Objective To evaluate the safety and feasibility of remote robot-assisted thoracoscopic surgery utilizing 5G technology. Methods Clinical data from five patients who underwent 5G remote robot-assisted thoracoscopic surgery at the Thoracic Surgery Center of Gansu Provincial People's Hospital from May to October 2024 were retrospectively analyzed. Results Finally, five patients were included. There were 2 males and 3 females at median age of 50 (42-63) years. All five surgeries (including 1 patient of lobectomy, 3 patients of partial lung resection and 1 patient of mediastinal lesion resection) were successfully completed without conversion to thoracotomy, complications, or mortality. The median intraoperative signal delay across the patients was 39 (37-42) ms. The median psychological load score for the surgeons was 9 (3-13). The median operation time was 100 (80-122) minutes with a median intraoperative blood loss of 100 (30-200) mL. Catheter drainage lasted a median of 4 (3-5) days, and the median drainage volumes on the first, second, and third postoperative day were 200 (100-300) mL, 150 (60-220) mL, and 80 (30-180) mL, respectively. The median postoperative hospital stay was 4 (3-7) days, and the median pain scores on the third postoperative day were 3 (1-4), 3 (0-3), and 1 (0-3), respectively. Conclusion 5G remote robot-assisted thoracoscopic surgery is safe and effective, with good surgical experience, smooth operation and small intraoperative delay.

As a potential vectored vaccine,Newcastle disease virus(NDV)has been subject to various studies for vaccine development,while relatively little research has outlined the immunomodulatory effect of the virus in antigen presentation.To elucidate the key inhibitory factor in regulating the interaction of infected dendritic cells(DCs)and T cells,DCs were pretreated with the NDV vaccine strain LaSota as an inhibitor and stimulated with lipopolysaccharide(LPS)for further detection by enzyme-linked immunosorbent assay(ELISA),flow cytometry,immunoblotting,and quantitative real-time polymerase chain reaction(qRT-PCR).The results revealed that NDV infection resulted in the inhibition of interleukin(IL)-12p40 in DCs through a p38 mitogen-activated protein kinase(MAPK)-dependent manner,thus inhibiting the synthesis of IL-12p70,leading to the reduction in T cell proliferation and the secretion of interferon-γ(IFN-γ),tumor necrosis factor-α(TNF-α),and IL-6 induced by DCs.Consequently,downregulated cytokines accelerated the infection and viral transmission from DCs to T cells.Furthermore,several other strains of NDV also exhibited inhibitory activity.The current study reveals that NDV can modulate the intensity of the innate?adaptive immune cell crosstalk critically toward viral invasion improvement,highlighting a novel mechanism of virus-induced immunosuppression and providing new perspectives on the improvement of NDV-vectored vaccine.

Purpose/Significance To explore the training path of smart medical compound talents with both medical knowledge and artificial intelligence(AI)engineering technology under the background of education digital transformation.Method/Process By apply-ing the methods of educational practice and literature research,the paper analyzes the challenges faced by education digital transforma-tion,expounds the construction method of the"real-virtual"digital transformation model of smart medical education,and puts forward the training path of smart medical talents.Result/Conclusion Under the background of education digital transformation,it is necessary to reshape the concept of smart medical education and innovate the evaluation mode of smart medical education,realize the reform of"teach-ing""learning"and"management"through the smart campus system.

Objective:To explore the current status of surgery for portal hypertension to grasp current status and future development of surgery in China.Methods:This study is jointly sponsored by China Hepatobiliary & Pancreatic Specialist Alliance & Portal Hypertension Alliance in China (CHESS).Comprehensive surveying is conducted for basic domestic situations of surgery for portal hypertension, including case load, surgical approaches, management of postoperative complications, primary effects, existing confusion and obstacles, liver transplantation(LT), laparoscopic procedures and transjugular intrahepatic portosystemic shunt(TIPS), etc.Results:A total of 8 512 cases of portal hypertension surgery are performed at 378 hospitals nationwide in 2021.Splenectomy plus devascularization predominated(53.0%)and laparoscopy accounted for 76.1%.Primary goal is preventing rebleeding(67.0%) and 72.8% of hospitals used preventive anticoagulants after conventional surgery.And 80.7% of teams believe that the formation of postoperative portal vein thrombosis is a surgical dilemma and 65.3% of hospitals practiced both laparoscopy and TIPS.The major reasons for patients with portal hypertension not receiving LT are due to a lack of qualifications for LT(69.3%)and economic factors(69.0%).Conclusions:Surgery is an integral part of management of portal hypertension in China.However, it is imperative to further standardize the grasp of surgical indications, the handling of surgical operation and the management of postoperative complications.Moreover, prospective, multi-center randomized controlled clinical studies should be performed.

