Efficacy of Intraoperative vs Preoperative Indocyanine Green Administration for Near-Infrared Cholangiography During Laparoscopic Cholecystectomy: An Open-Label, Non-Inferiority, Randomized Controlled Trial.

BACKGROUND: Near-infrared fluorescence cholangiography (NIRFC) improves the clinical effects of laparoscopic cholecystectomy. However, the administration of indocyanine green (ICG) remains controversial. Both the intraoperative (IS, 0.05mg) and preoperative (PS, 0.25mg/kg body weight, 1 day before operation) strategies have been shown to be superior to standard strategy (2.5mg, intraoperative). This trial was designed to determine whether IS offers non-inferior visualization of biliary ducts compared to PS. STUDY DESIGN: A total of 168 eligible patients undergoing laparoscopic cholecystectomy were enrolled in this non-inferiority, open-label, randomized controlled trial at Zhujiang hospital between August 2023 and November 2023. Participants were randomized in a 1:1 ratio into PS and IS groups after stratification by BMI and inflammation level. The fluorescence visualization of biliary structures was assessed by comparing the signal-to-background ratio (SBR) and surgeon evaluations. RESULTS: The common bile duct-liver SBR did not significantly differ between IS and PS groups (3.0±0.8 vs 3.1±1.2; p=0.636). The liver fluorescence intensity (FI) of the IS group was significantly lower than that of the PS group (46.3±12.9 vs 70.4±26.2; p<0.01). The visualization score of common hepatic ducts was significantly greater in the IS than in the PS group (4.1±0.7 vs 3.7±0.6; p＜0.01). The critical view of safety (CVS) was achieved more rapidly in the IS group compared to the PS group (9.4 vs 11.0 minutes, p<0.01). CONCLUSION: While IS did not improve the SBR, it significantly reduced the FI of the liver background, potentially enhancing the surgeon's subjective perception and thereby increasing the visualization score. Compared to PS, IS offers greater convenience and is more effective in facilitating CVS exposure.

Epidermal growth factor-incorporated hydrogen bond crosslinked hemostatic microparticles capable of timely response to accidental bleeding for prehospital rescue.

Prehospital rescue of accidental massive bleeding is crucial for saving lives. However, currently available hemostatic materials are still in infancy in treating accidental bleeding due to the challenges in fully satisfying the complex outdoor hemostatic requirements. Herein, we designed an epidermal growth factor (EGF)- incorporated, microparticle-formed, high-strength, dynamic environment-stable hemostatic gel system for prehospital rescue. Carboxyl and dimethylamide were employed as the hydrogen bond (H-bond) groups and were carefully engineered into the microparticles (DHMs). We demonstrated that the unique H-bond crosslinked micronized structure enabled the DHM-based gelling system to adequately meet the outdoor hemostatic requirements. The stable H-bond groups allow the DHMs to be stored at room temperature and be easily carried around. The small sizes (150-250 µm) of the DHMs enabled the filling of irregular defects, and upon encountering water, these DHMs integrated into hydrogels (DHMs-gels) with high mechanical strength (1.61 MPa), strong tissue adhesiveness (66.5 kPa) and stable performance under dynamic environments. In vivo results showed that the EGF-incorporated DHMs-gels (DHMs-EGF gel) achieved a 100 % survival rate in a simulated rescue process and promoted wound healing. Simultaneously possessing multiple prehospital rescue-required properties, the hemostatic DHMs-EGF may become an effective tool for emergency rescue.

Radiosurgery versus observation for brainstem cavernous malformations: a 5-year multicentre cohort study.

