At present, the da Vinci surgical system, recognized as the most advanced minimally invasive surgical system, has been garnering growing attention in its application within the field of breast surgery. This article provides a comprehensive review of the development trajectory of the da Vinci surgical system in breast surgery, its indications and contraindications, as well as the common surgical modalities of da Vinci robotic-assisted breast surgery. Additionally, it offers a prospective outlook on the future development directions of da Vinci robotic-assisted breast surgical procedures.

Objective To systematically evaluate the efficacy and safety of three-dimensional visualization technology in assisting ablation therapy for hepatocellular carcinoma.Methods This study was conducted according to PRISMA guidelines,with a PROSPERO registration number of CRD42023488398.PubMed,Embase,Web of Science,the Cochrane Library,CNKI,Wanfang Data,VIP,and CBM were searched for Chinese and English articles on three-dimensional visualization technology in assisting ablation therapy for hepatocellular carcinoma published up to March 2023.After quality assessment and data extraction of the studies included,RevMan 5.4 software was used to perform the meta-analysis.Results A total of 11 studies were included,with 972 patients in total,among whom 447 underwent ablation assisted by three-dimensional visualization technology(3D group)and 525 underwent ablation assisted by traditional two-dimensional imaging technology(2D group).The meta-analysis showed that compared with the 2D group,the 3D group had significantly higher success rate of first-time ablation treatment(odds ratio[OR]=5.43,95%confidence interval[CI]:2.64—11.18,P<0.001),technical efficiency(OR=6.15,95%CI:3.23—11.70,P<0.001),and complete ablation rate(OR=2.50,95%CI:1.08—5.78,P=0.03),as well as significantly lower incidence rate of major complications(OR=0.45,95%CI:0.24—0.87,P=0.02),local recurrence rate(OR=0.35,95%CI:0.17—0.72,P=0.004),and local tumor progression rate(OR=0.29,95%CI:0.16—0.50,P<0.001),while there was no significant difference in the incidence rate of mild complications between the two groups(P>0.05).Conclusion Three-dimensional visualization technology is safe and feasible in assisting ablation therapy for hepatocellular carcinoma and can improve ablation rate and reduce the incidence rate of serious complications,local recurrence rate,and local tumor progression rate,thereby showing an important application value in clinical practice.

Background and Aims:The incidence of papillary thyroid carcinoma (PTC) has shown a significant upward trend. Given its favorable prognosis,there is a growing trend toward de-escalating its treatment to improve patients' quality of life. Pathologists have renamed the encapsulated follicular variant of PTC with indolent biological behavior as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP),providing a theoretical basis for treatment de-escalation. However,challenges persist in the clinical pathological diagnosis of NIFTP,and it is still predominantly managed as classical PTC in most cases. This study was performed to explore the clinicopathologic diagnostic characteristics,surgical challenges,and prospects for de-escalation treatment of NIFTP.Methods:The clinical data of 33 patients with thyroid disease who were admitted to Xuanwu Hospital Capital Medical University from November 2017 to December 2022 and confirmed as NIFTP by final paraffin pathology were retrospectively analyzed. Results:Among the 33 NIFTP patients,there were 11 males and 22 females,with an average age of 50 years. Tumor sizes ranged from 0.6 to 7.5 cm. There were 31 cases of solitary NIFTP tumor and 2 cases of multifocal tumors (each involving 2 sites). Eleven patients had coexisting PTC (one lesion in each case),with 4 lesions located on the same side as the NIFTP and 7 on the opposite side. All patients underwent surgical treatment,including 27 cases of conventional open surgery and 6 cases of endoscopic surgery. Suspicious or potentially malignant lesions were treated according to PTC surgical principles (lobectomy of the affected side plus central compartment lymph node dissection on the same side). Preoperative ultrasonography revealed that the nodules were predominantly hypoechoic,relatively regular in shape,well-defined,often accompanied by calcifications,and had a longitudinal-to-transverse diameter ratio of<1. TI-RADS classifications were as follows:5 cases as grade 3,9 cases as grade 4a,and 11 cases as grade 4b or higher. Among 29 patients who underwent preoperative fine-needle aspiration,1 case was diagnosed as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS),12 as follicular neoplasm/suspicious for follicular neoplasm (FN/SFN),12 as suspicious for malignancy (SUS),and 4 as PTC. BRAFV600E mutation testing was performed postoperatively in 25 cases,and 7 mutations were detected,all in cases with concomitant PTC.Conclusion:The introduction of the NIFTP concept provides a foundation for de-escalation or individualized treatment of certain less aggressive thyroid tumors. However,the preoperative and intraoperative diagnosis of NIFTP remains challenging in clinical practice. More precise preoperative diagnostic criteria and methods are needed to enable surgeons to adjust treatment decisions accordingly.

