Objective:To summarise the main points of operation during thyroid surgery using bilateral axillo-breast approach (BABA) with a domestic robot and to analyse the learning curve.Methods:From May. 2023 to Oct. 2023, we retrospectively analysed the clinical data of 38 patients who underwent thyroid surgery with domestically manufactured robot via BABA attending the Department of Thyroid and Breast Surgery of the 960th Hospital of PLA Joint Logistics Support Force, proposed and constructed learning curves using cumulative and analytical methods to study the minimum number of learning cases required for the loading time of assistants and surgeon-in-charge with da Vinci surgical experience to transition from the initial learning stage to the proficiency stage. The age, BMI, surgical time (loading time, operating time), postoperative drainage time, and number of lymph nodes dissected were compared among patients at different stages of the learning curve.Results:A total of 38 thyroidectomy patients successfully underwent surgery, with an average surgical time of (176.61 ± 47.98) minutes. After 18 cases, the assistant's loading time shortened and stabilized at (42.20 ± 3.44) minutes. The operator reached peak proficiency at the 18th case (loading time, operating time), which was considered the dividing point between the learning phase and the proficiency phase. During the learning phase, the average surgical time was (209.72 ± 49.28) minutes, operation time: (165.44 ± 49.93) minutes, while in the proficiency phase, the average surgical time decreased to 146.80 ± 18.34 minutes, operation time: (104.60 ± 19.01) minutes. There were no statistically significant differences in baseline characteristics such as age, BMI, postoperative drainage time, or the number of central compartment lymph nodes dissected between the two phases ( P > 0.05) . Conclusion:Over the results of this study, it was shown that for robosurgeons with experience in da Vinci robotic surgery, the transition from the learning stage to the proficiency stage could be considered after crossing the learning curve for 18 cases, and that assistants could become proficient in loading techniques after 18 procedures.

BACKGROUND:Studies have found that inhibition of tumor necrosis factor receptor-associated factor 6 improves myocardial function and promotes myocardial autophagy in sepsis,but the specific mechanism is not clear.OBJECTIVE:To explore the effect of inhibiting tumor necrosis factor receptor-associated factor 6-regulated mTORC1/ULK1 autophagy signaling pathway on myocardial injury in sepsis mice.METHODS:Thirty male Kunming mice were randomly divided into sham operation group,cecal ligation and puncture group(model group),model+tumor necrosis factor receptor-associated factor 6 specific inhibitor C25-140(model+C)group,model+C25-140+autophagy inhibitor 3-methyladenine(model+C+3-MA)group,and model+C25-140+mTORC1-specific agonist MHY1485(model+C+M)group.The cecum of mice in the sham operation group was not ligated or punctured.The mice in the other groups underwent cecum ligation and puncture to establish the mouse sepsis model.C25-140,3-methyladenine,and MHY1485 were intraperitoneally injected 0.5 hours after surgery according to the grouping.Myocardial tissue was obtained 24 hours after surgery.Hematoxylin-eosin staining was used to evaluate myocardial inflammatory lesions.Transmission electron microscopy was used to observe the changes in the autophagic bodies and mitochondrial microstructures of myocardial cells.TUNEL assay was used to detect myocardial cell apoptosis.PCR was used to detect the relative expression of tumor necrosis factor receptor-associated factor 6 mRNA.Western blot assay was used to detect the expression of related proteins.RESULTS AND CONCLUSION:(1)Compared with sham operation group,myocardial inflammatory cell infiltration and fibrous edema were observed in the model group.The mitochondria of the cells were obviously swollen,and autophagosomes were occasionally seen;cardiomyocyte apoptosis increased significantly;the expression of tumor necrosis factor receptor-associated factor 6,phosphorylated nuclear factor κB P65/P65,p-mTOR/mTOR,p-ULK1/ULK1,P62 and Bax protein increased,and the expression of Bcl2 protein decreased(P＜0.05).(2)Compared with the model group,myocardial inflammation and fibrous edema were alleviated in the model+C group.Myocardial mitochondrial swelling was reduced and autophagosomes increased;cardiomyocyte apoptosis decreased;the expression of phosphorylated nuclear factor κB P65/nuclear factor-κB P65,p-mTOR/mTOR,p-ULK1/ULK1,P62,and Bax protein decreased,while the Beclin-1 and Bcl2 protein increased(P＜0.05).(3)Compared with the model+C group,myocardial autophagosomes decreased and myocardial mitochondrial swelling was more obvious in the model+C+3-MA group.Myocardial inflammation was aggravated;myocardial cell apoptosis increased;the expression of phosphorylated nuclear factor κB P65/nuclear factor κB P65,P62,and Bax protein increased,and the Beclin-1 and Bcl2 protein decreased(P＜0.05).(4)Compared with the model+C group,the expression of p-mTOR/mTOR and p-ULK1/ULK1 in the model+C+M group increased,and the Beclin-1 and microtubule-associated protein 1 light chain 3 Ⅱ/Ⅰ protein expression decreased(P＜0.05).It is concluded that inhibition of tumor necrosis factor receptor-associated factor 6 regulates mTORC1/ULK1 autophagy signal to promote myocardial autophagy and participate in the protection of myocardial injury in sepsis.

