Fatal risk in hysteroscopic surgery that should not be overlooked:Uterine artery pseudoaneurysm

This article provides a detailed account of the diagnosis and treatment of a case involving a uterine artery pseudoaneurysm(UAP),as well as an analysis of UAP etiology.This finding emphasizes that UAP should be considered in patients presenting with abnormal genital bleeding after hysteroscopy and offers valuable insights and lessons for gynecologists in hysteroscopic procedures.The patient underwent timely relevant examinations to confirm the diagnosis,allowing for crucial time required for her treatment.In this study,the primary cause of UAP formation in the patient was attributed to a prior hysteroscopic surgical procedure conducted at another medical facility,suggesting that the selection and imple-mentation of dilatation catheters are some of the predisposing factors for UAP.In conclusion,this case study offers a comprehensive analysis of the etiology of UAP and effectively provides timely diagnosis and treatment,offering valuable in-sights for the clinical diagnosis and management of UAP.

Cauda equina syndrome with urinary retention as a postoperative complication of lumbar spine surgery:A case report

BACKGROUND Cauda equina syndrome(CES)is characterized by a group of symptoms that may be caused by inflammation,spinal cord compression,venous congestion,or ischemia.This syndrome is commonly an indication for surgical intervention but has not been determined as a postoperative complication following surgery for lumbar spine disease.CASE SUMMARY To report the case of a 54-year-old male patient who had CES following spinal surgery,with no obvious compression lesions found during re-exploration,suggesting that vascular insufficiency may have contributed to the condition.Furthermore,a series of urodynamic studies on bladder recovery patterns in such complications have also been investigated.CONCLUSION Postoperative CES requires urgent imaging and exploration to rule out compression;noncompressive cases,including vascular insufficiency may performed conservative management.

Root canal therapy combined with endoscopic sinus surgery for odontogenic sinusitis:Efficacy comparison in a cohort study

BACKGROUND Odontogenic maxillary sinusitis,often triggered by dental issues like periapical periodontitis,significantly contributes to chronic sinusitis,mainly affecting adults around 50 years old,emphasizing the need for a multidisciplinary diagnostic and treatment approach.AIM To investigate the therapeutic effect and clinical value of root canal therapy combined with nasal endoscopic surgery compared with simple root canal the-rapy in the treatment of severe odontogenic maxillary sinusitis caused by peria-pical periodontitis.METHODS The clinical data,diagnosis,and treatment of 200 patients with severe odonto-genic maxillary sinusitis caused by periapical periodontitis from October 2020 to October 2021 were analyzed retrospectively.Among them,63 patients were treated with simple root canal therapy as the control group,and 137 patients were treated with root canal therapy combined with nasal endoscopic surgery as the observation group.The therapeutic effect,Lund-Kennedy endoscopic score,paranasal sinus Lund-Mackay score,complication rate,recurrence rate,and patient satisfaction were compared between the two groups.RESULTS First,we compared the effective rates:23 cases were cured,22 were improved,and 8 were ineffective in the control group,yielding a total effective rate of 84.90%.Meanwhile,97 cases were cured,34 improved,and 6 were ineffective in the observation group,resulting in a total effective rate of 95.62%.The observation group had a higher total effective rate compared with the control group(P<0.05).Second,we compared the Lund–Kennedy endoscopic score.Before treatment,no significant difference(P>0.05)was observed in this score between the two groups.After treatment,the Lund–Kennedy endoscopic score decreased in both groups.The Lund–Kennedy endoscopic score of the observation group at 3 and 6 mo after treatment was lower compared to that of the control group(P<0.05).Third,we compared the Lund–Mackay score of paranasal sinuses.Before treatment,there was no significant difference in this score between the two groups(P>0.05).After treatment,the Lund–Mackay scores of paranasal sinuses decreased in both groups.The Lund–Mackay scores of paranasal sinuses in the observation group at 3 and 6 mo after treatment were lower compared to those of the control group(P<0.05).Fourth,we compared the incidence and recurrence rate of complications.Three months after treatment,no significant difference was found in the incidence and recurrence rate of complications between the observation group(6.56%)and the control group(9.52%)(P>0.05).However,6 mo after treatment,the incidence and recurrence rate of complications in the observation group(2.91%)was significantly higher compared to that of the control group(12.69%)(P<0.05).Fifth,we compared patient satisfaction.Six months after treatment,the patient satisfaction of the observation group(93.43%)was significantly better than that of the control group(84.12%)(P<0.05).CONCLUSION Root canal therapy combined with nasal endoscopic surgery has a good therapeutic effect on severe odontogenic maxillary sinusitis caused by periapical periodontitis,and it can reduce the injury of maxillary sinus mucosa and bone,and significantly reduce the incidence of complications and recurrence rate.Meanwhile,it has high patient satisfaction and remarkable therapeutic effect,which is suggested to be popularized and applied in clinic.

