Clinical feasibility of laparoscopic left lateral segment liver resection with magnetic anchor technique:The first clinical study from China

BACKGROUND Magnetic anchor technique(MAT)has been applied in laparoscopic cholecystectomy and laparoscopic appendectomy,but has not been reported in laparoscopic partial hepatectomy.AIM To evaluate the feasibility of the MAT in laparoscopic left lateral segment liver resection.METHODS Retrospective analysis was conducted on the clinical data of eight patients who underwent laparoscopic left lateral segment liver resection assisted by MAT in our department from July 2020 to November 2021.The Y-Z magnetic anchor devices(Y-Z MADs)was independently designed and developed by the author of this paper,which consists of the anchor magnet and magnetic grasping apparatus.Surgical time,intraoperative blood loss,intraoperative accidents,operator experience,postoperative incision pain score,postoperative complications,and other indicators were evaluated and analyzed.RESULTS All eight patients underwent a MAT-assisted laparoscopic left lateral segment liver resection,including three patients undertaking conventional 5-port and five patients having a transumbilical single-port operation.The mean operation time was 138±34.32 min(range 95-185 min)and the mean intraoperative blood loss was 123±88.60 mL(range 20-300 mL).No adverse events occurred during the operation.The Y-Z MADs showed good workability and maneuverability in both tissue and organ exposure.In particular,the operators did not experience either a“chopstick”or“sword-fight”effect in the single-port laparoscopic operation.CONCLUSION The results show that the MAT is safe and feasible for laparoscopic left lateral segment liver resection,especially,exhibits its unique abettance for transumbilical single-port laparoscopic left lateral segment liver resection.

Animal experimental study on magnetic anchor technique-assisted endoscopic submucosal dissection of early gastric cancer

BACKGROUND Gastric cancer(GC)has high morbidity and mortality.Moreover,because GC has no typical symptoms in the early stages,most cases are already in the advanced stages by the time the symptoms appear,thus resulting in poor prognosis and a low survival rate.Endoscopic submucosal dissection(ESD)can realize the early detection and diagnosis of GC and become the main surgical method for early GC.However,ESD has a steep learning curve and high technical skill requirements for endoscopists,which is not conducive to its widespread implementation and advancement.Therefore,a series of auxiliary techniques have been derived.AIM To evaluate the safety and efficacy of magnetic anchor technique(MAT)-assisted ESD in early GC.METHODS This was an ex vivo animal experiment.The experimental models were the isolated stomachs of pigs,which were divided into two groups,namely the study group(n=6)with MAT-assisted ESD and the control group(n=6)with traditional ESD.Comparing the total surgical time,incidence of surgical complications,complete mucosal resection rate,specimen size,and the scores of endoscopist’s satisfaction with the procedure reflected their feelings about convenience during the surgical procedure between the two groups.The magnetic anchor device for auxiliary ESD in the study group comprised three parts,an anchor magnet(AM),a target magnet(TM),and a soft tissue clip.Under gastroscopic guidance,the soft tissue clip and the TM were delivered to the pre-marked mucosal lesion through the gastroscopic operating hole.The soft tissue clip and the TM were connected by a thin wire through the TM tail structure.The soft tissue clip was released by manipulating the operating handle of the soft tissue clip in a way that the soft tissue clip and the TM were fixed to the lesion mucosa.In vitro,ESD is aided by maneuvering the AM such that the mucosal dissection surface is exposed.RESULTS The total surgical time was shorter in the study group than in the control group(26.57±0.19 vs 29.97±0.28,P<0.001),and the scores of endoscopist’s satisfaction with the procedure were higher in the study group than in the control group(9.53±0.10 vs 8.00±0.22,P<0.001).During the operation in the study group,there was no detachment of the soft tissue clip and TM and no mucosal tearing.The magnetic force between the AM and TM provided good mucosal exposure and sufficient tissue tension for ESD.The mucosal lesion was completely peeled off,and the operation was successful.There were no significant differences in the incidence of surgical complications(100%vs 83.3%),complete mucosal resection rate(100%vs 66.7%,P=0.439),and specimen size(2.44±0.04 cm vs 2.49±0.02,P=0.328)between the two groups.CONCLUSION MAT-ESD is safe and effective for early GC.It provides a preliminary basis for subsequent internal animal experiments and clinical research.