O'Sullivan-Mcleod syndrome is a very rare variant of MND with a good prognosis. Its clinical feature is distal lower motor neuron syndrome of both upper limbs, and there is no effective treatment at present. We reported a case of O'Sullivan-Mcleod syndrome in this paper.The patient exhibited with middle-aged progressive distal muscle weakness and atrophy of both upper limbs, without sensory, cognitive or behavioral impairment and without pyramidal tract sign. Laboratory examination, imaging and genetic tests showed no obvious abnormalities. EMG revealed neurogenic damage to the small muscles of both hands. Now we retrospectively analyzed the clinical features of a patient with O'Sullivan-McLeod syndrome, and data from 18 cases for comparative analysis, in order to improve its understanding by clinicians.

OBJECTIVE：To study the ecological suitability zoning of Astragalus membranaceus var. mongholicus in Dingxi city. METHODS ：Taking 1 001 batches of A. membranaceus var. mongholicus in Dingxi city as the investigation samples （each natural village with A. membranaceus var. mongholicus cultivation as the collection unit ），the longitude and latitude information of them were obtained from Dingxi economic crop technology promotion station ，and 55 environmental ecological factors （including climate，terrain，soil，etc.）were obtained from the Grid Database of Spatial Information of TCM Resources . Combined with the information of longitude ，latitude and environmental ecological factors ，the maximum entropy model （MaxEnt model ） was established with 75％ samples as the training set ，and the main ecological factors were screened out ，and 25％ samples were set as the validation set for model validation. Then the suitable growing areas of A. membranaceus var. mongholicus were divided by using ArcGIS. RESULTS ：Established MaxEnt model had good prediction （the area under the working characteristic curve of subjects in training set and verification set was 0.970 and 0.968）. Eight main ecological factors ，such as altitude ，precipitation and temperature ， were selected （the total contribution rate was 98.90％）. The comprehensive analysis found that the altitude was 1 800 to 2 650 m， the average precipitation in April was 25 to 50 mm，the lowest temperature of the coldest month was －16 to －8 ℃，the wettest monthly precipitation was 95 to 110 mm，and the seasonal variation of temperature was 70 to 80，the average temperature in December was －6 to －3 ℃ ，the average precipitation in October was 30 to 50 mm，and the average precipitation in December was 0 to 10 mm，which was the suitable environmental parameter for the growth of A. membranaceus var. mongholicus in Dingxi city. Based the results of ArcGIS analysis ，in Dingxi city ，A. membranaceus var. mongholicus was generally suitable for growth ；in the northwest of Lintao county ，the north of Anding district ，the south of Tongwei county ，a small area in the south of Longxi county and the south of Minxian county ，the border between Weiyuan county ，Zhangxian county and Minxian county ，A membranaceus var. mongholicus was not suitable for growth. CONCLUSIONS： Ther results of established model is in E-mail：961308817@qq.com line with the actual investigation ， can provide reference for the planting regional planning of A. membranaceus var. mongholicus in Dingxi city.