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.

渤海湾沿海低地第II海相层MIS5a阶段海侵与全球海平面变化的时间对比研究

【研究目的 】渤海湾地区第II海相层的形成时代仍存争议,制约着该地区海平面变化研究进展。本研究对该层进行光释光定年,以期标定准确的地层年代及对应的海侵期次。【研究方法 】以渤海湾西岸CZ80、CZ85、CZ66钻孔为研究对象,在岩心沉积结构、构造及有孔虫丰度,沉积微相研究基础上,识别出了第II海相层,并建立了第II海相层对比剖面。通过光释光测年方法对该地层的形成时代进行了准确测定,进一步讨论第II海相层的发育时间与全球海平面变化关系。【研究结果 】CZ80、CZ85及CZ66孔在全新统(含第I海相层)以下均钻遇到了第II海相层,海相层底板埋深在35~33m,对应黄海高程-31.13~-28.39m,顶板埋深32~20m,高程-25.58~-15.39 m。光释光测年结果表明第II海相层所对应的海侵事件发育时间约为94~71 ka。【结论 】光释光测年结果表明,该区第II海相层始于94 ka或更早,海水影响在距今约71 ka结束。对比全球海面曲线,第II海相层时空特征与MIS5a阶段相符,记录了MIS5a阶段海侵事件。

Gin+GORM通用MIS系统设计

文章旨在介绍一种基于Go语言中的Gin和GORM框架开发的通用管理信息系统(Management Information System,MIS)的设计与实现。MIS系统在各种组织中发挥着关键作用,用于处理、管理和分析各种信息,通过Gin和GORM这两个流行的开源框架,可以快速搭建一个稳定、高效的MIS系统,以满足企业管理信息系统的需求,并提供友好的用户界面和可靠的数据管理。该方案可针对不同的业务需求进行快速定制和扩展功能,具有高度可扩展性和灵活性。

