Current status, challenges, and future directions of laparoscopic training in young surgeons: a nationwide survey in China.

BACKGROUND: With the rapid advancement of technology, minimally invasive surgery, particularly laparoscopic surgery, has made significant progress in the field of surgery. Despite the advantages of laparoscopic surgery, a systematic training system for laparoscopic procedures is lacking in Chinese postgraduate medical education. Our study aims to explore the prevalence of laparoscopic training among resident and attending physicians in China and to assess the current state of training programs. METHODS: A 10-item questionnaire was distributed to 1,750 resident and attending physicians specializing in surgery across China, with 1,324 valid responses (75.7% response rate). The survey focused on demographics, training curriculum content, and feedback on training effectiveness. Data analysis was conducted using Microsoft Excel and IBM SPSS. RESULTS: Among the 1,324 respondents, 30.7% reported receiving laparoscopic training, primarily at the attending physician stage. Only 4% of resident physicians and 14% of attending physicians could independently perform complex laparoscopic surgeries. Most respondents (76.6%) could only assist in surgeries. The majority expressed a desire for more frequent and longer training sessions, with suture training being identified as the most beneficial. CONCLUSIONS: This study underscores the critical need for comprehensive laparoscopic training in China. Early, frequent, and structured training programs are essential for developing proficient laparoscopic surgeons. Future initiatives should focus on expanding access to training at all levels of medical education, ensuring continuous skill development and improved surgical care quality.

Orbital Coupling of PbO7 Node in Single-Crystal Metal-Organic Framework Enhances Li-O2 Battery Electrocatalysis.

Optimizing the local coordination environment of metal centers in metal-organic frameworks (MOFs) is crucial yet challenging for regulating the overpotential of lithium-oxygen (Li-O2) batteries. Herein, we report the synthesis of a class of PbO7 nodes in a single crystal MOF (naphthalene-lead-MOF, known as Na-Pb-MOF) to significantly enhance the kinetics of both discharge and charge processes. Compared to the PbO6 node in the single-crystal tetramethoxy-lead-MOF (4OMe-Pb-MOF), the bond length between Pb and O in the PbO7 node of Na-Pb-MOF increases, resulting in weaker Pb 5d-O 2p orbital coupling, which optimizes the adsorption interaction toward intermediates, and thereby promotes the rate-determining steps of both the reduction of LiO2 to Li2O2 and the oxidation of LiO2 to O2 for reducing the activation energy of the overall reaction. Consequently, Li-O2 batteries based on Na-Pb-MOF electrocatalysts exhibit a low total charge-discharge overpotential of 0.52 V and an excellent cycle life of 140 cycles.

Fluorine-Lodged High-Valent High-Entropy Layered Double Hydroxide for Efficient, Long-Lasting Zinc-Air Batteries.

Efficient and stable bifunctional oxygen evolution reaction (OER) and oxygen reduction reaction (ORR) catalysts are urgently needed to unlock the full potential of zinc-air batteries (ZABs). High-valence oxides (HVOs) and high entropy oxides (HEOs) are suitable candidates for their optimal electronic structures and stability but suffer from demanding synthesis. Here, a low-cost fluorine-lodged high-valent high-entropy layered double hydroxide (HV-HE-LDH) (FeCoNi2F4(OH)4) is conveniently prepared through multi-ions co-precipitation, where F- are firmly embedded into the individual hydroxide layers. Spectroscopic detections and theoretical simulations reveal high valent metal cations are obtained in FeCoNi2F4(OH)4, which enlarge the energy band overlap between metal 3d and O 2p, enhancing the electronic conductivity and charge transfer, thus affording high intrinsic OER catalytic activity. More importantly, the strengthened metal-oxygen (M-O) bonds and stable octahedral geometry (M-O(F)6) in FeCoNi2F4(OH)4 prevent structural reorganization, rendering long-term catalytic stability. Furthermore, an efficient three-phase reaction interface with fast oxygen transportation was constructed, significantly improving the ORR activity. ZABs assembled with FeCoNi2F4(OH)4@HCC (hydrophobic carbon cloth) cathodes deliver a top performance with high round-trip energy efficiency (61.3 % at 10 mA cm-2) and long-term stability (efficiency remains at 58.8 % after 1050 charge-discharge cycles).

Identifying Fe as OER Active Sites and Ultralow-Cost Bifunctional Electrocatalysts for Overall Water Splitting.

Electrocatalysts based on Fe and other transition metals are regarded as most promising candidates for accelerating the oxygen evolution reaction (OER), whereas whether Fe is the catalytic active site for OER is still under debate. Here, unary Fe- and binary FeNi- based catalysts, FeOOH and FeNi(OH)x , are produced by self-reconstruction. The former is a dual-phased FeOOH, possessing abundant oxygen vacancies (VO ) and mixed-valence states, delivering the highest OER performance among all the unary iron oxides- and hydroxides- based powder catalysts reported to date, supporting Fe can be catalytically active for OER. As to binary catalyst, FeNi(OH)x is fabricated featuring 1) an equal molar content of Fe and Ni and 2) rich VO , both of which are found essential to enable abundant stabilized reactive centers (FeOOHNi) for high OER performance. Fe is found to be oxidized to 3.5+ during the *OOH process, thus, Fe is identified to be the active site in this new layered double hydroxide (LDH) structure with Fe:Ni = 1:1. Furthermore, the maximized catalytic centers enable FeNi(OH)x @NF (nickel foam) as low-cost bifunctional electrodes for overall water-splitting, delivering excellent performance comparable to commercial electrodes based on precious metals, which overcomes a major obstacle to the commercialization of bifunctional electrodes: prohibitive cost.