Objective To investigate the effects of dexmedetomidine postconditioning on brain injury after cardiac arrest and resuscitation in a swine model.Methods Twenty-eight healthy male domestic pigs,weighing 36±2 kg,were randomized (random number) into 4 groups (n=7 each group):sham operation group (S group),cardiopulmonary resuscitation group (CPR group),low-dose dexmedetomidine postconditioning group (LDP group),and high-dose dexmedetomidine postconditioning group (HDP group).Animals in the S group only underwent the surgical preparation.In the other three groups,the experimental model was established by 8 mins of electrically induced ventricular fibrillation and then 5 mins of cardiopulmonary resuscitation.At 5 min after resuscitation,a loading dose of dexmedetomidine of 0.25 μg/kg was intravenously infused followed by continuous infusion at a rate of 0.25 μg/(kg·h) for 6 h in the LDP group,and a loading dose of dexmedetomidine of 0.5 μ.g/kg was infused followed by continuous infusion at a rate of 0.5 μg/(kg·h) for 6 h in the HDP group.The same amount of normal saline was administered in the S and CPR groups.At 1 h,3 h,6 h and 24 h after resuscitation,the levels of serum neuron specific enolase (NSE) and S100B protein were measured.At 24 h after resuscitation,neurologic deficit score (NSD) was evaluated.After that,the animals were euthanized and cerebral cortex was obtained for the determination of tumor necrosis factor-α (TNF-α),interleukin-6 (IL-6)and malondialdehyde (MDA) contents,superoxide dismutase (SOD) activity,cell apoptosis and caspase-3 expression.Results Compared with the S group,post-resuscitation neurologic dysfunction and brain injury were observed in the other three groups,which were indicated by significantly higher NDS and markedly greater levels of serum NSE and S 100B (all P＜0.05).Compared with the CPR group,the score of NDS at 24 h post-resuscitation were significantly lower and the levels of serum NSE and S100B at 6 h and 24 h post-resuscitation were significantly less in the LDP and HDP groups [NDS:194±26,103±16 vs 278±23 at 24 h;NSE (ng/mL):32.4±1.8,28.6±3.7 vs 36.2±2.8 at 6 h,39.9±4.2,35.1±1.5 vs 45.1±3.0 at 24 h;S100B (pg/mL):2 534±207,2 382±170 vs 2 825±113 at 6 h,3 719±164,3 246±176 vs 4 085±161 at 24 h,all P＜0.05].Compared with the LDP group,neurologic dysfunction and brain injury at 24 h postresuscitation were further significantly alleviated in the HDP group (all P＜0.05).Pathological analysis indicated that brain inflammation,oxidative stress and cell apoptosis were observed after resuscitation in the CPR,LDP and HDP groups.However,the contents of TNF-α,IL-6 and MDA were significantly lower while the activity of SOD was significantly higher,and cell apoptosis and caspase-3 expression were significantly reduced in the brain after resuscitation in the LDP and HDP groups compared with the CPR group (all P＜0.05).In addition,those pathological injuries mentioned above were further significantly alleviated in the brain after resuscitation in the HDP group compared to the LDP group (all P＜0.05).Conclusions Dexmedetomidine postconditioning significantly alleviated the severity of postresuscitation brain injury in a dose-dependent manner,in which the protection was produced possibly through reducing tissue inflammation,oxidative stress and cell apoptosis.

Objective To analyze the impact of secondary infection on prognosis of liver failure. Methods A total of 384 hospitalized patients who were diagnosed with liver failure from January 2015 to Decembet 2017 in the Department of Infectious Diseases of the Second Xiangya Hospital of Central South University were retrospectively analyzed.The patients were divided into infected group and non-infected group according to whether they were complicated with infection during hospitalization .The cause of liver failure, the area and source of infection were recorded.The infected group was divided into bacterial group and fungal group.The liver and kidney function , international normalized ratio ( INR).The model for end-stage liver disease ( MELD ) score, hospitalization days , medical expenditure , and mortality were calculated and evaluated.T test was used for normally distributed continuous variables , and chi-square test was used for classified variables.Results A total of 384 hospitalized patients with liver failure were enrolled , including 321 males and 63 females with age of (45.5 ±13.4) years.There were 240 patients (62.5%, infected group) who had secondary infection during the whole course , and 144 patients (37.5%, non-infected group ) were not infected.Among the 384 patients, 328 patients (85.4%) were infected with hepatitis B virus, 8(2.1%) with hepatitis C virus, and 10(2.6%) with alcoholic hepatitis.As for the clinical types of liver failure , 187 patients (48.7%) were diagnosed with acute-on-chronic (subacute) liver failure and 158 (41.1%) with chronic liver failure.Among the 240 patients in the infected group, 122 patients (50.8%) had abdominal infection, 84 (35%) had pulmonary infection, 8(3.3%) had urinary tract infection, 13(5.4%) had biliary tract infection , and 11 ( 4.6%) had bloodstream infection.The levels of total bilirubin , creatinine, MELD scores, hospitalization days and medical expenditure in the infected group and non -infected group were statistically significant (all P＜0.01) after 30 days in hospital.In the infected group, 362 various samples from 240 patients were submitted for bacterial culture , among which 87 samples were positive, including Candida in 15 samples, Aspergillus in 8 samples, Acinetobacter baumannii in 13 samples, Staphylococcus in 10 samples, Escherichia coli in 11 samples, Klebsiella pneumoniae in 14 samples, Bacillus faecalis in 4 samples, Bacillus pallid in 4 samples, Stenotrophomonas maltophilia in 4 samples and Aeromonas hydrophila in 4 samples.Among the 240 patients in the infected group , 182 patients were diagnosed with bacterial infection and 58 with fungal infection. There were significant differences in total bilirubin , serum creatinine, INR, MELD scores and mortality rate between the two groups ( all P＜0.05).Conclusions The rate of secondary infection in patients with liver failure is not related with age.The development of secondary infection , especially fungal infection , worsens the prognosis of patients with liver failure.

