Percutaneous nephrolithotomy guided by 5G-powered robot-assisted teleultrasound diagnosis system: first clinical experience with a novel tele-assistance approach (IDEAL stage 1)

BACKGROUND

To demonstrate the technical feasibility of percutaneous nephrolithotomy (PCNL) guided by 5G-powered robot-assisted teleultrasound diagnosis system (RTDS) in a complex kidney-stone (CKS) cohort and present our preliminary outcomes. PCNL is highly skill-required, which hinders it popularization in primary medical units of remote regions. We designed an innovative tele-assistance approach to make PCNL easy to be operated by inexperienced surgeons.

METHODS

This was a prospective proof-of-concept study (IDEAL phase 1) on intraoperative tele-assistance provided by online urological experts via a 5G-powered RTDS. Total 15 CKS patients accepted this technology. Online experts manipulated a simulated probe to assist unskilled local operators by driving a patient-side robot-probe to guide and monitor the steps of access establishment and finding residual stones.

RESULTS

Median total delay was 177ms despite one-way network-connecting distance > 5,800 km. No perceptible delay of audio-visual communication, driving robot-arm or dynamic ultrasound images was fed back. Successful tele-assistance was obtained in all cases. The first-puncture access-success rate was 78.6% with a one-session SF rate of 71.3% and without complications of grade III-V.

CONCLUSIONS

The current technology based on 5G-powered RTDS can provide high-quality intraoperative tele-assistance, which has preliminarily shown satisfactory outcomes and reliable safety. It will break down a personal competence-based barrier to endow PCNL with more popular utilization.

TRIAL REGISTRATION

The study was approved by ethics committee of the Xinjiang Kezhou People's Hospital and ethics committee of the First Affiliated Hospital of Nanjing Medical University and was registered on http://www.chictr.org.cn (ChiCTR2200065849, 16/11/2022).

The relationship between 5G technology affordances, consumption values, trust and intentions: An exploration using the TCV and S-O-R paradigm

5G mobile communication technology is anticipated to merge with many other sectors, spurring innovation and creating substantial ripple effects. Despite the significance of this advancement, current research provides limited knowledge of users' behavioral reactions to the affordances, values, and trust generated from 5G technology. To investigate this relationship, this study used the Stimulus-response theory and the consumption values theory. The empirical data was gathered from 373 consumers in China using a survey method. To validate the model's suggested relationships, the author utilized the partial least squares-structural equation modelling (PLS-SEM) technique. The finding designates that the affordances and purchase intention relationship was mediated by consumption values and trust. Given the significance of 5G technology and its potential, this study investigates what drives and deters consumers from obtaining 5G technology. Original findings insights on the role of affordances in developing marketing strategies and increasing consumer intentions to purchase 5G technology products.

Comparison of copper and graphene-assembled films in 5G wireless communication and THz electromagnetic-interference shielding

Since first developed, the conducting materials in wireless communication and electromagnetic interference (EMI) shielding devices have been primarily made of metal-based structures. Here, we present a graphene-assembled film (GAF) that can be used to replace copper in such practical electronics. The GAF-based antennas present strong anticorrosive behavior. The GAF ultra-wideband antenna covers the frequency range of 3.7 GHz to 67 GHz with the bandwidth (BW) of 63.3 GHz, which exceed ~110% than the copper foil-based antenna. The GAF Fifth Generation (5G) antenna array features a wider BW and lower sidelobe level compared with that of copper antennas. EMI shielding effectiveness (SE) of GAF also outperforms copper, reaching up to 127 dB in the frequency range of 2.6 GHz to 0.32 THz, with a SE per unit thickness of 6,966 dB/mm. We also confirm that GAF metamaterials exhibit promising frequency selection characteristics and angular stability as flexible frequency selective surfaces.