术前体位复位联合术中提拉复位辅助Mis-TLIF技术治疗峡部裂型腰椎滑脱

目的:探讨应用微创经椎间孔腰椎椎间融合术(minimally invasive transforaminal lumbar interbody fusion,Mis-TLIF)结合术前体位复位治疗峡部裂型腰椎滑脱的临床效果并总结其优点。方法:回顾性分析2016年7月至2022年7月收治的60例腰椎峡部裂型滑脱患者,其中男26例,女34例;年龄35~72(51.32±4.24)岁。依据手术方式分为观察组和对照组。观察组30例,男12例,女18例;年龄35~71(51.80±6.38)岁;病程12~60(24.17±1.98)个月;L4滑脱18例,L5滑脱12例;Meyerding分级Ⅰ度滑脱20例,Ⅱ度滑脱10例;采用术前体位复位联合术中撑开复位后经Quadrant通道Mis-TLIF。对照组30例,男14例,女16例;年龄36~72(50.00±4.24)岁;病程12~60(23.70±1.53)个月;L4滑脱16例,L5滑脱14例;Meyerding分级Ⅰ度滑脱19例,Ⅱ度滑脱11例;采用传统后路开放椎体融合术治疗。分析两组的手术时间、术中及术后出血量、术后住院时间、放射线暴露时间和并发症等方面的差异。采用视觉模拟评分(visual analogue scale,VAS)、Oswestry功能障碍指数(Oswestry disability index,ODI)及日本骨科协会(Japanese Orthopaedic Association,JOA)评分(腰椎评分标准)评估临床效果,随访复查X线及CT评估椎间融合情况。结果:所有患者获得12个月的随访。两组在手术时间、腰痛VAS、滑脱角、滑脱率等方面差异无统计学意义(P>0.05)。观察组术中术后出血量(165.50±15.56)、(59.17±10.59)ml,均少于对照组(259.33±35.32)、(165.33±29.56)ml(P<0.05);观察组住院时间(3.53±0.68)d,少于对照组(5.20±0.41)d(P<0.05);末次随访时两组椎间隙高度、滑脱角、滑脱率、ODI、VAS、JOA评分均较术前明显改善(P<0.05)。末次随访观察组与对照组ODI[(9.93±1.11)%vs(10.93±1.11)%]和JOA[(26.07±1.01)分vs(25.43±1.25)分]比较,差异有统计学意义(P<0.05)。结论:在峡部裂型腰椎滑脱的治疗中,术前体位复位联合术中提拉复位辅助Mis-Tlif技术相比传统开放性手术具有创伤小、出血少、住院周期短等优点,是一种安全有效的技术。

CT三维重建技术在腰椎退行性疾病MIS-TLIF中应用效果及影像学研究

目的探讨CT三维重建技术在腰椎退行性疾病MIS-TLIF中应用效果及影像学结果。方法前瞻性选取2021年4月至2023年4月衡水市第四人民医院腰椎退行性疾病患者106例作为研究对象,随机数字表法分组,各53例。对照组采取MIS-TLIF,研究组采取CT三维重建技术辅助MIS-TLIF。统计2组围术期指标、影像学结果(置钉准确性、关节突关节侵犯程度、椎间融合状态)、并发症及手术前后细胞因子[白细胞介素-10(IL-10)、肿瘤坏死因子-α(TNF-α)、IL-17]、Oswestry功能障碍指数(ODI)、视觉模拟评分法(VAS)得分。结果与对照组比较,研究组术中出血量、透视次数较少,住院时间、每枚螺钉置入时间较短,手术时间较长(P<0.05);研究组Gertzbein-Robbins、FJV分级均优于对照组(P<0.05);术后1d,2组血清IL-10、TNF-α、IL-17含量均高于术前,且研究组低于对照组(P<0.05);术后5 d、6个月、12个月,2组VAS、ODI评分均低于术前(P<0.05);2组椎间融合状态及并发症发生率比较差异无统计学意义(P>0.05)。结论CT三维重建技术在腰椎退行性疾病MIS-TLIF中效果确切,有助于减少透视次数,提高置钉准确性,缩短住院时间,且对细胞因子影响较小。

Bariatric surgery and diabetes remission: Sleeve gastrectomy or mini-gastric bypass?