Objective To evaluate the effect of dexmedetomidine on receptor-interacting protein 1 (RIP1) signaling pathway during brain injury after cardiac arrest and resuscitation in pigs.Methods Twenty-one healthy domestic male white pigs,weighing 33-41 kg,were divided into 3 groups (n =7 each) using a random number table method:sham operation group (group S),cardiac arrest-resuscitation group (group CA-R) and dexmedetomidine group (group D).Ventricular fibrillation was electrically induced and untreated for 8 min followed by 5 min of cardiopulmonary resuscitation to establish the model of brain injury after cardiac arrest and resuscitation in anesthetized domestic white pigs.Dexmedetomidine was infused via the femoral vein in a loading dose of 0.5 μg/kg at 5 min after successful resuscitation,followed by an infusion of 0.5 μg · kg-1 · h-1 for 6 h in group D.The equal volume of normal saline was given instead in S and CA-R groups.The concentrations of neuron-specific endase (NSE) and S-100β protein in serum were measured at 1,3,6 and 24 h after resuscitation (T1-4).Neurologic deficit score (NDS) was evaluated at T4.The animals were sacrificed at T4,brains were removed and cerebral cortex tissues were obtained for determination of the expression of RIP1,RIP3 and mixed lineage kinase domain-like protein (MLKL) by Western blot.Results Compared with group S,the serum concentrations of NSE and S-100β protein were significantly increased at T1-4,the NDS was increased at T4,and the expression of RIP1,R1P3 and MLKL in cerebral cortex tissues was up-regulated in CA-R and D groups (P＜0.05).Compared with group CA-R,the serum concentrations of NSE and S-100β protein were significantly decreased at T3,4,the NDS was decreased at T4,and the expression of RIP1,RIP3 and MLKL in cerebral cortex tissues was down-regulated in group D (P＜0.05).Conclusion The mechanism by which dexmedetomidine reduces brain injury after cardiac arrest and resuscitation may be related to inhibiting the activation of RIP 1 signaling pathway in pigs.

Objective To investigate the relationship and clinical significance between circulating soluble low-density lipoprotein receptor family member 11 (sLR11) level,type 2 diabetes (T2DM) and carotid intima-media thickness (CIMT). Methods Newly diagnosed patients with T2DM (T2DM group,n=55)and healthy controls (NC group,n=55)were enrolled in this study. The sLR11 level was measured by ELISA. The level of sLR11,CIMT,age,blood lipid,and blood pressure were compared between the two groups. Another 165 patients with T2DM treated with conventional pharmaceutical medications were also selected in this study. The relationship between sLR11,CIMT and atherosclerosis were analyzed. The influences of sLR11 and FPG in the progress of CIMT were also evaluated. Results The sLR11 level and CIMT were higher in T2DM group than in NC group [(8.35 ± 2.65) vs (6.64 ± 1.99)ng/ml,P= 0.026;(0.87 ± 0.37) vs (0.73 ± 0.26) mm,P= 0.037]. In the 165 patients with T2DM,the level of sLR11 and CIM T were(9.79 ± 3.54)ng/ml and (0.79 ± 0.18)mm respectively. Correlation analysis showed that sLR11 levels were positively correlated with age,systolic blood pressure, LDL-C,fasting plasma-glucose (FPG),and HbA1c (r = 0.226,0.162,0.166,0.276,0.176). Multivariate linear regression analysis indicated that FPG was an independent risk factor for sLR 11 (β=0.175,P<0.05),and sLR11 was a independent risk factor of CIMT in the absence of age factor (β=0.008,P<0.05). Conclusion The sLR11 level may relate to blood glucose in T 2DM,and reflect the situation of CIM T and the pathological status of vessel intimal smooth muscle cells (SMCs).