Background and Aims:The incidence of papillary thyroid carcinoma (PTC) has shown a significant upward trend. Given its favorable prognosis,there is a growing trend toward de-escalating its treatment to improve patients' quality of life. Pathologists have renamed the encapsulated follicular variant of PTC with indolent biological behavior as noninvasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP),providing a theoretical basis for treatment de-escalation. However,challenges persist in the clinical pathological diagnosis of NIFTP,and it is still predominantly managed as classical PTC in most cases. This study was performed to explore the clinicopathologic diagnostic characteristics,surgical challenges,and prospects for de-escalation treatment of NIFTP.Methods:The clinical data of 33 patients with thyroid disease who were admitted to Xuanwu Hospital Capital Medical University from November 2017 to December 2022 and confirmed as NIFTP by final paraffin pathology were retrospectively analyzed. Results:Among the 33 NIFTP patients,there were 11 males and 22 females,with an average age of 50 years. Tumor sizes ranged from 0.6 to 7.5 cm. There were 31 cases of solitary NIFTP tumor and 2 cases of multifocal tumors (each involving 2 sites). Eleven patients had coexisting PTC (one lesion in each case),with 4 lesions located on the same side as the NIFTP and 7 on the opposite side. All patients underwent surgical treatment,including 27 cases of conventional open surgery and 6 cases of endoscopic surgery. Suspicious or potentially malignant lesions were treated according to PTC surgical principles (lobectomy of the affected side plus central compartment lymph node dissection on the same side). Preoperative ultrasonography revealed that the nodules were predominantly hypoechoic,relatively regular in shape,well-defined,often accompanied by calcifications,and had a longitudinal-to-transverse diameter ratio of<1. TI-RADS classifications were as follows:5 cases as grade 3,9 cases as grade 4a,and 11 cases as grade 4b or higher. Among 29 patients who underwent preoperative fine-needle aspiration,1 case was diagnosed as atypia of undetermined significance/follicular lesion of undetermined significance (AUS/FLUS),12 as follicular neoplasm/suspicious for follicular neoplasm (FN/SFN),12 as suspicious for malignancy (SUS),and 4 as PTC. BRAFV600E mutation testing was performed postoperatively in 25 cases,and 7 mutations were detected,all in cases with concomitant PTC.Conclusion:The introduction of the NIFTP concept provides a foundation for de-escalation or individualized treatment of certain less aggressive thyroid tumors. However,the preoperative and intraoperative diagnosis of NIFTP remains challenging in clinical practice. More precise preoperative diagnostic criteria and methods are needed to enable surgeons to adjust treatment decisions accordingly.

Objective:To investigate the causes and prognosis of salvage cholecystectomy for relapsing cholecystolithiasis after gallbladder-preserving gall stones removal surgery.Methods:From Jul 2015 to Dec 2019, 24 referral patients with gallstone recurrence after gallbladder-preserving cholelithotomy surgery received salvage cholecystectomy. The clinical data was analyzed to explore the causes for re-operation and the prognosis.Results:Twenty-two cases had definite gallstone recurrence, among them 19 cases were symptomatic, 2 cases were operated on suspected gallbladder tumor and common bile duct stones induced acute cholangitis. Laparoscopic cholecystectomy was successfully performed in 23 cases and 1 case was converted to open surgery. No severe complication were observed in all the patients.Conclusions:Symptomatic gallstone recurrence is the most common causes of salvage cholecystectomy after gallbladder-preserving cholelithotomy. Laparoscopic surgery procedure is still highly successful.