The role of radiosurgery in preventing haemorrhage in brainstem cavernous malformations remains a subject of debate. This study aims to evaluate whether radiosurgery provides a protective benefit against haemorrhage in these patients. This multicentre, prospective observational study was conducted in 17 centres and enrolled eligible patients with brainstem cavernous malformations consecutively. Data collected included clinical baseline information, radiosurgery planning details, periodic follow-up evaluations, and any adverse radiation effects. The primary outcome of the study was the incidence of first prospective haemorrhage, while the secondary outcome was the development of new or worsening neurological dysfunctions. The impact of radiosurgery was assessed using multivariate Cox regression analysis. From March 2016 to August 2018, the study enrolled 377 patients: 280 in the observation group receiving standard care alone and 97 in the radiosurgery group receiving both radiosurgery and standard care. The overall cohort consisted of 173 females (45.9%) with a mean age of 40.5 years (range, 18-68 years), and there were no significant differences in baseline characteristics between the two groups. After a median follow-up period of 70 months, haemorrhage occurred in 25.0% (n = 70) of patients in the observation group and 10.3% (n = 10) of patients in the radiosurgery group. Multivariate Cox regression analysis identified radiosurgery as an independent protective factor against haemorrhage (hazard ratio 0.379, 95% confidence interval 0.195-0.738, P = 0.004). Following 1:2 propensity score matching, the incidence of prospective haemorrhage were 24.9% (45/181) in the observation group compared to 10.3% (10/97) in the radiosurgery group (hazard ratio 0.379, 95% confidence interval 0.190-0.755, P = 0.006). Adverse radiation effects were observed in 12 patients (12.4%), with none were permanent. Additionally, new or worsening neurological dysfunctions were significantly more common in the observation group (28.9%) compared to the radiosurgery group (16.5%) (P = 0.016). These results suggest that radiosurgery is associated with a low rate of haemorrhage in patients with brainstem cavernous malformations and could provide a benefit in selected patients. However, further research is required to confirm these findings.

Copper-catalyzed perfluoroalkylation of propargyl gem-dichlorides.

Herein, we present a highly efficient copper-catalyzed protocol for transforming propargyl gem-dichlorides into the corresponding chloro-substituted fluoroalkylated allenes. This protocol demonstrates a broad substrate scope and excellent tolerance towards various functional groups. Moreover, the strategy of utilizing the chloro-substituted pentafluoroethylation allenes for multiple transformations has shown significant value in synthetic chemistry.

Temporal interaction and its role in the evolution of cooperation.

This research investigates the impact of dynamic, time-varying interactions on cooperative behavior in social dilemmas. Traditional research has focused on deterministic rules governing pairwise interactions, yet the impact of interaction frequency and synchronization in groups on cooperation remains underexplored. Addressing this gap, our work introduces two temporal interaction mechanisms to model the stochastic or periodic participation of individuals in public goods games, acknowledging real-life variances due to exogenous temporal factors and geographical time differences. We consider that the interaction state significantly influences both game payoff calculations and the strategy updating process, offering new insights into the emergence and sustainability of cooperation. Our results indicate that maximum game participation frequency is suboptimal under a stochastic interaction mechanism. Instead, an intermediate activation probability maximizes cooperation, suggesting a vital balance between interaction frequency and inactivity security. Furthermore, local synchronization of interactions within specific areas is shown to be beneficial, as time differences hinder the spread of cross-structures but promote the formation of dense cooperative clusters with smoother boundaries. We also note that stronger clustering in networks, larger group sizes, and lower noise increase cooperation. This research contributes to understanding the role of node-based temporality and probabilistic interactions in social dilemmas, offering insights into fostering cooperation.

Health literacy and its associated factors among the population in two schistosomiasis-endemic villages in Jiangxi Province, China.

This cross-sectional study aimed to assess the levels of health literacy and the associated factors among the general population living in 2 schistosomiasis-endemic villages in Jiangxi Province, China. Multistage stratified random sampling was used to select participants, and a face-to-face survey was conducted from July to August 2021 to collect participants' socio-demographic characteristics and levels of overall health literacy (HL) and its 3 subscales: health literacy of basic knowledge and concepts (HL-BKC), health literacy of behavior and lifestyle (HL-BAL), and health literacy of health-related skills (HL-HRS). The Chi-square test and logistic regression models were used to assess the association between socio-demographic characteristics and low HL levels. The prevalence rates of low overall HL, HL-BKC, HL-BAL, and HL-HRS were 84.3%, 61.8%, 82.6%, and 86%, respectively. In addition, no significant differences (P > .05) were noted between the 2 villages regarding overall HL scores and the 3 subscales of health literacy scores. Older age (P < .001), occupation (P < .001), lower educational level (P < .001), and lower annual household income (P < .05) were associated with an increased risk of low HL. Multivariate logistic regression revealed that occupation as a student (OR = 32.289, 95% CI:1.965-530.462, P < .05) and fishermen (OR = 27.902, 95%CI:1.91-407.642, P < .05), lower education level (OR = 0.384, 95%CI:0.149-0.99, P < .05), older age (OR = 5.228, 95%CI:1.458-18.75, P < .001), and lower annual household income (OR = 0.452, 95%CI:0.24-0.851, P < .05) were independently associated with low HL. The prevalence of low HL is high among the population in the schistosomiasis-endemic villages of Jiangxi Province, China. Age, education level, occupation, and annual household income were all independent factors associated with HL levels. Health educational interventions to improve HL should be simultaneously conducted in health promotion work to reduce risky habits.

