Robotic surgery is known as the"third technological revolution"in the field of surgery,and is an important milestone in the development of modern surgery.However,our country's innovative surgical robot industry is still in its early stages,and it is only being utilized in certain surgical fields.To explore the effectiveness of the application of do-mestic surgical robot in oral and maxillofacial surgery,the author successfully completed a case of benign parotid tumor resection with the assistance of a domestic autonomous robot.The operation was successful,facial nerve function was preserved,and postoperative wound healing was good.

Diabetes mellitus (DM) is a major metabolic disease endangering global health, with diabetic nephropathy (DN) as a primary complication lacking curative therapy. Sporoderm-broken spores of Ganoderma lucidum (GLP), an herbal medicine, has been used for the treatment of metabolic disorders. In this study, DN was induced in Sprague-Dawley rats using streptozotocin (STZ) and a high-fat diet (HFD), and the protective mechanisms of GLP were investigated through transcriptomic, metabolomic, and network pharmacology (NP) analyses. Our results demonstrated that GLP intervention ameliorated renal damage and inflammation levels in DN rats. Integrative metabolomic and transcriptomic analysis revealed that GLP treatment modulated glucose and cellular energy metabolisms by regulating relevant genes. GLP significantly suppressed the inflammations by impacting glucose and energy metabolism-related gene expression (Igfbp1 and Angptl4) and enhanced metabolic biomarkers of 4-Aminocatechol. In addition, NP analysis further indicated that GLP may efficiently alleviate DN via immune-related pathways. In conclusion, this study provides supportive evidence of the anti-inflammatory effects of GLP supplements, highlighting their potential for promising clinical applications in treating DN.

Objective:To compare the clinical efficacies of O-arm combined with CT three-dimensional navigation system assisted screw placement versus manual screw placement in treating lower cervical fracture and dislocation.Methods:A retrospective cohort study was used to analyze the clinical data of 41 patients with lower cervical fracture and dislocation, who were treated in Honghui Hospital, Xi′an Jiaotong University from May 2021 to February 2022. The patients included 26 males and 15 females, aged 31.5-48.6 years [(41.5±15.0)years]. The injured segments were C 3 in 3 patients, C 4 in 12, C 5 in 13, C 6 in 10 and C 7 in 3. Nineteen patients were treated with cervical pedicle screws by O-shaped arm combined with CT three-dimensional navigation system (navigation group, 76 screws) and 22 by bare hands (traditional group, 88 screws). The total operation time, effective operation time, single nail placement time, single screw correction times, screw distance from anterior cortex, intraoperative blood loss, intraoperative fluoroscopic radiation dose, incision length and length of hospital stay were compared between the two groups, and the height of intervertebral space, Cobb angle, interbody slip distance and American Spinal injury Association (ASIA) grade were compared before operation and at 3 days after operation. Visual analogue score (VAS), Japanese Orthopedic Association (JOA) score, and neck dysfunction index (NDI) were evaluated before operation, at 3 days, 3 months after operation and at the last follow-up. Accuracy of screw placement and incidence of complications (adjacent facet joint invasion, infection, screw loosening) were detected as well. Results:All the patients were followed up for 11.1-13.9 months [(12.5±1.4)months]. The total operation time, intraoperative blood loss, intraoperative fluoroscopic radiation dose and incision length in the navigation group were more or longer than those in the traditional group (all P<0.05). The effective operation time, single nail placement time, single nail correction times and screw distance from anterior cortex in the navigation group were markedly less or smaller than those in the traditional group (all P<0.05). There was no significant difference in the length of hospital stay between the two groups ( P>0.05). There were significant improvements in the height of intervertebral space, Cobb angle and interbody slip distance between the two groups at 3 days after operation (all P<0.05). There was no significant difference in the height of intervertebral space, Cobb angle, interbody slip distance or ASIA grade between the two groups before operation or at 3 days after operation (all P>0.05). Compared with pre-operation, the VAS, JOA score and NDI were significantly improved in both groups at 3 days, 3 months after operation and at the last follow-up (all P<0.05), with further improvement with time. There was no significant difference in VAS between the two groups before operation or at 3 months after operation (all P>0.05), but it was markedly lower in the navigation group compared with the traditional group at 3 days after operation and at the last follow-up (all P<0.05). There were no significant differences in JOA score or NDI between the two groups before operation or at 3 days and 3 months after operation (all P>0.05), but both were lower in the navigation group compared with the traditional group at the last follow-up (all P<0.05). The accuracies of placement of grade 0 and grade 0+1 screws were 92.0% (70/76) and 96.6% (73/76) in the navigation group, respectively, which were markedly higher than 88.7% (78/88) and 93.5% (82/88) in the traditional group (all P<0.05). The rates of adjacent facet joint invasion of A, B, and C degrees were 71.2% (54/76), 28.8% (22/76) and 0% (0/76) in the navigation group, respectively, while the invasion rates were 60.5% (53/88), 32.3% (28/88) and 7.3% (7/88) in the traditional group ( P<0.05). No screw loosening was noted in the navigation group, but the screw loosening rate was 9.1% (8/88) in the traditional group ( P<0.01). Conclusion:Compared with manual screw placement, O-arm combined with CT three-dimensional navigation system assisted screw placement for lower cervical fracture and dislocation has the advantages of shorter effective operation time, quicker screw placement, stronger screw holding force, better cervical stability, slighter postoperative pain, higher screw placement accuracy, and lower facet joint invasion and screw loosening rates.

