Objective To systematically evaluate the efficacy and safety of robot-assisted laparoscopic surgery (RAS) and conventional laparoscopic surgery (CLS) in hiatal hernia repair. Methods PubMed, Cochrane Library, CNKI, Web of Science, VIP, and Wanfang databases were searched to collect literature comparing the efficacy and safety of RAS and CLS for hiatal hernia repair published from their inception to November 7, 2023. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included studies, and RevMan 5.4.1 software was used for meta-analysis. Results A total of 15 retrospective cohort studies with 18239 patients were finally included. The NOS scores of the included literature were all ≥7 points. Meta-analysis results showed that RAS was superior to CLS in terms of postoperative complications as the primary outcome [OR=0.56, 95%CI (0.42, 0.77), P<0.01]. There was no statistical difference between the two methods in terms of average operation time [MD=−0.74, 95%CI (−12.99, 11.51), P=0.91], average intraoperative blood loss [MD=−24.47, 95%CI (−54.80, 5.87), P=0.11], intraoperative complications [OR=0.76, 95%CI (0.29, 2.01), P=0.58], average postoperative hospital stay [MD=−0.24, 95%CI (−0.75, 0.27), P=0.36], postoperative GERD score [MD=−0.04, 95%CI (−0.41, 0.33), P=0.81], and 30-day readmission rate [OR=0.60, 95%CI (0.30, 1.20), P=0.15]. The cost of CLS surgery was less than that of RAS [SMD=1.59, 95%CI (1.16, 2.01), P<0.01]. Conclusion RAS has comparable efficacy and safety to CLS in hiatus hernia repair.

Objective To compare the short-term efficacy and safety of inflatable video-assisted mediastinoscopic transhiatal esophagectomy (IVMTE) and minimally invasive transthoracic esophagectomy (MITE) in the treatment of esophageal cancer. Methods The Cochrane Library, EMbase, PubMed, Wanfang Database, VIP, and CNKI were searched. Literatures related to the short-term efficacy and safety of IVMTE and MITE in the treatment of esophageal neoplasms published from the establishment of the database to December 2023 were searched and meta-analysis was conducted by using RevMan5.4. Quality of case control study or cohort study was assessed by the Newcastle-Ottawa Scale (NOS) and quality of randomized controlled trial was assessed by Cochrane Handbook. Results A total of 14 studies (12 case control studies and 1 prospective cohort study wiht NOS score more than 7 points and 1 randomized controlled trial wiht low bias risk) were included, comprising 1 163 patients, with 525 in the IVMTE group and 638 in the MITE group. The results of meta-analysis revealed that the IVMTE group exhibited significantly shorter operative time [MD=−60.42, 95%CI (−83.78, −37.07), P<0.001] and postoperative hospital stay [MD=−2.44, 95%CI (−2.93, −1.94), P<0.01] compared to the MITE group. Moreover, intraoperative blood loss [MD=−34.67, 95%CI (−59.11, −10.23), P=0.005], three-day postoperative drainage [MD=−286.66, 95%CI (−469.93, −103.40), P=0.002], incidence of postoperative pulmonary infection [OR=0.38, 95%CI (0.26, 0.56), P<0.001], lung leakage rate [OR=0.12, 95% CI (0.02, 0.63), P=0.01] and overall complication rate [MD=0.41, 95%CI (0.22, 0.75), P=0.004] were all lower in the IVMTE group compared to those in the MITE group. However, the MITE technique demonstrated superiority over IVMTE regarding intraoperative lymph dissection number [MD=−3.52, 95%CI (−6.36, –0.68), P=0.02] and intraoperative recurrent laryngeal nerve injury [OR=1.78, 95%CI (1.22, 2.60), P=0.003]. No significant difference was observed between both methods concerning anastomotic fistula. Conclusion Compared to MITE, IVMTE has advantages such as shorter operation time, less intraoperative blood loss, shorter hospital stay, less postoperative drainage within 3 days, and a lower incidence of pulmonary complications. In terms of laryngeal recurrent nerve injury and lymphatic dissection, MITE operation offers more benefits.