Magnetic anchor technique assisted endoscopic submucosal dissection for early esophageal cancer

BACKGROUND Esophageal cancer has high incidence globally and is often diagnosed at an advanced stage.With the widespread application of endoscopic technologies,the need for early detection and diagnosis of esophageal cancer has gradually been realized.Endoscopic submucosal dissection(ESD)has become the standard of care for managing early tumors of the esophagus,stomach,and colon.However,due to the steep learning curve,difficult operation,and technically demanding nature of the procedure,ESD has currently been committed to the development of various assistive technologies.AIM To explore the feasibility and applicability of magnetic anchor technique(MAT)-assisted ESD for early esophageal cancer.METHODS Isolated pig esophagi were used as the experimental model,and the magnetic anchor device was designed by us.The esophagi used were divided into two groups,namely the operational and control groups,and 10 endoscopists completed the procedure.The two groups were evaluated for the following aspects:The total operative time,perforation rate,rate of whole mucosal resection,diameter of the peering mucosa,and scores of endoscopists’feelings with the procedure,including the convenience,mucosal surface exposure degree,and tissue tension.In addition,in the operational group,the soft tissue clip and the target magnet(TM)were connected by a thin wire through a small hole at the tail end of the TM.Under gastroscopic guidance,the soft tissue clip was clamped to the edge of the lesioned mucosa,which was marked in advance.By changing the position of the anchor magnet(AM)outside the esophagus,the pulling force and pulling direction of the TM could be changed,thus exposing the mucosal peeling surface and assisting the ESD.RESULTS Herein,each of the two groups comprised 10 isolated esophageal putative mucosal lesions.The diameter of the peering mucosa did not significantly differ between the two groups(2.13±0.06 vs 2.15±0.06,P=0.882).The total operative time was shorter in the operational group than in the control group(17.04±0.22 min vs 21.94±0.23 min,P<0.001).During the entire experiment,the TM remained firmly connected with the soft tissue clip and did not affect the opening,closing,and release of the soft tissue clip.The interaction between the TM and AM could provide sufficient tissue tension and completely expose the mucosa,which greatly assists the surgeon with the operation.There was no avulsion of the mucosa,and mucosal lesions were intact when peeled.Therefore,the scores of endoscopists’feelings were higher in the operational group than in the control group in terms of the convenience(9.22±0.19 vs 8.34±0.15,P=0.002),mucosal surface exposure degree(9.11±0.15 vs 8.25±0.12,P<0.001),and tissue tension(9.35±0.13 vs 8.02±0.17,P<0.001).The two groups did not significantly differ in the perforation rate and rate of whole mucosal resection.CONCLUSION We found MAT-assisted ESD safe and feasible for early esophageal cancer.It could greatly improve the endoscopic operation experience and showed good clinical application prospects.

Mechanical responses of anchoring structure under triaxial cyclic loading

Dynamic load on anchoring structures(AS)within deep roadways can result in cumulative damage and failure.This study develops an experimental device designed to test AS under triaxial loads.The device enables the investigation of the mechanical response,failure mode,instability assessment criteria,and anchorage effect of AS subjected to combined cyclic dynamic-static triaxial stress paths.The results show that the peak bearing strength is positively correlated with the anchoring matrix strength,anchorage length,and edgewise compressive strength.The bearing capacity decreases significantly when the anchorage direction is severely inclined.The free face failure modes are typically transverse cracking,concave fracturing,V-shaped slipping and detachment,and spallation detachment.Besides,when the anchoring matrix strength and the anchorage length decrease while the edgewise compressive strength,loading rate,and anchorage inclination angle increase,the failure intensity rises.Instability is determined by a negative tangent modulus of the displacement-strength curve or the continued deformation increase against the general downward trend.Under cyclic loads,the driving force that breaks the rock mass along the normal vector and the rigidity of the AS are the two factors that determine roadway stability.Finally,a control measure for surrounding rock stability is proposed to reduce the internal driving force via a pressure relief method and improve the rigidity of the AS by full-length anchorage and grouting modification.