Objective:To study the risk factors of patients with hepatocellular carcinoma (HCC) to transcatheter arterial chemoembolization(TACE) refractoriness.Methods:The clinical data of 106 HCC patients who underwent TACE at the Affiliated Hospital of Xuzhou Medical University from January 2020 to December 2021 were retrospectively studied. There were 90 males and 16 females, with the age of (59.9±9.3) years. These patients were divided into the TACE-refractory group ( n=47) and the control group ( n=59) based on whether TACE refratoriness occurred after surgery. Serum alpha-fetoprotein (AFP), protein induced by vitamin K absence or antagonist-II (PIVIKA-II), maximum diameter of tumor, number of tumor and tumor vascularization patterns between the two groups were compared. Multivariate logistic regression analysis was performed to analyse the risk factors of TACE refractoriness in patients with HCC after TACE. Results:The proportion of patients with AFP >400 μg/L, PIVIKA-II >40 AU/L, number of tumor and tumor vascularization patterns Ⅲ+ Ⅳ (uneven enhancement) were significantly higher in the TACE-refractory group than the control group (all P<0.05). The maximum diameter of tumor for patients in the TACE-refractory group was significantly larger than that in the control group ( Z=-2.41, P=0.016). Multivariate logistic regression analysis showed that patients with serum AFP >400 μg/L( OR=2.707, 95% CI: 1.008-7.271), multiple tumors ( OR=6.069, 95% CI: 2.115-17.415) and tumor vascularization patterns Ⅲ+ Ⅳ (uneven enhancement)( OR=7.813, 95% CI: 2.246-27.176) before the first TACE were at increased risks of TACE refractoriness (all P<0.05). Conclusion:Preoperative AFP >400 μg/L, multiple tumors and tumor vascularization patterns Ⅲ+ Ⅳ were independent risk factors for TACE refractoriness in patients with HCC.