Application of decalcified bone matrix in Salmon bone for tibial defect repair in rat model.

AIM: The optimal preparation conditions of Salmon decalcified bone matrix (S-DBM) were explored, and the properties of S-DBM bone particles and bone powder were studied respectively. The therapeutic effect of S-DBM on tibial defect in female Sprague Dawley (SD) rats was preliminarily verified. METHODS: This study assessed the structural and functional similarities of Salmon bone DBM (S-DBM). The biocompatibility assessment was conducted using both in vivo and in vitro experiments, establishing an animal model featuring tibial defects in rats and on the L929 cell line, respectively. The control group, bovine DBM (bDBM), was compared to the S-DBM-treated tibial defect rats. Imaging and histology were used to study implant material changes, defect healing, osteoinductive repair, and degradation. RESULTS: The findings of our study indicate that S-DBM exhibits favorable repairing effects on bone defects, along with desirable physicochemical characteristics, safety, and osteogenic activity. CONCLUSIONS: The S-DBM holds significant potential as a medical biomaterial for treating bone defects, effectively fulfilling the clinical demands for materials used in bone tissue repair engineering.

Laparoscopic Right Hemi-hepatectomy of the Bile Duct-Obstructed Area Guided by Real-Time Fluorescence Imaging.

BACKGROUND: The regions of the liver with cholestasis caused by biliary tumors or thrombosis can be distinctly identified using indocyanine green (ICG) fluorescence imaging.1 The authors' team reported the application of bile-duct obstructed area imaging (BOAI) to assist open hepatectomy for intrahepatic cholangiocarcinoma (ICC) combined with intrahepatic bile duct obstruction previously.2 This video is the first report of real-time BOAI-guided three-dimensional (3D) laparoscopic hepatectomy using a 3D-4K fluorescence imaging system. METHODS: A 65-year-old man was admitted to the authors' institution with clonorchiasis. Preoperative computed tomography (CT) and magnetic resonance cholangiopancreatography (MRCP) showed an obstruction and diffuse dilation of the right hepatic duct. A 15-min retention of ICG (ICG R15) was performed 5 days before the operation, with a 3.3% result. Preoperative planning involved performing laparoscopic right hemi-hepatectomy with regional lymph node dissection assisted by visualization technology.3 During the procedure, significant fluorescence accumulation in the right liver was shown by fluorescence imaging. With the guidance of real-time BOAI (Fig. 1), the regions of biliary obstruction were precisely resected, and the middle hepatic vein (MHV) was passively and adequately exposed on the cutting plane. Fig. 1 Administration steps for real-time bile duct-obstructed area imaging. A ICG is injected intravenously 3-5 days before operation at a dose of 0.5 mg/kg. B ICG is accumulated in the whole liver within a few minutes after injection. C ICG is selectively absorbed by the liver and excreted into the intestines, whereby it is retained in areas of biliary obstruction RESULTS: The histopathologic diagnosis indicated high-grade intraepithelial neoplasia of the right bile duct tumor without lymph node metastases and clonorchiasis. The duration of the operation was 300 min, with an intraoperative blood loss of 50 ml. No postoperative complications occurred, and the patient was discharged after 7 days. CONCLUSION: Laparoscopic right hemi-hepatectomy for the bile-duct obstructed area with the guidance of real-time BOAI is feasible and effective.