AIM:To investigate the weight loss and glycemic control status[blood glucose,hemoglobin A1c(HbA1c)and hypoglycaemic treatment].METHODS:The primary risk factor for type 2 diabetes is obesity,and 90%of all patients with type 2 diabetes are overweight or obese.Although a remarkable effect of bariatric surgery is the profound and durable resolution of type 2 diabetes clinical manifestations,little is known about the difference among various weight loss surgical procedures on diabetes remission.Data from patients referred during a 3-year period(from January2009 to December 2011)to the University of Naples"FedericoⅡ"diagnosed with obesity and diabetes were retrieved from a prospective database.The patients were split into two groups according to the surgical intervention performed[sleeve gastrectomy(SG)and mini-gastric bypass(MGB)].Weight loss and glycemic control status(blood glucose,HbA1c and hypoglycaemic treatment)were evaluated.RESULTS:A total of 53 subjects who underwent sleeve gastrectomy or mini-gastric bypass for obesity and diabetes were screened for the inclusion in this study.Of these,4 subjects were excluded because of surgical complications,7 subjects were omitted because young surgeons conducted the operations and 11 subjects were removed because of the lack of follow-up.Thirtyone obese patients were recruited for this study.A total of 15 subjects underwent SG(48.4%),and 16underwent MGB(51.6%).After adjusting for various clinical and demographic characteristics in a multivariate logistic regression analysis,high hemoglobin A1c was determined to be a negative predictor of diabetes remission at 12 mo(OR=0.366,95%CI:0.152-0.884).Using the same regression model,MGB showed a clear trend toward higher diabetes remission rates relative to SG(OR=3.780,95%CI:0.961-14.872).CONCLUSION:Although our results are encouraging regarding the effectiveness of mini-gastric bypass on diabetes remission,further studies are needed to provide definitive conclusions in selecting the ideal procedure for diabetes remission.

Two case reports of acute upper gastrointestinal bleeding from duodenal ulcers after Roux-en-Y gastric bypass surgery: Endoscopic diagnosis and therapy by single balloon or push enteroscopy after missed diagnosis by standard esophagogastroduodenoscopy

The diagnosis and opportunity for endoscopic therapy of gastric or duodenal lesions may be missed at esophagogastroduodenoscopy(EGD) because of technical difficulty in intubating at EGD the postoperatively excluded stomach and proximal duodenum in patients status post Roux-en-Y gastric bypass(RYGB). Two cases are reported of acute upper gastrointestinal bleeding 10 or 11 years status postRYGB, performed for morbid obesity, in which the EGD was non-diagnostic due to failure to intubate the excluded stomach and proximal duodenum, whereas subsequent push enteroscopy or single balloon enteroscopy were diagnostic and revealed 4-cm-wide or 5-mm-wide bulbar ulcers and even permitted application of endoscopic therapy. These case reports suggest consideration of push enteroscopy, or single balloon enteroscopy, where available, in the endoscopic evaluation of acute UGI bleeding in patients status post RYGB surgery when the EGD was non-diagnostic because of failure to intubate these excluded segments.

基于多重生物信息学数据库分析Mis18β在膀胱癌组织中的表达及其临床意义

目的:探讨Mis18β基因在膀胱癌组织中的表达、临床意义及在疾病过程中的作用。方法:通过癌症基因组图谱(The Cancer Genome Atlas, TCGA)数据库获得膀胱癌患者Mis18β mRNA测序数据及临床资料数据,通过基因表达综合(Gene Expression Omnibus, GEO)数据库获得膀胱癌Mis18β表达数据,分析Mis18β在膀胱癌组织和癌旁组织中mRNA表达差异及与患者临床病理参数的相关性并进行生存分析,利用基因本体论(Gene Ontology, GO)功能分析以及京都基因与基因组百科全书(Kyoto Encyclopedia of Gene and Genomes, KEGG)通路富集分析探索Mis18β在膀胱癌发生发展中可能的信号通路。收集膀胱癌患者及健康对照者外周血标本,RT-PCR方法验证Mis18β mRNA表达水平的差异。结果:TCGA数据库和GEO数据库分析显示膀胱癌组Mis18β的表达量明显高于对照组(P<0.05)。生存分析提示Mis18β高表达组膀胱癌患者的总生存期明显低于低表达组(P<0.05)。功能富集分析显示Mis18β主要参与细胞有丝分裂,调控细胞周期及DNA复制等过程。膀胱癌患者外周血有核细胞中Mis18β的含量明显高于对照组(P<0.05)。结论:Mis18β在膀胱癌中呈高表达,其表达水平与患者年龄、病理类型、总生存期等临床病理特征存在相关性,为揭示膀胱癌发生发展的分子机制及寻找新的诊断、预后标志物提供了理论基础。