Objective:To explore the efficacy of O-arm navigation system-assisted upper cervical pedicle screw internal fixation in the treatment of traumatic atlantoaxial instability.Methods:A retrospective cohort study was conducted to analyze the clinical data of 61 patients with atlantoaxial instability admitted to Affiliated Honghui Hospital of Xi′an Jiaotong University from January 2021 to June 2022, including 34 males and 27 females, aged 20-77 years [(50.2±13.1)years]. A total of 38 patients were treated with unarmed screw placement (unarmed group), and 23 with O-arm navigation system-assisted screw placement (navigation group). The unarmed group was divided into experienced group ( n=20) and unexperienced group ( n=18) based on the surgeons′ experience (whether they had 20 years or longer experience of spinal surgery and performed more than 100 atlantoaxial surgeries independently). The screw placement and surgical time of each group was recorded. The cervical CT scan was conducted at 7 days after surgery to evaluate the satisfaction rate of pedicle screw placement and cortical penetration rate according to Neo grading criteria. The cervical nerve function of the patients before, at 7 days after surgery and at the last follow-up was evaluated using the Japanese Orthopedic Association (JOA) score and the Neck Disability Index (NDI). The occurrence of complications was observed. Results:All patients were followed up for 9-25 months [(16.3±4.2)months]. There were no statistically significant differences in the screw placement and surgical time between the navigation group and the unarmed group (all P>0.05). The screw placement time of the navigation group was (41.0±7.8)minutes, longer than that of the experienced group [(23.6±6.8)minutes] ( P<0.01) and shorter than that of the unexperienced group [(50.1±10.1)minutes] ( P<0.05). The surgical time of the navigation group was (101.9±9.9)minutes, which was longer than that of the experienced group [(67.6±8.3)minutes] ( P<0.01) and shorter than that of the unexperienced group [(126.1±16.4)minutes] ( P<0.01). The satisfaction rate of pedicle screw placement and cortical penetration rate of the navigation group were 98.9% and 4.3%, respectively, which were better than those of the unarmed group (94.1% and 17.8%), the experienced group (96.2% and 13.8%), and the unexperienced group (91.7% and 22.2%) ( P<0.05 or 0.01). There was no statistically significant difference in JOA score or NDI before, at 7 days after surgery or at the last follow-up between the navigation group and the unarmed group, and no difference between the navigation group and the experienced group or the unexperienced group (all P>0.05). No complications such as spinal cord nervous or vascular injuries were observed during surgery in the navigation group or the unarmed group. Conclusions:Compared with the unarmed screw placement, O-arm navigation system-assisted upper cervical pedicle screw internal fixation shows no significant difference in screw placement time, surgical time, and postoperative neurological function status in the treatment of traumatic atlantoaxial instability, but has a higher accuracy in screw placement. Compared with the experienced surgeons′ unarmed screw placement, the technique also has higher screw placement accuracy but longer screw placement time and surgical time. Whereas in comparison with unexperienced surgeons′ unarmed screw placement, the technique can not only significantly improve its screw placement accuracy, while shortening screw placement time and surgical time so as to improve the surgical safety.

Objective:To study the effects of shenmai injection on postoperative delirium (POD) in patients undergoing off-pump coronary artery bypass graft (OPCABG).Methods:40 patients undergoing OPCABG from September 2019 to March 2020 in Linyi People's Hospital were randomly divided into (group S) and control group (group C), 20 cases in each group. Shenmai injection (0.6 ml/kg)was diluted to 150 ml with 5% glucose in group S, and pumped through the central vein at the beginning of the operation. In the group C, at the beginning of the operation, 5% glucose injection (150 ml) was pumped through central vein. The values of ejection fraction (EF), cardiac output (CO), stroke volume (SV), stroke volume variation (SVV), bispectral index (BIS), oxygen partial pressure (PO 2), central venous oxygen saturation (ScVO 2) and lactic acid (LAC) at anesthesia induction (T 0), at the beginning of operation (T 1), at the beginning of coronary artery bypass graft (T 2), at the end of coronary artery bypass graft (CABG) (T 3), and at the end of operation (T 4) were recorded. Patients were evaluated for delirium on the 3rd and 7th day after surgery. Results:The EF, CO in the patients of group C and group S at T 2 were found to be significantly lower than those at T 0 ( P<0.05). The ScVO 2, PO 2 in the patients of group C and group S at T 4 were found to be significantly lower than those at T 0 ( P<0.05). The EF, CO and SV in the patients of group S at T 3 to T 4 were found to be significantly higher than those in group C ( P<0.05). The incidence of postoperative delirium on the third day in the group S was significantly lower than that in the group C ( P<0.05). Conclusions:Shenmai injection can improve the cardiac function and reduce the incidence of POD in patients with OPCABG.