Mechanism of high-preload support based on the NPR anchor cable in layered soft rock tunnels

The control of large deformation problems in layered soft rock tunnels needs to solve urgently.The roof problem is particularly severe among the deformation issues in tunnels.This study first analyzes the asymmetric deformation modes in layered soft rock tunnels with large deformations.Subsequently,we construct a mechanical model under ideal conditions for controlling the roof of layered soft rock tunnels through high preload with the support of NPR anchor cables.The prominent roles of long and short NPR anchor cables in the support system are also analyzed.The results indicate the significance of high preload in controlling the roof of layered soft rock tunnels.The short NPR anchor cables effectively improve the integrity of the stratified soft rock layers,while the long NPR anchor cables effectively mobilize the self-bearing capacity of deep-stable rock layers.Finally,the high-preload support method with NPR anchor cables is validated to have a good effect on controlling large deformations in layered soft rock tunnels through field monitoring data.

Seismic stability of expansive soil slopes reinforced by anchor cables using a modified horizontal slice method

Earthquake-induced slope failures are common occurrences in engineering practice and pre-stressed anchor cables are an effective technique in maintaining slope stability,especially in areas that are prone to earthquakes.Furthermore,the soil at typical engineering sites also exhibit unsaturated features.Explicit considerations of these factors in slope stability estimations are crucial in producing accurate results.In this study,the seismic responses of expansive soil slopes stabilized by anchor cables is studied in the realm of kinematic limit analysis.A modified horizontal slice method is proposed to semi-analytically formulate the energy balance equation.An illustrative slope is studied to demonstrate the influences of suction,seismic excitations and anchor cables on the slope stability.The results indicate that the stabilizing effect of soil suction relates strongly to the seismic excitation and presents a sine shape as the seismic wave propagates.In higher and steeper slopes,the stabilizing effect of suction is more evident.The critical slip surface tends to be much more shallow as the seismic wave approaches the peak and vice versa.

Three-dimensional limit variation analysis on the ultimate pullout capacity of the anchor cables based on the Hoek-Brown failure criterion

Only simplified two-dimensional model and a single failure mode are adopted to calculate the ultimate pullout capacity(UPC)of anchor cables in most previous research.This study focuses on a more comprehensive combination failure mode that consists of bond failure of an anchorage body and failure of an anchored rock mass.The three-dimensional ultimate pullout capacity of the anchor cables is calculated based on the Hoek-Brown failure criterion and variation analysis method.The numerical solution for the curvilinear function in fracture plane is obtained based on the finite difference theory,which more accurately reflects the failure state of the anchor cable,as opposed to that being assumed in advance.The results reveal that relying solely on a single failure mode for UPC calculations has limitations,as changes in parameter values not only directly impact the UPC value but also can alter the failure model and thus the calculation method.

Minimum 10-year follow-up outcomes of arthroscopic Bankart’s repair with metallic anchors:Reliable results with low redislocation rates

BACKGROUND With stiff competition from alternative albeit more expensive counterparts,it has become important to establish the applicability of metallic anchors for shoulder instability in the modern era.This can be accomplished,in part,by analysing long-term outcomes.AIM To analyse minimum 10-year outcomes from 30 patients following arthroscopic anterior stabilisation using metallic anchors.METHODS Prospectively collected data from arthroscopic Bankart repairs performed using metal anchors during 2007P-2010 were retrospectively analysed in this singlesurgeon study.Comprehensive data collection included historical and clinical findings,dislocation details,operative specifics,and follow-up radiological and clinical findings including shoulder scores.The primary outcomes were patientreported scores(Constant,American Shoulder and Elbow Surgeons[ASES],and Rowe scores)and pain and instability on a visual analogue scale(VAS).RESULTS A 3% recurrence rate of dislocation was noted at the final follow-up.Total constant scores at 10 years postoperatively measured between 76 and 100(mean 89)were significantly better than preoperative scores(mean 62.7).Congruous improvements were also noted in the Rowe and ASES scores and VAS at the 10-year review.CONCLUSION Reliable long-term outcomes with metallic anchors in surgery for shoulder instability can be expected.Our results provide additional evidence of their continued,cost-effective presence in the modern scenario.