Mussel-Inspired Injectable Adhesive Hydrogels for Biomedical Applications.

The impressive adhesive capacity of marine mussels has inspired various fascinating designs in biomedical fields. Mussel-inspired injectable adhesive hydrogels, as a type of promising mussel-inspired material, have attracted much attention due to their minimally invasive property and desirable functions provided by mussel-inspired components. In recent decades, various mussel-inspired injectable adhesive hydrogels have been designed and widely applied in numerous biomedical fields. The rational incorporation of mussel-inspired catechol groups endows the injectable hydrogels with the potential to exhibit many properties, including tissue adhesiveness and self-healing, antimicrobial, and antioxidant capabilities, broadening the applications of injectable hydrogels in biomedical fields. In this review, we first give a brief introduction to the adhesion mechanism of mussels and the characteristics of injectable hydrogels. Further, the typical design strategies of mussel-inspired injectable adhesive hydrogels are summarized. The methodologies for integrating catechol groups into polymers and the crosslinking methods of mussel-inspired hydrogels are discussed in this section. In addition, we systematically overview recent mussel-inspired injectable adhesive hydrogels for biomedical applications, with a focus on how the unique properties of these hydrogels benefit their applications in these fields. The challenges and perspectives of mussel-inspired injectable hydrogels are discussed in the last section. This review may provide new inspiration for the design of novel bioinspired injectable hydrogels and facilitate their application in various biomedical fields.

Electronic transfer and structural reconstruction in porous NF/FeNiP-CoP@NC heterostructure for robust overall water splitting in alkaline electrolytes.

Multimetal phosphides derived from metal-organic frameworks (MOFs) have garnered significant interest owing to their distinct electronic configurations and abundant active sites. However, developing robust and efficient catalysts based on metal phosphides for overall water splitting (OWS) remains challenging. Herein, we present an approach for synthesizing a self-supporting hollow porous cubic FeNiP-CoP@NC catalyst on a nickel foam (NF) substrate. Through ion exchange, the reconstruction chemistry transforms the FeNi-MOF nanospheres into intricate hollow porous FeNi-MOF-Co nanocubes. After phosphorization, numerous N, P co-doped carbon-coated FeNiP-CoP nanoparticles were tightly embedded within a two-dimensional (2D) carbon matrix. The NF/FeNiP-CoP@NC heterostructure retained a porous configuration, numerous heterogeneous interfaces, distinct defects, and a rich composition of active sites. Moreover, incorporating Co and the resulting structural evolution facilitated the electron transfer in FeNiP-CoP@NC, enhancing the oxygen evolution reaction (OER) and hydrogen evolution reaction (HER) processes. Consequently, the NF/FeNiP-CoP@NC catalyst demonstrated very low overpotentials of 78 mV for OER and 254 mV for HER in an alkaline medium. It also exhibited excellent long-term stability at various potentials (@10 mA cm-2, @20 mA cm-2, and @50 mA cm-2). As an overall water splitting cell, it required only 1.478 V to drive a current density of 50 mA cm-2 and demonstrated long-term stability. Density functional theory (DFT) calculations revealed a synergistic effect between multimetal phosphides, enhancing the intrinsic OER and HER activities of FeNiP-CoP@NC. This work not only elucidates the role of heteroatom induction in structural reconstruction but also highlights the importance of electronic structure modulation.

Epidermal growth factor-loaded, dehydrated physical microgel-formed adhesive hydrogel enables integrated care of wet wounds.