Objective:To explore the effects of cold ischemia time (CIT) and donor age upon postoperative and long-term follow-ups of heart transplantation.Methods:A total of 761 patients underwent orthotopic heart transplantation from 2004 to 2018. According to the length of CIT, they were divided into group of >4 hours (n=502) and group of <4 hours (n=259). Each group was further divided into two subgroups according to the age of donors: group of <40 years and group of <40 years. The basic profiles of recipients and donors were recorded, including applying mechanical assistance during and after operation, postoperative mortality and follow-up survival rate.Results:The average age of donors was (31.1±8.6)(5-58) years and the average CIT (5.3±2.0)(1.0-12.0) hours. No significant difference existed in hospital mortality between CIT groups (3.5% vs 5.6%, P=0.22). In subgroup analysis, there was a significant increase (4.3% vs 12.0%, P=0.01) in subgroup with CIT >4 hours and higher donor age. No significant difference existed in the number of patients using mechanical assistance during or after operation. During follow-ups, no significant difference existed in survival rate between CIT groups ( P=0.97) or survival rate among subgroups. Conclusions:Long CIT has a more significant effect on postoperative mortality of heart donors. However, it does not significantly increase the proportion of mechanical assistance, follow-up mortality and the incidence of cardiac allograft vasculopathy.

Objective To investigate whether the preoperative nutritional risk index(NRI) can predict the clinical out-comes of the patients underwent homologous orthotopic heart transplantation after 4 weeks.Methods With the use of continu-ous sampling method, a total of 168 adult patients who underwent homologous orthotopic heart transplantation from March 2013 to March 2015 were enrolled in this study.According to the cut-off points of the NRI, the patients were divided into 4 groups (high, moderate, mild and no nutritional risk).4 weeks after transplantation, the data about the length of stay in ICU, infec-tive and non-infective complications were collected , and the predictive value of the preoperative NRI for the clinical outcomes of the patients underwent homologous orthotopic heart transplantation were evaluated after 4 weeks of operation.In addition, the enrolled patients were divided into 2 groups according to their nutritional risk(with or without), and the differences between the two groups were compared.Results Among the patients, the prevalence of high, moderate, and low nutritional risk was 7. 1％, 32.7％ and 9.5％, respectively.The prevalence of infective complications for the 4 groups(from high risk to no risk) was 16.7％、7.3％、6.3％ and 3.5％, and the corresponding prevalence of non-infective complications was 16.7％、9.1％、6.3％ and 2.4％, respectively.In addition, the length of ICU stay of the 4 group was(10.9 ±1.0)days,(7.8 ±0.5)days, (6.7 ±0.7)days and(5.9 ±0.6)days, respectively.There were significant differences of length of ICU stay, infective and non-infective complications among the 4 groups(P<0.05 for all).Totally, there were significant differences of clinical out-comes between patients with and without nutritional risk(P <0.05 for all).Conclusion Preoperative NRI can predict the clinical outcomes regarding infective and no-infective complications as well as length of ICU stay for the adult patients under-went homologous orthotopic heart transplantation .

