan by microfluidic technology combining with chemical crosslinking and solvent extraction. This chitosan microsphere （CS-MS） was prepared with a two-step solidification process, which was acquired by drying for the enhancement of mechanical property in final. The adsorption behavior of CS-MS towards copper （II） and main influencing factors on adsorption performance were investigated by batch experiments. Kinetic data high-lighted dominant chemical bonding along with electrons transferring in adsorption process. Isothermal analysis indicated that adsorption capacity was relevant to the number of active site. All these explorations provided a new direction for preparing highly comprehensive performance sorbent used in heavy metal treatment via microfluidic technology.展开更多
文摘Despite the prevailing emphasis in the medical literature on establishing evidence,many changes in the practice of surgery have not been achieved using proper evidence-based assessment.This paper examines the adoption of laparoscopic cholecystectomy(LC)into regular use for the treatment of cholecystitis and the process of its acceptance,focusing on the limited role of technology assessment in its appraisal.A review of the published medical literature concerning LC was performed.Approximately 3000 studies of LC have been conducted since 1985,and there have been nearly 8500 publications to date.As LC was adopted enthusiastically into practice,the results of outcome studies generally showed that it compared favorably with the traditional,open cholecystectomy with regard to mortality,complications,and length of hospital stay.However,despite the rapid general agreement on surgical technique,efficacy,and appropriateness,there remained lingering doubts about safety,outcomes,and cost of the procedure that suggested that essential research questions were ignored even as the procedure became standard.Using LC as a case study,there are important lessons to be learned about the need for important guidelines for surgical innovation and the adoption of minimally invasive surgical techniques into current clinical and surgical practice.We highlight one recent example,natural orifice transluminal endoscopic surgery and how necessary it is to properly evaluate this new technology before it is accepted as a safe and effective surgical option.
基金We acknowledge the support by the National Basic Research Program of China （2014CB748500） and the National Natural Science Foundation of China （Grant Nos. 51578239 and 51322805）.
文摘A microsphere biosorbent with uniform size （CV = 1.52%）, controllable morphology and component, and high mechanical strength was synthesized from chitosan by microfluidic technology combining with chemical crosslinking and solvent extraction. This chitosan microsphere （CS-MS） was prepared with a two-step solidification process, which was acquired by drying for the enhancement of mechanical property in final. The adsorption behavior of CS-MS towards copper （II） and main influencing factors on adsorption performance were investigated by batch experiments. Kinetic data high-lighted dominant chemical bonding along with electrons transferring in adsorption process. Isothermal analysis indicated that adsorption capacity was relevant to the number of active site. All these explorations provided a new direction for preparing highly comprehensive performance sorbent used in heavy metal treatment via microfluidic technology.