Anchor free与Anchor base算法结合的拥挤行人检测方法

由于精度相对较高,Anchor base算法目前已成为拥挤场景下行人检测的研究热点。但是,该算法需要手工设计锚框,限制了其通用性。同时,单一的非极大值抑制(NMS)筛选阈值作用于不同密度的人群区域会导致一定程度的漏检和误检。为此,该文提出一种Anchor free与Anchor base检测器相结合的双头检测算法。具体地,先利用Anchor free检测器对图像进行粗检测,将粗检测结果进行自动聚类生成锚框后反馈给区域建议网络(RPN)模块,以代替RPN阶段手工设计锚框的步骤。同时,通过对粗检测结果信息的统计可得到不同区域人群的密度信息。该文设计一个行人头部-全身互监督检测框架,利用头部检测结果与全身的检测结果互相监督,从而有效减少被抑制与漏检的目标实例。提出一种新的NMS算法,该方法可以自适应地为不同密度的人群区域选择合适的筛选阈值,从而最大限度地减少NMS处理引起的误检。所提出的检测器在CrowdHuman数据集和CityPersons数据集进行了实验验证,取得了与目前最先进的行人检测方法相当的性能。

A Localization Algorithm Using a Mobile Anchor Node Based on Region Determination in Underwater Wireless Sensor Networks

At present, most underwater positioning algorithms improve the positioning accuracy by increasing the number of anchor nodes which resulting in the increasing energy consumption. To solve this problem, the paper proposes a localization algorithm assisted by mobile anchor node and based on region determination(LMRD), which not only improves the positioning accuracy of nodes positioning but also reduces the energy consumption. This algorithm is divided into two stages: region determination stage and location positioning stage. In the region determination stage, the target region is divided into several sub-regions by the region division strategy with the smallest overlap rate which can reduce the number of virtual anchor nodes and lock the target node to a sub-region, and then through the planning of mobile nodes to optimize the travel path, reduce the moving distance, and reduce system energy consumption. In the location positioning stage, the target node location can be calculated using the HILBERT path planning and trilateration. The simulation results show that the proposed algorithm can improve the positioning accuracy when the energy consumption is reduced.

Magnetic anchor guidance for endoscopic submucosal dissection and other endoscopic procedures

Endoscopic submucosal dissection(ESD) is a wellestablished, minimally invasive treatment for superficial neoplasms of the gastrointestinal tract. The universal adoption of ESD has been limited by its slow learning curve, long procedure times, and high risk of complications. One technical challenge is the lack of a second hand that can provide traction, as in conventional surgery. Reliable tissue retraction that exposes the submucosal plane of dissection would allow for safer and more efficient dissection. Magnetic anchor guided endoscopic submucosal dissection(MAGESD) has potential benefits compared to other current traction methods. MAG-ESD offers dynamic tissue retraction independent of the endoscope mimicking a surgeon's "second hand". Two types of magnets can be used: electromagnets and permanent magnets. In this article we review the MAG-ESD technology, published work and studies of magnets in ESD. We also review the use of magnetic anchor guidance systems in natural orifice transluminal endoscopic surgery and the idea of magnetic non-contact retraction using surface ferromagentization. We discuss the current limitations, the future potential of MAG-ESD and the developments needed for adoption of this technology.

Miniature magnetically anchored and controlled camera system for trocar-less laparoscopy

AIM To design a miniature magnetically anchored and controlled camera system to reduce the number of trocars which are required for laparoscopy.METHODS The system consists of a miniature magnetically anchored camera with a 30° downward angle, an external magnetically anchored unit, and a vision output device. The camera weighs 12 g, measures Φ10.5 mm × 55 mm and has two magnets, a vision model, a light source, and a metal hexagonal nut. To test the prototype, the camera was inserted through a 12-mm conventional trocar in an ex vivo real liver laparoscopic training system. A trocar-less laparoscopic cholecystectomy was performed 6 times using a 12-mm and a 5-mm conventional trocar. In addition, the same procedure was performed in four canine models.RESULTS Both procedures were successfully performed using only two conventional laparoscopic trocars. The cholecystectomy was completed without any major complication in 42 min(38-45 min) in vitro and in 50 min(45-53 min) using an animal model. This camera was anchored and controlled by an external unit magnetically anchored on the abdominal wall. The camera could generate excellent image. with no instrument collisions.CONCLUSION The camera system we designed provides excellent optics and can be easily maneuvered. The number of conventional trocars is reduced without adding technical difficulties.