Numerous studies of relationship between epigenomic features have focused on their strong correlation across the genome, likely because such relationship can be easily identified by many established methods for correlation analysis. However, two features with little correlation may still colocalize at many genomic sites to implement important functions. There is no bioinfor-matic tool for researchers to specifically identify such feature pairs. Here, we develop a method to identify feature pairs in which two features have maximal colocalization minimal correlation (MACMIC) across the genome. By MACMIC analysis of 3306 feature pairs in 16 human cell types, we reveal a dual role of CCCTC-binding factor (CTCF) in epigenetic regulation of cell identity genes. Although super-enhancers are associated with activation of target genes, only a subset of super-enhancers colocalized with CTCF regulate cell identity genes. At super-enhancers colocalized with CTCF, CTCF is required for the active marker H3K27ac in cell types requiring the activation, and also required for the repressive marker H3K27me3 in other cell types requiring repression. Our work demonstrates the biological utility of the MACMIC analysis and reveals a key role for CTCF in epigenetic regulation of cell identity. The code for MACMIC is available at https://github.com/bxia888/MACMIC.

Objective    To establish a model of tracheomalacia in beagle dogs. Methods    Six healthy male beagles were selected with a weight of 12-15 kg and age of 12-18 months. The dog was placed in supine position after being anesthetized. Then midline incision was performed on dogs' cervical skin and main trachea was dissected. Six continuous cartilage rings separated from the tracheal wall were removed. Finally, the endotracheal mucosal was examined and the wound was sutured layer by layer. Different degrees of cartilage were removed to simulate different degrees of tracheomalacia. The beagle dogs were classified into two groups (n=3 in each group): a mild tracheomalacia (MTM) group (part of the cartilage near the trachea membrane was retained) and a severe tracheomalacia (STM) group (cartilage was removed as much as possible). Results    The dogs in the MTM group survived for a long time after the operation, showing symptoms of airway stenosis such as wheezing and coughing. The dogs were killed at postoperative week 2, and the pathological examination was performed. In the STM group, severe asphyxia occurred in the experimental animals after tracheal intubation removed, and all dogs died within 1 hour after surgery. Postoperative bronchoscopy revealed that the trachea of the MTM group dogs collapsed in the phase of inhalation, but it could maintain a certain patency. The trachea of the STM group dogs collapsed completely in the phase of inhalation. Postoperative X-ray showed that the diameter of the airway in the MTM group was reduced and trachea did not completely collapse. In the STM group, the trachea collapsed completely at the cartilage removed segment. Pathological examination showed that the cartilage in the MTM group was partially removed and tracheomalacia was obvious in the cartilage removed segment. In the STM group, most of the cartilage was removed with only few cartilages left. Conclusion    The clinical symptoms of tracheomalacia in different degrees can be simulated and repeatable. Animal models can be established by controlling the degree of removal of tracheal cartilage ring in dogs. This method provides a simple, repeatable and standardized large animal model for the treatment and transformation of tracheomalacia.