Objective:To summarise the main points of operation during thyroid surgery using bilateral axillo-breast approach (BABA) with a domestic robot and to analyse the learning curve.Methods:From May. 2023 to Oct. 2023, we retrospectively analysed the clinical data of 38 patients who underwent thyroid surgery with domestically manufactured robot via BABA attending the Department of Thyroid and Breast Surgery of the 960th Hospital of PLA Joint Logistics Support Force, proposed and constructed learning curves using cumulative and analytical methods to study the minimum number of learning cases required for the loading time of assistants and surgeon-in-charge with da Vinci surgical experience to transition from the initial learning stage to the proficiency stage. The age, BMI, surgical time (loading time, operating time), postoperative drainage time, and number of lymph nodes dissected were compared among patients at different stages of the learning curve.Results:A total of 38 thyroidectomy patients successfully underwent surgery, with an average surgical time of (176.61 ± 47.98) minutes. After 18 cases, the assistant's loading time shortened and stabilized at (42.20 ± 3.44) minutes. The operator reached peak proficiency at the 18th case (loading time, operating time), which was considered the dividing point between the learning phase and the proficiency phase. During the learning phase, the average surgical time was (209.72 ± 49.28) minutes, operation time: (165.44 ± 49.93) minutes, while in the proficiency phase, the average surgical time decreased to 146.80 ± 18.34 minutes, operation time: (104.60 ± 19.01) minutes. There were no statistically significant differences in baseline characteristics such as age, BMI, postoperative drainage time, or the number of central compartment lymph nodes dissected between the two phases ( P > 0.05) . Conclusion:Over the results of this study, it was shown that for robosurgeons with experience in da Vinci robotic surgery, the transition from the learning stage to the proficiency stage could be considered after crossing the learning curve for 18 cases, and that assistants could become proficient in loading techniques after 18 procedures.

Objective To explore the effect of transjugular intrahepatic portosystemic shunt(TIPS)on gut microbiota and blood ammonia level in patients with decompensated cirrhosis,and to analyze the correlation between the gut microbiota and blood ammonia level.Methods From July 2021 to December 2023,the patients with decompensated cirrhosis and portal hypertension complicated by esophagogastric variceal bleeding and/or refractory ascites,who received TIPS at Zhuhai Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine,were collected.The blood and stool samples were collected before and after TIPS.The changes in blood routine,prothrombin time,liver function,and blood ammonia level were determined.The change of gut microbiota was detected using 16S rRNA high-throughput sequencing,and Spearman correlation analysis was used to assess the correlation between the gut microbiota and blood ammonia level.Results In 20 patients,the post-TIPS one-month levels of AST,TBil,DBiL,PT,and blood ammonia were higher than their pre-TIPS values(P＜0.05),and the albumin(Alb)level was lower than the pre-TIPS value(P＜0.05).The post-TIPS 3-month levels of TBil,DBil,PT,and blood ammonia were higher than their pre-TIPS values(P＜0.05).One month after TIPS,the beta diversity of the gut microbiota became significantly different from the pre-TIPS pattern(P＜0.05).After TIPS,the harmful bacteria such as Veillonella,Streptococcus and Haemophilus were significantly reduced,the difference was statistically significant(P＜0.05).The correlation analysis of gut microbiota and blood ammonia level showed that in T0 group Colidextribacter was positively correlated with blood ammonia level,while Roxobella was negatively correlated with blood ammonia level;and in T1 group,Colidextribacter and Streptococcus were positively correlated with blood ammonia level,while Coprococcus,Bifidobacterium and Parasutterella were negatively correlated with blood ammonia level,and the differences were statistically significant(all P＜0.05).Conclusion In patients with decompensated cirrhosis after receiving TIPS,significant changes in the pattern of gut microbiota occur.Certain correlations exist between the changes of some microbiota and blood ammonia levels.Regulating the intestinal microecology may contribute to reducing blood ammonia level after TIPS.