Application of Improved Robot-assisted Laparoscopic Telesurgery with 5G Technology in Urology

The demand for telesurgery is rising rapidly, but robust evidence regarding the feasibility of its application in urology is still rare. From March to October 2021, a surgeon-controlled surgical robot in a tertiary hospital in Qingdao was used to remotely conduct robot-assisted laparoscopic radical nephrectomy (RN) in 29 patients located in eight primary hospitals. The median round-trip delay was 26 ms (interquartile range [IQR] 5) and the median distance between the primary hospital and the surgeon was 187 km (IQR 57). Both the master unit and the slave unit were guaranteed by network and mechanical engineers, and surgical assistants were well prepared on the patient side to prevent complications. The primary evaluation metric was the success rate, defined as the percentage of patients who underwent successful remote RN without conversion to other surgical procedures and no major intraoperative or postoperative complications. The results demonstrate that the combination of 5G technology and surgical robots is a novel potential telemedicine-based therapy choice for renal tumors. PATIENT SUMMARY: Our study shows that telesurgery using 5G technology is a safe and feasible treatment option for patients with kidney tumors. The total delay between the remote location and the operating rooms where surgery was being performed was just 200 ms. This approach could reduce health care costs and improve the quality of medical services accessed by patients.

Assessment of EMF Human Exposure Levels Due to Wearable Antennas at 5G Frequency Band

(1) Background: This work aims to assess human exposure to EMF due to two different wearable antennas tuned to two 5G bands. (2) Methods: The first one was centered in the lower 5G band, around f = 3.5 GHz, whereas the second one was tuned to the upper 5G band, at 26.5 GHz. Both antennas were positioned on the trunk of four simulated human models. The exposure assessment was performed by electromagnetic numerical simulations. Exposure levels were assessed by quantifying the specific absorption rate averaged on 10 g of tissue (SAR_10g) and the absorbed power density (S_ab), depending on the frequency of the wearable antenna. (3) Results: the higher exposure values that resulted were always mainly concentrated in a superficial area just below the antenna itself. In addition, these resulting distributions were narrowed around their peak values and tended to flatten toward lower values in farther anatomical body regions. All the exposure levels complied with ICNIRP guidelines when considering realistic input power. (4) Conclusions: This work highlights the importance of performing an exposure assessment when the antenna is placed on the human wearer, considering the growth of wearable technology and its wide variety of application, particularly regarding future 5G networks.

Problems of China's Legal Supervision System on the Internet Medical Care Under the Background of 5G Medical Application

With the advent of 5G network technology and the maturity of medical applications associated with 5G, the Internet medical service industry is gradually developing. Given the COVID-19 pandemic crisis occasionally happened in China, hospitals were taken up most of the medical resources, the Internet medical care is seen as the alternative way for patients to access medical care and treatment. With the aid of 5G, patients nowadays can seek remote medical care, diagnosis, and surgery. However, this is not without any problems. The current legal supervision system in the Internet medical service industry is still incomplete, and ought to be augmented. This essay serves to identify and evaluate the loopholes existing in the legal supervision system in the Internet medical service industry, in the hope to improve the current system and ensure the safety of patients who are seeking Internet medical services.

MIMO Antennas: Design Approaches, Techniques and Applications

The excessive use of digital platforms with rapidly increasing users in the wireless domain enforces communication systems to provide information with high data rates, high reliability and strong transmission connection quality. Wireless systems with single antenna elements are not able to accomplish the desired needs. Therefore, multiple-input multiple-output (MIMO) antennas are getting more attention in modern high-speed communication systems and play an essential part in the current generation of wireless technology. However, along with their ability to significantly increase channel capacity, it is a challenge to achieve an optimal isolation in a compact size for fifth-generation (5G) terminals. Portable devices, automobiles, handheld gadgets, smart phones, wireless sensors, radio frequency identification and other applications use MIMO antenna systems. In this review paper, the fundamentals of MIMO antennas, the performance parameters of MIMO antennas, and different design approaches and methodologies are discussed to realize the three most commonly used MIMO antennas, i.e., ultra-wideband (UWB), dual-band and circularly polarized antennas. The recent MIMO antenna design approaches with UWB, dual band and circularly polarized characteristics are compared in terms of their isolation techniques, gain, efficiency, envelope correlation coefficient (ECC) and channel capacity loss (CCL). This paper is very helpful to design suitable MIMO antennas applicable in UWB systems, satellite communication systems, GSM, Bluetooth, WiMAX, WLAN and many more. The issues with MIMO antenna systems in the indoor environment along with possible solutions to improve their performance are discussed. The paper also focuses on the applications of MIMO characteristics for future sixth-generation (6G) technology.