Penetration Depth of Torpedo Anchor in Two-Layered Cohesive Soil Bed by Free Fall

The penetration depth of torpedo anchor in two-layered soil bed was experimentally investigated. A total of 177 experimental data were obtained in laboratory by varying the undrained shear strength of the two-layered soil and the thickness of the top soil layer. The geometric parameters of the anchor and the soil properties(the liquid limit, plastic limit, specific gravity, undrained shear strength, density, and water content) were measured. Based on the energy analysis and present test data, an empirical formula to predict the penetration depth of torpedo anchor in two-layered soil bed was proposed. The proposed formula was extensively validated by laboratory and field data of previous researchers. The results were in good agreement with those obtained for two-layered and single-layered soil bed.Finally, a sensitivity analysis on the parameters in the formula was performed.

Free-Fall Penetration Behaviors of A New Dynamically Installed Plate Anchor in Marine Clay

A new dynamically installed plate anchor, the Flying Wing Anchor~?, has been developed as a sustainable anchor concept for deep-water offshore wind turbines. The anchor is firstly installed by free-fall penetration and then followed by drag embedment. If the anchor is subjected to environmental loads, it dives deeper to mobilize a higher capacity. This study presents a series of free-fall penetration tests with model anchors in different weights to assess the anchor behavior during the free-fall penetration performance in one-layer soil with a constant shear strength profile. Anchor velocities and embedment depths were measured by a magnetometer. An energy-based model and a force-based model were calibrated against the test results of model anchors with different weights. Based on the calibrated force-based model, a series of design charts were developed to estimate the embedment depth of anchors in different sizes and with different impact velocities in various marine clays. The framework to plot design charts presented herein can be potentially applied to other dynamically installed anchors to predict embedment depth in engineering practice.

Epigenetic interventions for brain rejuvenation：anchoring age-related transposons

Highlights：1.Iron and homocysteine accumulation in aging neurons alter genomic methylation.2.The altered methylome reactivates neuronal cell cycle,enabling transposable element mobilization.3.mi R29/p53 axis restores age-related methylation shifts,reactivating neuronal plasticity.4.Augmentation of mi R-29/p53 axis may preempt neurodegenerative disorders.

Six-Degree-of-Freedom Measurement of Plate Anchors in Centrifuge by Magnetometers

The six-degree-of-freedom movement of an offshore plate anchor is essential to evaluate anchor performance.As an emerging technology,magnetometer has shown its potential in measuring the six-degree-of-freedom movement of offshore anchors under 1-g model laboratory tests.The paper presents the feasibility of adopting a magnetometer system in geotechnical centrifuge testing.Interference factors that may affect the measuring accuracy of the magnetometer system are investigated.The results demonstrate that the magnetometer system can accurately catch the anchor movement in the soils with the restrictions of:(1)the model anchor was made with stainless steel;(2)the system was placed at least 30 cm away from the side wall of soil model tank;(3)started the measurement when the artificial acceleration by centrifuge was stable.

Energy‐based analysis of seismic damage mechanism of multi‐anchor piles in tunnel crossing landslide area