Integrated wound care, a sequential process of promoting wound hemostasis, sealing, and healing, is of great clinical significance. However, the wet environment of wounds poses formidable challenges for integrated care. Herein, we developed an epidermal growth factor (EGF)-loaded, dehydrated physical microgel (DPM)-formed adhesive hydrogel for the integrated care of wet wounds. The DPMs were designed using the rational combination of hygroscopicity and reversible crosslinking of physical hydrogels. Unlike regular bioadhesives, which consider interfacial water as a barrier to adhesion, DPMs utilize water to form desirable adhesive structures. The hygroscopicity allowed the DPMs to absorb interfacial water and subsequently, the interfacial adhesion was realized by the interactions between tissue and DPMs. The reversible crosslinks further enabled DPMs to integrate into hydrogels (DPM-Gels), thus achieving wet adhesion. Importantly, the water-absorbing gelation mode of DPMs enabled facile loading of biologically active EGF to promote wound healing. We demonstrated that the DPM-Gels possessed wet tissue adhesive performance, with about 40 times the wet adhesive strength of fibrin glue and about 4 times the burst pressure of human blood pressure. Upon application at the injury site, the EGF-loaded DPM-Gels sequentially promoted efficient wound hemostasis, stable sealing, and quick healing, achieving integrated care of wet wounds.

A-Site Engineering of the High-Entropy Perovskite Pr0.4La0.4Ba0.4Sr0.4Ca0.4Fe2O5+δ Cathode for Intermediate-Temperature SOFCs.

Mixed-oxygen ionic and electronic conduction is crucial for the cathode materials of solid oxide fuel cells, ensuring high efficiency and low-temperature operation. However, the electronic and oxygen ionic conductivity of traditional Fe-based layered perovskite cathode materials is low, resulting in insufficient oxygen reduction reactivity. Herein, a type of high-entropy perovskite oxide consisting of five equimolar metals, Pr0.4La0.4Ba0.4Sr0.4Ca0.4Fe2O5+δ (PLBSCF), a high-performance cobalt-free cathode derived from the PrBaFe2O5+δ (PBF), is proposed. Such A-site engineering could not only increase the oxygen vacancy concentration of PLBSCF but also give higher conductivity than PBF, thus significantly reducing the polarization impedance of the symmetric cell to only 0.052 Ω·cm2 at 750 °C. The good output performance of a single cell is also realized. The peak power density of the single cell with PLBSCF-Ce0.9Gd0.1O2-δ (GDC) as the cathode at 750 °C was 0.853 W·cm-2. Additionally, the single cell with the PLBSCF cathode exhibits a good durable performance of 100 h at 750 °C. Combining the distribution of relaxation time analysis, it can be seen that the enhancement of the oxygen reduction reaction is due to the reduction of intermediate-frequency and low-frequency resistance, indicating an improvement in the charge transfer process and adsorption/dissociation process of molecular oxygen.

In Situ Exsolution-Prepared Solid-Solution-Type Sulfides with Intracrystal Polarization for Efficient and Selective Absorption of Low-Frequency Electromagnetic Wave.

The excellent dielectric properties and tunable structural design of metal sulfides have attracted considerable interest in realizing electromagnetic wave (EMW) absorption. However, compared with traditional monometallic and bimetallic sulfides that are extensively studied, the unique physical characteristics of solid-solution-type sulfides in response to EMW have not been revealed yet. Herein, a unique method for preparing high-purity solid-solution-type sulfides is proposed based on solid-phase in situ exsolution of different metal ions from hybrid precursors. Utilizing CoAl-LDH/MIL-88A composite as a precursor, Fe0.8Co0.2S single-phase nanoparticles are uniformly in situ formed on an amorphous substrate (denoted as CoAl), forming CoAl/Fe0.8Co0.2S heterostructure. Combing with density functional theory (DFT) calculations and wave absorption simulations, it is revealed that Fe0.8Co0.2S solid solution has stronger intracrystal polarization and electronic conductivity than traditional monometallic and bimetallic sulfides, which lead to higher dielectric properties in EM field. Therefore, CoAl/Fe0.8Co0.2S heterostructure exhibits significantly enhanced EMW absorption ability in the low-frequency region (2-6 GHz) and can achieve frequency screening by selectively absorbing EMW of specific frequency. This work not only provides a unique method for preparing high-purity solid-solution-type sulfides but also fundamentally reveals the physical essence of their excellent EMW absorption performance.

Constructing Built-In Electric Fields with Semiconductor Junctions and Schottky Junctions Based on Mo-MXene/Mo-Metal Sulfides for Electromagnetic Response.