[Orthopedic robot based on 5G technology for remote navigation of percutaneous screw fixation in pelvic and acetabular fractures]

Objective

To investigate the accuracy and safety of percutaneous screw fixation for pelvic and acetabular fractures with remote navigation of orthopedic robot based on 5G technology.

Methods

Between January 2021 and December 2021, 15 patients with pelvic and/or acetabular fractures were treated with percutaneous screws fixation which were placed by remote navigation of orthopedic robot based on 5G technology. There were 8 males and 7 females. The age ranged from 20 to 98 years, with an average of 52.1 years. The causes of trauma included traffic accident injury in 6 cases, falling from height injury in 6 cases, fall injury in 2 cases, and heavy object smashing injury in 1 case. The time from injury to operation ranged from 3 to 32 days, with an average of 10.9 days. There were 8 cases of simple pelvic fractures, 2 simple acetabular fractures, and 5 both pelvic and acetabular fractures. There were 7 cases of pelvic fractures of Tile type B2, 2 type B3, 1 type C1, and 3 type C2; 4 cases of unilateral anterior column fracture of the acetabulum, 2 bilateral anterior column fractures, and 1 anterior wall fracture. CT images within 5 days after operation were collected for screw position assessment. The screw planning time and guidewire placement time were recorded, as well as the presence of intraoperative adverse events and complications within 5 days after operation.

Results

All patients achieved satisfactory surgical results. A total of 36 percutaneous screws were inserted (20 sacroiliac screws, 6 LC Ⅱ screws, 9 anterior column screws, and 1 acetabular apical screw). In terms of screw position evaluation, 32 screws (88.89%) were excellent and 4 screws (11.11%) were good; there was no screw penetrating cortical bone. The screw planning time ranged from 4 to 15 minutes, with an average of 8.7 minutes. The guidewire placement time ranged from 3 to 10 minutes, with an average of 6.8 minutes. The communication delayed in 2 cases, but the operation progress was not affected, and no serious intraoperative adverse events occurred. No delayed vascular or nerve injury, infection, or other complications occurred within 5 days after operation. No cases need surgical revision.

Conclusion

The fixation of pelvic and acetabular fractures by percutaneous screw with remote navigation of orthopedic robot based on 5G technology is accurate, safe, and reliable.

Building a Mobile Stroke Unit Based on 5G Technology - A Study Protocol

Background: In-time treatment of acute stroke is critical to saving people's lives and improving the quality of post-stroke life. A mobile stroke unit (MSU) with fifth-generation (5G) mobile networks strengthens the interaction of patient information and healthcare resources, thereby reducing response times and improving thrombolysis results. However, clinical evidence of better outcomes compared to regular care is still lacking. Method and Design: In this randomized controlled trial, 484 patients with acute stroke are allocated into the MSU and regular care groups. We establish medical records for each patient and conduct a follow-up of 90 days. The primary outcomes are functional results as defined by utility-weighted modified Rankin Scale (uw-mRS) 90 days after the incidence occurred, whereas secondary outcomes include the alarm to CT scan completed time, the alarm to treatment decision time, the alarm to thrombolytic time, quality of life, and symptomatic intracranial hemorrhage combined with NIHSS score as well as cost-effectiveness. Discussion: This study establishes an innovative MSU (based on 5G) to manage acute stroke, comparing its clinical and economic outcomes to regular care and informing decision-makers of the effectiveness of the stroke emergency system. Clinical Trial Registration: [http://www.chictr.org.cn/showproj.aspx?proj=63874], identifier [ChiCTR2000039695].

Timing Offset and Timing Stability for a Dual-Clock Channel Sounder

We describe a mathematical framework for evaluating timing offset and timing noise in channel sounders based on a second-order deterministic model and a stochastic metric based on the Allan Deviation. Using this framework, we analyze the timing offset and noise for a 1-6 GHz correlation-based channel sounder that uses rubidium clocks to provide a common timebase between the transmitter and receiver. We study timing behavior in three clock-distribution configurations. In the "untethered" configuration, the transmitter and receiver each have a rubidium clock, and no physical timing cable is connected between the clocks. In the "tethered" configuration, a coaxial cable synchronizes timing between the two separate clocks. Finally, a benchmark "single-clock" configuration is used where a single rubidium clock drives the transmitter and receiver.