To study the damage mechanism of multi‐anchor piles in tunnel crossing landslide area under earthquake,the damping performance of multi‐anchor piles was discussed.The energy dissipation springs were used as the optimization device of the anchor head to carry out the shaking table comparison test on the reinforced slope.The Hilbert spectrum and Hilbert marginal spectrum were proposed to analyze the seismic damage mechanism of the multi‐anchor piles,and the peak Fourier spectrum amplitude(PFSA)was used to verify the effectiveness of the method.The results show that the seismic energy is concentrated in the high‐frequency component(30-40Hz)of the Hilbert spectrum and the low‐frequency component(12-30 Hz)of the marginal spectrum.This indicates that they can be combined with the distribution law of the PFSA to identify the overall and local dynamic responses of the multi‐anchored piles,respectively.The stretchable deformation of the energy‐dissipation springs improves the coordination of the multi‐anchor piles,resulting in better pile integrity.The damage mechanism of the multi‐anchor piles is elucidated based on the energy method:local damage at the top and middle areas of the multi‐anchor piles is mainly caused by the low‐frequency component(12-30 Hz)of the marginal spectrum under the action of 0.15g and 0.20g seismic intensities.As the seismic intensity increases to 0.30g,the dynamic response of the slope is further amplified by the high‐frequency component(30-40 Hz)of the Hilbert energy spectrum,which leads to the overall damage of the multi‐anchor piles.

Artificial Neural Network Model for Predicting Ultimate Tensile Capacity of Adhesive Anchors

To predict the tensile capacity of adhesive anchors, a multilayered feed-forward neural network trained with the back-propagation algorithm is constructed. The ANN model have 5 inputs, including the compressive strength of concrete, tensile strength of concrete, anchor diameter, hole diameter, embedment of anchors, and ultimate load. The predictions obtained from the trained ANN show a good agreement with the experiments. Meanwhile, the predicted ultimate tensile capacity of anchors is close to the one calculated from the strength formula of the combined cone-bond failure model.

Application of a new basalt fiber-reinforced polymer anchorage structure in the tunnel–slope system under rainfall action

The application of basalt fiber-reinforced polymer(BFRP)anchors has gained significant attention,particularly in the field of geotechnical anchorage engineering because of its high strength and corrosion resistance.The research on the applicability of BFRP anchor in a tunnel–slope system under rainfall is of practical significance to solve the problem of instability damage to anchored slopes caused by corrosion of steel anchors.In this study,model tests of BFRP and steel anchorage structures were conducted to compare their reinforcement capability in a tunnel–slope system under heavy rainfall.The results show that the BFRP anchorage structure is better than the steel in coordinating slope deformation and stabilizing earth pressure around the tunnel.The deformation of slopes under rainfall is classified into four stages:initial,isokinetic,accelerated,and blocked deformations.BFRP anchors have the same axial strain distribution pattern as the steel anchors,and they are convexly distributed along the axial direction of the anchors.The correlation analysis and Pearson linear correlation analysis of the multi-attribute data of the slope and BFRP anchors showed a positive correlation among BFRP anchor strain,earth pressure inside the slope,slope deformation displacement,and accumulated rainfall.These research results provide a basis and reference for the application of BFRP anchors in the anchorage engineering of the tunnel–slope system under rainfall action.

A new anchor-siphon drainage combined method used for slope stabilization

A new anchor-siphon drainage combined method used for slope stabilization is proposed in this paper.It includes an anchoring section and a siphon drainage section.The novelty of the anchor-siphon drainage combined method is the realization of the drainage and anchoring in the one inclined borehole.The engineering cost of drilling and the resulting disturbance to the slope is reduced.To validate the feasibility of the proposed method,a numerical method that combines the pore water pressure distribution after siphon drainage and the anchoring force of the anchoring section is used to evaluate the safety of the slope with the anchor-siphon drainage method.The proposed method was illustrated and validated with the Hongpu Village landslide,in Tonglu County,Zhejiang Province,in China.Compared with the common anchor bar with the same length in the anchoring section,the factor of safety(FOS)for Hongpu Village slope with anchorsiphon drainage is increased by 0.085.The calculation method of the optimal length ratio between the drainage section and the anchoring section and its influencing factors were studied.For the different design parameters,there is always an optimal length ratio of the drainage section.Compared with the siphon drainage and full-length anchor bar with the same borehole length,the anchor-siphon drainage combined method shows better landslide prevention ability.Moreover,when the optimized parameters with a bond strength of 560kPa,a borehole inclination of 35°,and no reduction in length are used,the calculated safety factor is 1.316,which is significantly higher than the FOS of 1.131 for the slope with siphon drainage.