The exploration of novel multivariate heterostructures has emerged as a pivotal strategy for developing high-performance electromagnetic wave (EMW) absorption materials. However, the loss mechanism in traditional heterostructures is relatively simple, guided by empirical observations, and is not monotonous. In this work, we presented a novel semiconductor-semiconductor-metal heterostructure system, Mo-MXene/Mo-metal sulfides (metal = Sn, Fe, Mn, Co, Ni, Zn, and Cu), including semiconductor junctions and Mott-Schottky junctions. By skillfully combining these distinct functional components (Mo-MXene, MoS2, metal sulfides), we can engineer a multiple heterogeneous interface with superior absorption capabilities, broad effective absorption bandwidths, and ultrathin matching thickness. The successful establishment of semiconductor-semiconductor-metal heterostructures gives rise to a built-in electric field that intensifies electron transfer, as confirmed by density functional theory, which collaborates with multiple dielectric polarization mechanisms to substantially amplify EMW absorption. We detailed a successful synthesis of a series of Mo-MXene/Mo-metal sulfides featuring both semiconductor-semiconductor and semiconductor-metal interfaces. The achievements were most pronounced in Mo-MXene/Mo-Sn sulfide, which achieved remarkable reflection loss values of - 70.6 dB at a matching thickness of only 1.885 mm. Radar cross-section calculations indicate that these MXene/Mo-metal sulfides have tremendous potential in practical military stealth technology. This work marks a departure from conventional component design limitations and presents a novel pathway for the creation of advanced MXene-based composites with potent EMW absorption capabilities.

Real-Time Automatic M-Mode Echocardiography Measurement With Panel Attention.

Motion mode (M-mode) echocardiography is essential for measuring cardiac dimension and ejection fraction. However, the current diagnosis is time-consuming and suffers from diagnosis accuracy variance. This work resorts to building an automatic scheme through well-designed and well-trained deep learning to conquer the situation. That is, we proposed RAMEM, an automatic scheme of real-time M-mode echocardiography, which contributes three aspects to address the challenges: 1) provide MEIS, the first dataset of M-mode echocardiograms, to enable consistent results and support developing an automatic scheme; For detecting objects accurately in echocardiograms, it requires big receptive field for covering long-range diastole to systole cycle. However, the limited receptive field in the typical backbone of convolutional neural networks (CNN) and the losing information risk in non-local block (NL) equipped CNN risk the accuracy requirement. Therefore, we 2) propose panel attention embedding with updated UPANets V2, a convolutional backbone network, in a real-time instance segmentation (RIS) scheme for boosting big object detection performance; 3) introduce AMEM, an efficient algorithm of automatic M-mode echocardiography measurement, for automatic diagnosis; The experimental results show that RAMEM surpasses existing RIS schemes (CNNs with NL & Transformers as the backbone) in PASCAL 2012 SBD and human performances in MEIS.

Tissue-adhesive, stretchable and compressible physical double-crosslinked microgel-integrated hydrogels for dynamic wound care.

Integrated wound care through sequentially promoting hemostasis, sealing, and healing holds great promise in clinical practice. However, it remains challenging for regular bioadhesives to achieve integrated care of dynamic wounds due to the difficulties in adapting to dynamic mechanical and wet wound environments. Herein, we reported a type of dehydrated, physical double crosslinked microgels (DPDMs) which were capable of in situ forming highly stretchable, compressible and tissue-adhesive hydrogels for integrated care of dynamic wounds. The DPDMs were designed by the rational integration of the reversible crosslinks and double crosslinks into micronized gels. The reversible physical crosslinks enabled the DPDMs to integrate together, and the double crosslinked characteristics further strengthen the formed macroscopical networks (DPDM-Gels). We demonstrated that the DPDM-Gels simultaneously possess outstanding tensile (∼940 kJ/m3) and compressive (∼270 kJ/m3) toughness, commercial bioadhesives-comparable tissue-adhesive strength, together with stable performance under hundreds of deformations. In vivo results further revealed that the DPDM-Gels could effectively stop bleeding in various bleeding models, even in an actual dynamic environment, and enable the integrated care of dynamic skin wounds. On the basis of the remarkable mechanical and appropriate adhesive properties, together with impressive integrated care capacities, the DPDM-Gels may provide a new approach for the smart care of dynamic wounds. STATEMENT OF SIGNIFICANCE: Integrated care of dynamic wounds holds great significance in clinical practice. However, the dynamic and wet wound environments pose great challenges for existing hydrogels to achieve it. This work developed robust adhesive hydrogels for integrated care of dynamic wounds by designing dehydrated, physical double crosslinked microgels (DPDMs). The reversible and double crosslinks enabled DPDMs to integrate into macroscopic hydrogels with high mechanical properties, appropriate adhesive strength and stable performance under hundreds of external deformations. Upon application at the injury site, DPDM-Gels efficiently stopped bleeding, even in an actual dynamic environment and showed effectiveness in integrated care of dynamic wounds. With the fascinating properties, DPDMs may become an effective tool for smart wound care.