OBJECTIVE： To study the effects of aspirin on the growth and autoghagy of human gastric cancer cells SGC-7901 and BGC-823. METHODS： SGC-7901 and BGC-823 cells were selected as research objects， with phosphate buffer （PBS） as negative control treated for 48 h， MTT assay was used to detect the effects of 1， 2， 4， 6， 8， 10 mmol/L aspirin， 5 mmol/L aspirin alone or combined with 2.5 μmol/L chloroquine， 2.5 μmol/L 3-methyladenine （3-MA） on survival rate of gastric cancer cells. Flow cytometry was used to detect the effects of 2 and 5 mmol/L aspirin， 5 mmol/L aspirin alone or combined with 2.5 μmol/L chloroquine and 2.5 μmol/L 3-MA on the apoptosis rate and cell cycle distribution of gastric cancer cells. Hoechst33258 staining was used to observe the effects of 5 mmol/L aspirin on morphology of gastric cancer cell nucleus； Transwell chamber test was adopted to detect the effects of 5 mmol/L aspirin on the migration of gastric cancer cell. Laser confocal scanning microscopy was used to observe the effects of 5 mmol/L aspirin on autophagy formation in gastric cancer cells. Western blot method was used to detect the effects of 2 and 5 mmol/L aspirin on the protein expression of autophagy markers LC3-Ⅱin gastric cancer cells. RESULTS： Compared with negative control group， aspirin could inhibit the survival rates of SGC-7901 and BGC-823 cells in dose-dependent manner， but had no significant effects on apoptosis rate of SGC-7901 and BGC-823 cells； SGC-7901 and BGC-823 cells were blocked in G1 phase. Compared with aspirin alone group， the survival rates of SGC-7901 and BGC-823 were increased significantly after treated with aspirin+chloroquine and aspirin+3-MA， while the distribution rate of SGC-7901 and BGC-823 cells at G1 phase were decreased significantly， with statistical significance （P＜0.05 or P＜0.01）. Compared with negative control group， there were no obvious DNA fragmentation fragments， apoptotic bodies and fragments of dense bright blue， while the number of migration cells were decreased significantly in SGC-7901 and BGC-823 cells after treated with aspirin （P＜0.001）； the number of autophagosome was increased significantly and the protein expression of LC3-Ⅱ was enhanced significantly （P＜0.05）. CONCLUSIONS： Aspirin can significantly inhibit the growth of SGC-7901 and BGC-823 cells， and arrest cell cycle in G1 phase， the mechanism of which may be associated with the activation of autophagy.

Objective To explore effects of dizocilpine (MK-801) preconditioning on excitatory amino acids and inflammatory response in rats induced by cardiac arrest-cardiopulmonary resuscitation (CACPR).Methods 18 male Sprague Dawley (SD) rats were randomly divided into three groups:control group,CA group and CA + MK-801 group.To establish rat models of CA-CPR and keep samples of serum and specimens of brain tissues for following detection.The injury of neurons was observed by HE staining and expression of N-methyl-D-aspartic acid receptor (NMDAR) in brain tissues was detected by Western blot.The concentrations of interleukin 1 beta (IL-1 β) and tumor necrosis factor (TNF)-α in serum were detected by enzyme linked immunosorbent assay (ELISA).Results Neurons in CA group were disorganized,cells shrank,nuclei pyknosis,and cytoplasmic eosinophilia,accompanied by inflammatory cell infiltration.Preconditioning with MK-801 reduced the pathological damage of neuron and degree of macrophage infiltration.The relative expression of NMDAR protein in CA group were significantly higher than that in control group (907.9 ±24.9 vs 321.6 ± 18.4,P ＜0.001).Preconditioning with MK-801 significantly decreased the expression of NMDAR in CA + MK-801 group compared with that in CA group (512.4 ± 21.1 vs 907.9 ± 24.9).The CA group showed significantly increased concentrations of IL-1 β and TNF-α than that in control group (P ＜ 0.001),and this effect was abolished by preconditioning with MK-801.CA rats treated with MK-801 showed higher concentrations of IL-1 β and TNF-α than the control group.Conclusions Cardiac arrest causes pathological injury of neurons,up-regulates expression of NMDAR and aggravates inflammatory response.These results induce the apoptosis of nerve cells.Blocking glutamate receptor with MK-801 can inhibit expression of NMDAR,decrease level of cytokines,down-regulate inflammatory reaction degree therefore to protect the brain.