The Janus of mIS in hepatobiliary surgery:Importance of maximally invasive surgery in an era of minimally invasive surgery

As surgeons formidably continue to forge into the twentytwenties,after a considerably coronavirus-induced rocky start,one can predict that the era of minimally invasive surgery(mIS),an era of robotics,telehealth,and enhanced recovery after surgery(ERAS■),is not only here to stay but will continue to thrive,develop,and transform our practices.Critics of robotics platforms would be hard pressed not to indulge in this prediction.Will the satisfyingly large midline“stem to stern”,the impressing exposuregenerating Makuuchi or transverse abdominal,the Kocher,paramedian,McBurney,Chevron,and Pfannenstiel incisions begin to disappear and fade away into a scar minimizing future precluding trauma laparotomies?Most likely not.Understanding and developing the skill and technique for a minimally invasive“mIS”approach does not negate or abrogate the maximally invasive“MIS”ones.It is not one or the other;not a“to be or not to be”Shakespearean scenario.Hepatobiliary surgery is a qualified landscape upon which to illuminate and exemplify this declaration:the necessity and companionship of“mIS”and“MIS”–minimally and maximally invasive surgery.

Effect of oncometabolic surgery on gastric cancer:The remission of hypertension,type 2 diabetes mellitus,and beyond

This review summarizes the definition and surgical methods of oncometabolic surgery according to previous studies.Then,the authors discuss the beneficial effects observed after gastrectomy in gastric cancer(GC)patients with concurrent hypertension or type 2 diabetes mellitus(T2DM).The authors summarize the current studies analyzing the remission rate and the hypotheses of the mechanisms underlying these effects.The remission rate ranged from 42.5%-65.4%in T2DM patients and from 11.1%-57.6%among those with hypertension.Furthermore,the remission of T2DM could have an impact on overall survival rates as well.The mechanisms underlying the remission of hypertension and T2DM is unclear in current studies,but oncometabolic surgery is expected to be applied in clinical practice.In addition,the effect of oncometabolic surgery on other chronic metabolic comorbidities is expected to be proven in further studies.Therefore,the purpose of this review is to discuss the effects of oncometabolic surgery reported in current studies with a primary focus on the remission of hypertension and T2DM after gastrectomy in GC patients.The possibility of the remission of other metabolic comorbidities in GC patients who undergo oncometabolic surgery is also discussed.

Diabetes remission after bariatric surgery

Over the last decade,obesity rates have continued to rise in the United States as well as worldwide and are showing no signs of slowing down.This rise is in parallel with the increasing rates of type 2 diabetes mellitus(T2DM).Given the association between obesity and T2DM and their strong correlation with increased morbidity and mortality in addition to healthcare expenditure,it is important to recognize the most effective ways to combat them.Thus,we performed a review of literature that focused on assessing the outcomes of T2DM following bariatric surgery.Available evidence suggests that bariatric surgery provides better T2DM resolution in obese patients when compared to best medical management alone.Additionally,Biliopancreatic diversion with duodenal switch as well as Roux-en-Y gastric bypass have demonstrated higher rates of T2DM resolution when compared with other bariatric procedures.

Which predictors could effect on remission of type 2 diabetes mellitus after the metabolic surgery:A general perspective of current studies?