Simultaneous Salt Rejection and Heat Localization Via Engineering Macrochannels in Morning Glory-Shaped 3D Evaporator.

Solar desalination is a promising solution for alleviating water scarcity due to its low-cost, environmentally friendly, and off-grid capabilities. However, simultaneous salt rejection and heat localization remain challenging, as the rapid salt convection often results in considerable heat loss. Herein, this challenge is overcome via a facile design: i) isolating high-temperature and high-salt zones by rationally designing morning glory-shaped wick structures and ii) bridging high-salt zones and bulk water with low-tortuosity macrochannels across low-temperature surfaces. The salinity gradient in the macrochannels passively triggers convective flow, facilitating the rapid transfer of salt ions from the high-salt zone to the bulk water. Meanwhile, the macrochannels are spatially isolated from the high-temperature zone, preventing heat loss during salt convection and thereby achieving a high evaporation rate (≈3 kg m-2 h-1) and superior salt rejection even in highly concentrated real seawater. This work provides new insights into salt rejection strategies and advances practical applications for sustainable seawater desalination.

From salt water to bioceramics: Mimic nature through pressure-controlled hydration and crystallization.

Modern synthetic technology generally invokes high temperatures to control the hydration level of ceramics, but even the state-of-the-art technology can still only control the overall hydration content. Magically, natural organisms can produce bioceramics with tailorable hydration profiles and crystallization traits solely from amorphous precursors under physiological conditions. To mimic the biomineralization tactic, here, we report pressure-controlled hydration and crystallization in fabricated ceramics, solely from the amorphous precursors of purely inorganic gels (PIGs) synthesized from biocompatible aqueous solutions with most common ions in organisms (Ca2+, Mg2+, CO32-, and PO43-). Transparent ceramic tablets are directly produced by compressing the PIGs under mild pressure, while the pressure regulates the hydration characteristics and the subsequent crystallization behaviors of the synthesized ceramics. Among the various hydration species, the moderately bound and ordered water appears to be a key in regulating the crystallization rate. This nature-inspired study offers deeper insights into the magic behind biomineralization.

Direct Synthesis of Ammonia from Nitrate on Amorphous Graphene with Near 100% Efficiency.

Ammonia is an indispensable commodity in the agricultural and pharmaceutical industries. Direct nitrate-to-ammonia electroreduction is a decentralized route yet challenged by competing side reactions. Most catalysts are metal-based, and metal-free catalysts with high nitrate-to-ammonia conversion activity are rarely reported. Herein, it is shown that amorphous graphene synthesized by laser induction and comprising strained and disordered pentagons, hexagons, and heptagons can electrocatalyze the eight-electron reduction of NO3 - to NH3 with a Faradaic efficiency of ≈100% and an ammonia production rate of 2859 µg cm-2 h-1 at -0.93 V versus reversible hydrogen electrode. X-ray pair-distribution function analysis and electron microscopy reveal the unique molecular features of amorphous graphene that facilitate NO3 - reduction. In situ Fourier transform infrared spectroscopy and theoretical calculations establish the critical role of these features in stabilizing the reaction intermediates via structural relaxation. The enhanced catalytic activity enables the implementation of flow electrolysis for the on-demand synthesis and release of ammonia with >70% selectivity, resulting in significantly increased yields and survival rates when applied to plant cultivation. The results of this study show significant promise for remediating nitrate-polluted water and completing the NOx cycle.

Comparative Analysis of Gene Expression Profiles of Human Dental Fluorosis and Kashin-Beck Disease.

To explore the pathologies of Kashin-Beck disease (KBD) and KBD accompanied with dental fluorosis (DF), we conducted a comparative analysis of gene expression profiles. 12 subjects were recruited, including 4 KBD patients, 4 patients with KBD and DF and 4 healthy subjects. Genome-wide expression profiles from their peripheral blood mononuclear cells were evaluated by customized oligonucleotide microarray. R programming software was used for the microarray data analysis followed by functional enrichment analysis through KOBAS. Several potential biomarkers were identified, and quantitative real-time reverse transcription-polymerase chain reaction (qRT-PCR) was used for their validation. In this study, 28 genes and 8 genes were found to be up- and down-regulated respectively in KBD patients compared with health subjects. In patients with KBD and DF, we obtained 10 up-regulated and 3 down-regulated genes compared with health controls. Strikingly, no differential expression gene (DEG) was identified between the two groups of patients. A total of 10 overlaps (DUSP2, KLRF1, SRP19, KLRC3, CD69, SIK1, ITGA4, ID3, HSPA1A, GPR18) were obtained between DEGs of patients with KBD and patients with KBD and DF. They play important roles in metabolism, differentiation, apoptosis and bone-development. The relative abundance of 8 DEGs, i.e. FCRL6, KLRC3, CXCR4, CD93, CLK1, GPR18, SRP19 and KLRF1, were further confirmed by qRT-PCR analysis.