Recent Advances in the Degradability and Applications of Tissue Adhesives Based on Biodegradable Polymers.

In clinical practice, tissue adhesives have emerged as an alternative tool for wound treatments due to their advantages in ease of use, rapid application, less pain, and minimal tissue damage. Since most tissue adhesives are designed for internal use or wound treatments, the biodegradation of adhesives is important. To endow tissue adhesives with biodegradability, in the past few decades, various biodegradable polymers, either natural polymers (such as chitosan, hyaluronic acid, gelatin, chondroitin sulfate, starch, sodium alginate, glucans, pectin, functional proteins, and peptides) or synthetic polymers (such as poly(lactic acid), polyurethanes, polycaprolactone, and poly(lactic-co-glycolic acid)), have been utilized to develop novel biodegradable tissue adhesives. Incorporated biodegradable polymers are degraded in vivo with time under specific conditions, leading to the destruction of the structure and the further degradation of tissue adhesives. In this review, we first summarize the strategies of utilizing biodegradable polymers to develop tissue adhesives. Furthermore, we provide a symmetric overview of the biodegradable polymers used for tissue adhesives, with a specific focus on the degradability and applications of these tissue adhesives. Additionally, the challenges and perspectives of biodegradable polymer-based tissue adhesives are discussed. We expect that this review can provide new inspirations for the design of novel biodegradable tissue adhesives for biomedical applications.

A pilot study of virtual liver segment projection technology in subsegment-oriented laparoscopic anatomical liver resection when indocyanine green staining fails (with video).

BACKGROUND: Precision surgery for liver tumors favors laparoscopic anatomical liver resection (LALR), involving the removal of specific liver segments or subsegments. Indocyanine green (ICG)-negative staining is a commonly used method for defining resection boundaries but may be prone to failure. The challenge arises when ICG staining fails, as it cannot be repeated during surgery. In this study, we employed the virtual liver segment projection (VLSP) technology as a salvage approach for precise boundary determination. Our aim was to assess the feasibility of the VLSP to be used for the determination of the boundaries of the liver resection in this situation. METHODS: Between January 2021 and June 2023, 12 consecutive patients undergoing subsegment-oriented LALR were included in this pilot series. The VLSP technology was utilized to define the resection boundaries at the time of ICG-negative staining failure. Routine surgical parameters and short-term outcomes were evaluated to assess the safety of VLSP in this procedure. In addition, its feasibility was assessed by analyzing the accuracy between the predicted resected liver volume (PRLV) and actual resected liver volume (ARLV). RESULTS: Of the 12 enrolled patients, the mean operation time was 444.58 ± 101.70 min (range 290-570 min), with a mean blood loss of 125.00 ± 96.53 ml (range 50-400 mL). One patient (8.3%) was converted to laparotomy for subsequent parenchymal transection, four (33.3%) received blood transfusions and four (33.3%) had postoperative complications. All patients received an R0 resection. The Pearson correlation coefficient (r) between PRLV and ARLV was 0.98 (R2 = 0.96, p < 0.05), and the relative error (RE) was 8.62 ± 6.66% in the 12 patients, indicating agreement. CONCLUSION: Failure of intraoperative ICG-negative staining during subsegment-oriented LALR is possible, and VLSP may be an alternative to define the resection boundaries in such cases.