BACKGROUND:Studies have found that inhibition of tumor necrosis factor receptor-associated factor 6 improves myocardial function and promotes myocardial autophagy in sepsis,but the specific mechanism is not clear.OBJECTIVE:To explore the effect of inhibiting tumor necrosis factor receptor-associated factor 6-regulated mTORC1/ULK1 autophagy signaling pathway on myocardial injury in sepsis mice.METHODS:Thirty male Kunming mice were randomly divided into sham operation group,cecal ligation and puncture group(model group),model+tumor necrosis factor receptor-associated factor 6 specific inhibitor C25-140(model+C)group,model+C25-140+autophagy inhibitor 3-methyladenine(model+C+3-MA)group,and model+C25-140+mTORC1-specific agonist MHY1485(model+C+M)group.The cecum of mice in the sham operation group was not ligated or punctured.The mice in the other groups underwent cecum ligation and puncture to establish the mouse sepsis model.C25-140,3-methyladenine,and MHY1485 were intraperitoneally injected 0.5 hours after surgery according to the grouping.Myocardial tissue was obtained 24 hours after surgery.Hematoxylin-eosin staining was used to evaluate myocardial inflammatory lesions.Transmission electron microscopy was used to observe the changes in the autophagic bodies and mitochondrial microstructures of myocardial cells.TUNEL assay was used to detect myocardial cell apoptosis.PCR was used to detect the relative expression of tumor necrosis factor receptor-associated factor 6 mRNA.Western blot assay was used to detect the expression of related proteins.RESULTS AND CONCLUSION:(1)Compared with sham operation group,myocardial inflammatory cell infiltration and fibrous edema were observed in the model group.The mitochondria of the cells were obviously swollen,and autophagosomes were occasionally seen;cardiomyocyte apoptosis increased significantly;the expression of tumor necrosis factor receptor-associated factor 6,phosphorylated nuclear factor κB P65/P65,p-mTOR/mTOR,p-ULK1/ULK1,P62 and Bax protein increased,and the expression of Bcl2 protein decreased(P＜0.05).(2)Compared with the model group,myocardial inflammation and fibrous edema were alleviated in the model+C group.Myocardial mitochondrial swelling was reduced and autophagosomes increased;cardiomyocyte apoptosis decreased;the expression of phosphorylated nuclear factor κB P65/nuclear factor-κB P65,p-mTOR/mTOR,p-ULK1/ULK1,P62,and Bax protein decreased,while the Beclin-1 and Bcl2 protein increased(P＜0.05).(3)Compared with the model+C group,myocardial autophagosomes decreased and myocardial mitochondrial swelling was more obvious in the model+C+3-MA group.Myocardial inflammation was aggravated;myocardial cell apoptosis increased;the expression of phosphorylated nuclear factor κB P65/nuclear factor κB P65,P62,and Bax protein increased,and the Beclin-1 and Bcl2 protein decreased(P＜0.05).(4)Compared with the model+C group,the expression of p-mTOR/mTOR and p-ULK1/ULK1 in the model+C+M group increased,and the Beclin-1 and microtubule-associated protein 1 light chain 3 Ⅱ/Ⅰ protein expression decreased(P＜0.05).It is concluded that inhibition of tumor necrosis factor receptor-associated factor 6 regulates mTORC1/ULK1 autophagy signal to promote myocardial autophagy and participate in the protection of myocardial injury in sepsis.