BACKGROUND The alarming rise in the worldwide prevalence of obesity is paralleled by an increasing burden of type 2 diabetes mellitus(T2DM).Metabolic surgery is the most effective means of obtaining substantial and durable weight loss in individual obese patients with T2DM.There are randomized trials that justify the inclusion of metabolic surgery into the treatment algorithm for patients with T2DM,but remission rates of T2DM after metabolic surgery can display great variability.AIM To discuss the most commonly used surgical options including vertical sleeve gastrectomy,adjustable gastric banding,Roux-en-Y gastric bypass,and biliopancreatic diversion with duodenal switch.METHODS We also report from observational and randomized controlled studies on rate of remission of T2DM after the surgical procedures.RESULTS In light of the recent findings,metabolic surgery is a safe and effective treatment option for obese patient with T2DM,but further studies are needed to clarify better the rate of diabetes remission.CONCLUSION In light of the recent findings,metabolic surgery is a safe and effective treatment option for obese patients with T2DM,but further studies are needed to clarify better the rate of diabetes remission.

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.

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.

Cellular therapy:A promising tool in the future of colorectal surgery

Cellular therapy may be the solution of challenging problems in colorectal surgery such as impaired healing leading to anastomotic leakage and metastatic colorectal cancer(CRC). This review aimed to illustrate the role of cellular therapy in promotion of wound healing and management of metastatic CRC. An organized literature search for the role of cellular therapy in promotion of wound healing and management of metastatic CRC was conducted. Electronic databases including PubMed/Medline, Scopus, and Embase were queried for the search process. Two types of cellular therapy have been recognized, the mesenchymal stem cells(MSCs) and bone marrow-mononuclear cells(BM-MNCs) therapy.These cells have been shown to accelerate and promote healing of various tissue injuries in animal and human studies. In addition, experimental studies have reported that MSCs may help suppress the progression of colon cancer in rat models. This article reviews the possible mechanisms of action and clinical utility of MSCs and BM-MNCs in promotion of healing and suppression of tumor growth in light of the published literature. Cellular therapy has a potentially important role in colorectal surgery, particularly in the promotion of wound healing and management of metastatic CRC. Future directions of cellular therapy in colorectal surgery were explored which may help stimulate futures studies on the role of cellular therapy in colorectal surgery.

青藏高原“MIS 4冰进”的^(10)Be地表暴露测年证据

地貌地层证据及绝对测年数据显示,青藏高原及其周边山地在第四纪期间经历了多次显著的冰川进退。深海氧同位素4阶段(MIS 4)作为末次冰期的一个冰阶,全球平均气温降低、大陆冰量增多、海平面下降,零星测年数据显示青藏高原少数几个山地可能在MIS 4冷期出现冰川前进(本文统一用“MIS 4冰进”来指代冰川漂砾暴露测年数据落在MIS 4的冰川前进,但冰进过程本身不一定完全发生在MIS 4期间)。辽阔的青藏高原面上分布着无数高海拔山地,MIS 4冰进是否广泛存在于其他山地?冰川发育的时间过程又是如何?这些问题仍缺乏系统论述。本文统计并重新计算了青藏高原已发表的落在MIS 4及相近年代的冰川漂砾^(10)Be地表暴露年代,进一步运用P-CAAT方法对暴露年代进行细化分析,最终得到12组(即12个地点)落在MIS 4区间的暴露年代数据,这12个地点主要分布在高原的中南部和西部地区,分析得到:(1)MIS 4时期,青藏高原西部、南部、东部与内部地区曾发生过冰川前进,冰进规模西部最大,南部其次,内部最小,可能主要与冰川补给量的多寡有关。(2)青藏高原MIS 4冰进主要受控于北半球夏季太阳辐射与大气CO_(2)浓度的变化以及北半球中纬度西风带的迁移:MIS 5a至MIS 4早期,太阳辐射逐渐下降至最低值,同期CO_(2)浓度也显著降低,高原气温相应降低,同时,北半球高低纬间温度梯度增大,西风增强且位置南移,可能带来较多冬半年(固态)降水,冰川物质积累量增加,导致冰川前进;MIS 4中、晚期,随着夏季太阳辐射进一步增多及CO_(2)浓度的迅速上升,冰川开始快速退缩。

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.