Summary of The Third Capsule Endoscopy Global Summit

In order to emphasize the epidemic prevention during capsule endoscopy examinations, exhibit the latest achievements of capsule endoscopy, and strengthen international exchanges and cooperation in capsule endoscopy products, quality control, R&D, clinical applications, and talents, The Third Capsule Endoscopy Global Summit was held in Chongqing, China. The summit invited foreign experts to live online and remotely broadcast special academic speeches. The invited domestic experts brought the latest academic reports on the spot. A total of 17 medical experts presented a number of latest technologies and academic achievements in the field of capsule endoscopy from five levels. Professor Xue-Liang Jiang, President of the World Chinese Digestive Society and Editor-in-Chief of the World Chinese Journal of Digestology, was invited to give a report on the clinical application of capsule endoscopy.

Low-Cost Unattended Design of Miniaturized 4 × 4 Butler Matrices with Nonstandard Phase Differences

Design of Butler matrices dedicated to Internet of Things and 5th generation (5G) mobile systems—where small size and high performance are of primary concern—is a challenging task that often exceeds capabilities of conventional techniques. Lack of appropriate, unified design approaches is a serious bottleneck for the development of Butler structures for contemporary applications. In this work, a low-cost bottom-up procedure for rigorous and unattended design of miniaturized 4 × 4 Butler matrices is proposed. The presented approach exploits numerical algorithms (governed by a set of suitable objective functions) to control synthesis, implementation, optimization, and fine-tuning of the structure and its individual building blocks. The framework is demonstrated using two miniaturized matrices with nonstandard output-port phase differences. Numerical results indicate that the computational cost of the design process using the presented framework is over 80% lower compared to the conventional approach. The footprints of optimized matrices are only 696 and 767 mm², respectively. Small size and operation frequency of around 2.6 GHz make the circuits of potential use for mobile devices dedicated to work within a sub-6 GHz 5G spectrum. Both structures have been benchmarked against the state-of-the-art designs from the literature in terms of performance and size. Measurements of the fabricated Butler matrix prototype are also provided.

Physiological effects of millimeter-waves on skin and skin cells: an overview of the to-date published studies

The currently ongoing deployment if the fifth generation of the wireless communication technology, the 5G technology, has reignited the health debate around the new kind of radiation that will be used/emitted by the 5G devices and networks - the millimeter-waves. The new aspect of the 5G technology, that is of concern to some of the future users, is that both, antennas and devices will be continuously in a very close proximity of the users' bodies. Skin is the only organ of the human body, besides the eyes, that will be directly exposed to the mm-waves of the 5G technology. However, the whole scientific evidence on the possible effects of millimeter-waves on skin and skin cells, currently consists of only some 99 studies. This clearly indicates that the scientific evidence concerning the possible effects of millimeter-waves on humans is insufficient to devise science-based exposure limits and to develop science-based human health policies. The sufficient research has not been done and, therefore, precautionary measures should be considered for the deployment of the 5G, before the sufficient number of quality research studies will be executed and health risk, or lack of it, scientifically established.

Integrating IoT and Blockchain for Ensuring Road Safety: An Unconventional Approach

The Internet of things (IoT), the Internet of vehicles, and blockchain technology have become very popular these days because of their versatility. Road traffic, which is increasing day by day, is causing more and more deaths worldwide. The world needs a product that would reduce the number of road accidents. This paper suggests combining IoT and blockchain technology to mitigate road hazards. The new intelligent transportation system technologies and the subsequent emergence of 5G technologies will be a blessing, delivering the necessary speed to ensure both safety and quality of service (QoS). Hashgraph technology, a distributed ledger technology is used to create communication networks between the different vehicles and other relevant parameters. Scheduling the requests according to the priorities for ensuring better QoS quotient can be effectively done using hashgraph. We demonstrated how the hashgraph outstrips other equivalents platforms. The proposed model was simulated using OMNeT++ with proper design and network description files. A hardware implementation of the proposed model was also done. Messages were transferred between the vehicles and prioritized using a hashgraph. This paper proposes an effective model in reducing the accidents in terms of parameters like speed, security, stability, and fairness.