To investigate the current status of the postpartum weight retention (PPWR) in Kaifu District of Changsha, and explore the influential factors with PPWR based on the generalized estimating equation model.
 Methods: A cluster sampling method was applied to select women who gave birth at the health service centers of 3 street communities in Kaifu District of Changsha during 2015. According to the inclusion and exclusion criteria, 783 cases were finally included in the study. Data on PPWR were collected prospectively by using the self-made questionnaire at 1, 3, 6 and 8 months after childbirth. Analysis were performed to investigate the associations between PPWR and its potential factors with generalized estimation equation model.
 Results: The mean PPWR of women was gradually decreased with the increase of postpartum time, and 34.6% of them have returned to the pre-pregnancy weight in the 8 months postpartum. Our findings revealed that gestation weight gain (GWG), pre-pregnancy body mass index, feeding patterns, and delivery mode were significantly associated with maternal PPWR (P<0.05). In contrast, maternal age, educational level, per capita income of family, parity and postpartum depression were not contributed to PPWR (P>0.05).
 Conclusion: GWG is one of the most important predictors for PPWR. The key to reducing PPWR is to control GWG systematically. Early targeted interventions and health education should be taken to prevent women from excessive PPWR at the first-year postpartum, in particular to the women who underwent cesarean deliveries and breastfed their infants. It is conducive to reduce the risks of overweight or obesity caused by PPWR.
Body Mass Index ; Female ; Gestational Weight Gain ; Humans ; Obesity ; Overweight ; Postpartum Period ; Pregnancy

[Abstract] Objective: To explore the mRNA molecular targets for diagnosis of hepatic carcionoma and to investigate their functional roles in proliferation and cell cycle of hepatic cancer cells. Methods: Based on the statistical analysis of miRNA expression data from 377 hepatic carcionoma samples and 37 adjacent non-cancerous samples in TCGAdatabase, a group of 33 differentially expressed miRNAs were identified.A further screen of these differentially expressed miRNAs was performed using the receiver operating characteristic curve (ROC curve) and Kaplan-Meier survival analysis; and with referring to the current publications, miR-451 was screened as the study subject. HepG2 cells were transfected with pLVX-shRNA2-miR-451 to over-express miR-451. The effect of miR-451 over-expression on the proliferation of HepG2 cell was determined by CCK-8 assay; while the effect on cell cycles was detected by flow cytometry. Results: The expression of miR-451 in the adjacent non-cancerous tissues was significantly lower than that in cancer tissues ([473.40±390.24] vs [1 990.47±2 118.04], P<0.05). MiR-451 could be used as an early diagnostic biomarker of hepatic carcionoma, with a high ROC value of 0.91 (sensitivity 0.89, specificity 0.87). The results of in vitro experiments showed that the proliferation of HepG2 cells was significantly decreased after miR-451 over-expression (48 h: [0.69±0.04] vs [1.08±0.05]; 72 h: [0.76±0.07] vs [1.52± 0.02]; all P<0.01), and a large number of cells were blocked in S phase(P<0.05). Conclusion: miR-451 has the potential to be used as a biomarker for hepatic carcionoma diagnosis and prognosis; moreover, it also exhibits the inhibitory effect on proliferation of hepatic cancer cells.

Objectve To explore the application of exercise test use in diagnosis of periodic paraly sis.Methods Forty five cases of hypokalemic periodic paralysis were collected,and 40 health persons as control group.Both groups were measured serum potassium,serum creatase and thyroid function tests.All of them were taken exercise test (ET) and observe 50 minutes,measured before and after the test to seek the changes of compound muscle action potentials (CMAP),and its decreased more than 33％ were considered abnormal.The application of exercise test use was analyzed in diagnosis of periodic paralysis.Results In patients with periodic paralysis,the incidence of ET positive was higher than the control subjects (80％ vs 3.3％,P ＜ 0.001).This trend was significant after 20 minutes,such as 30 min[(37.8 ± 13.2)％ vs (6.2±3.2)％,P＜0.01],40min [(40.3 ±17.6)％ vs (3.2±1.9)％,P＜0.01],50min [(45.26 ± 19.9) ％ vs (-5.1 ± 2.6) ％,P ＜ 0.01].Moreover,linear correlation analysis showed that the serum potassium had negative correlation with serum creatase (r =-0.483,P =0.024).ALL of symptoms improved after a week treatment,the ET positive rate was still higher in patients with periodic paralysis than the control subjects (80.0％ vs 71.1％,P =0.824).Conclusions Exercise test was one of the important objective basis in the diagnosis of low potassium type periodic paralysis,and was not affected by treatment and testing time.