Humans ; Gastrointestinal Microbiome ; Constipation/therapy* ; Probiotics/therapeutic use* ; Patients

With increasing age, more and more patients with posterior chamber intraocular lens (ICL) implantation are facing the threat of cataracts to their visual acuity.When examining the eyes of cataract patients after ICL surgery, attention should be paid to whether the density of corneal endothelial cells is greater than 2 000 cells/mm 2, the state of the anterior chamber angle, and whether there are fundus abnormalities such as retinal detachment and choroidal neovascularization.When conducting eye biometry measurement, attention should be paid to the measurement starting and ending lines of anterior chamber depth and lens thickness.If patients undergo ICL combined with corneal refractive surgery, they should be examined with two or more devices to obtain corneal refractive power according to the examination requirements after corneal laser vision correction.When selecting the type of intraocular lens, consideration should be given to the histological characteristics of high myopia.Compared to C- and L- loops, plate-haptic is relatively more stable in patients with high myopia accompanied by large capsules and larger diameters of continuous curvilinear capsulorhexis.Kane, Barrett Universal Ⅱ, Olsen, Hill-RBF formulas for calculating the refractive power of intraocular lenses are more accurate in people with long axial length.It is recommended to perform ICL removal simultaneously with phacoemulsification and intraocular lens implantation, preferably with a surgical incision greater than 2.6 mm.Femtosecond laser assisted cataract extraction surgery, although superior to traditional phacoemulsification in reducing corneal endothelial cell loss, reducing corneal edema, and high-quality capsulorhexis, can cause incomplete capsulorhexis and fragmentation due to the cavitation bubbles, manual adjustment of location, and the impact of lower vault.It is recommended to use it with caution.Ophthalmologists should fully understand and pay attention to the characteristics and difficulties of cataract surgery after ICL surgery, communicate fully with patients, and make personalized surgery to achieve better visual outcomes.

Purpose/Significance To construct a named entity corpus of traditional Chinese medicine(TCM)ancient records,and to improve the recognition accuracy and applicability of the general domain named entity recognition(NER)model in the field of TCM ancient records.Method/Process Annotation standards for entities in TCM ancient records are formulated,and 2 384 Xin'an medical records are annotated.A RoBERTa-BiLSTM-CRF model is developed,and word vectors with semantic features are generated using the RoBERTa pre-trained language model.The BiLSTM-CRF model is used to learn the global semantic features of sequences and decode and output the optimal label sequence.Dictionary and rule features are incorporated to enhance the model's capability to recognize entity boundaries and categories.Result/Conclusion The model shows a good recognition effect on the named entity corpus of Xin'an medical cases.Integration of domain terminology dictionaries and rule-based features improves the overall Fl score to 72.8％.

Nonalcoholic fatty liver disease (NAFLD) is currently the most common chronic liver disease,with a prevalence of about 29.2％ in China.A large number of clinical studies have shown that NAFLD is closely related to cardiovascular-related metabolic diseases such as obesity,dyslipidemia,diabetes mellitus,hypertension,etc.,and NAFLD is an independent risk factor for atherosclerotic cardiovascular disease (ASCVD),and cardiovascular disease is the leading cause of death in patients with NAFLD.This article reviews the relationship between NAFLD and metabolic dysfunction-associated fatty liver disease (MAFLD) with ASCVD and related metabolic diseases,and discusses the related pathophysiological mechanisms such as insulin resistance,oxidative stress,and inflammation,aiming to provide practical recommendations for reducing the risk of NAFLD-associated cardiovascular disease.

OBJECTIVE To develop an artificial intelligence-based intelligent auxiliary diagnosis and treatment system for Xin'an medicine to address the challenges of integrating ancient Xin'an medical case records into modern clinical applications.METHODS The project involved structuring and standardizing case records from ancient texts of Xin'an medicine to build a compre-hensive Xin'an medicine database.Advanced techniques,such as data annotation,entity relationship extraction,and data mining,were applied to create a Xin'an medicine knowledge base.Furthermore,a knowledge graph of Xin'an medicine was constructed using techniques for knowledge acquisition,integration,storage,and graph-based question-answering,improving the efficiency of knowl-edge organization and retrieval.The LangChain framework was utilized to connect the Xin'an medicine knowledge base to a large lan-guage model,enabling a model-driven local knowledge base question-answering system.RESULTS The study successfully estab-lished a systematic and standardized knowledge base for Xin'an medical case records.The application of knowledge graph technology provided a clear visualization of Xin'an medicine's knowledge structure,and the development of an intelligent question-answering module significantly improved the efficiency of knowledge management and retrieval.The local knowledge base question-answering sys-tem,powered by a large language model and based on Xin'an medicine's theoretical and practical expertise,delivered accurate diag-nostic and treatment support,promoting the heritage and innovation of Xin'an medicine.CONCLUSION This research validates the feasibility of modernizing traditional medical texts and provides an innovative approach to knowledge development and clinical applica-tion in Chinese medicine.The findings have significant academic value and promising clinical implications.