Objective To systematically evaluate the efficacy of adjuvant radiotherapy after thymoma resection. Methods The PubMed, EMbase, The Cochrane Library, Web of Science, Wanfang, VIP, CNKI databases were systematically searched to find relevant literature comparing the efficacy and effectiveness of thymoma resection and thymoma resection+postoperative radiation therapy (PORT) for treating thymoma published from inception to January 2024. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of included retrospective studies, and Review Manager 5.4 software was used to perform meta-analysis. Results A total of 23 articles were included, all of which were retrospective studies. There were a total of 13742 patients, including 6980 patients in the simple surgery group, with 3321 males and 3659 females, and an average age of 54.08 years; 6762 patients in the surgery+PORT group, with 3385 males and 3377 females, and an average age of 53.76 years. The NOS scores of the included literature were all≥7 points. The results of the meta-analysis showed that compared with the simple surgery group, the surgery+PORT group had higher 1-year overall survival rate [OR=0.32, 95%CI (0.25, 0.42), P<0.001], 3-year overall survival rate [OR=0.55, 95%CI (0.48, 0.64), P<0.001], 5-year overall survival rate [OR=0.66, 95%CI (0.58, 0.75), P<0.001], 10-year overall survival rate [OR=0.71, 95%CI (0.57, 0.88), P=0.002], 1-year disease-free survival rate [OR=0.47, 95%CI (0.23, 0.93), P=0.030], 5-year disease-free survival rate [OR=0.61, 95%CI (0.45, 0.84), P=0.003], 3-year disease-specific survival rate [OR=0.44, 95%CI (0.35, 0.55), P<0.001], 5-year disease-specific survival rate [OR=0.53, 95%CI (0.44, 0.63), P<0.001] and 10-year disease-specific survival rate [OR=0.53, 95%CI (0.35, 0.82), P=0.004]. But there was no statistically significant difference between the two groups in terms of 3-year disease-free survival rate [OR=0.86, 95%CI (0.61, 1.22), P=0.400], 10-year disease-free survival rate [OR=0.70, 95%CI (0.47, 1.05), P=0.080] and 1-year disease-specific survival rate [OR=0.83, 95%CI (0.55, 1.26), P=0.380]. Conclusion PORT after thymoma resection has more advantages than simple surgical treatment in terms of 1-, 3-, 5-, and 10-year overall survival, 1- and 5-year disease-free survival, and 3-, 5- and 10-year disease-specific survival.

Objective:To understand the infection status and molecular types of rhinovirus (RV) among cases of Acute Respiratory Infections (ARIs) in Luohe City, Henan Province, from 2017 to 2022.Methods:From October 2017 to June 2022, clinical and epidemiological data were collected from 2 270 cases of ARIs at Luohe Central Hospital in Henan Province. Throat swab specimens were obtained from these cases. Real-time quantitative polymerase chain reaction (qPCR) was used to screen for RV-positive specimens. Subsequently, the positive samples were subjected to nested reverse transcription polymerase chain reaction (nested RT-PCR) to amplify the full-length VP1 region. Using the MEGA software, along with 169 RV reference strains recommended by the International Committee on Taxonomy of Viruses, a phylogenetic tree was constructed to determine RV types.Results:Among the 2 270 cases of ARIs, there were 1 283 male cases (56.52%). The median age ( Q 1, Q 3) was 3 (1, 6) years, with the population under 5 years old accounting for 68.59% (1 557/2 270). RV was detected in 137 cases (6.04%), of which 68 cases (49.64%) showed co-detection with other viruses, with the most common being co-detection with enterovirus, accounting for 14.60% (20/137). The RV detection rates in the age groups of 0-4 years, 5-14 years, 15-59 years, and≥60 years were 6.42% (100/1 557), 4.69% (21/448), 3.80% (6/158), and 9.35% (10/107), respectively, with no statistically significant differences ( χ2=5.310, P=0.150). The overall detection rates of RV before (2017-2019) and during (2020-2022) the COVID-19 pandemic showed no statistically significant difference ( χ2=1.823, P=0.177). A total of 109 VP1 sequences were obtained, including 62 types. Among them, RV-A, RV-B, and RV-C had 42, 3, and 17 types respectively. Conclusion:RV is one of the predominant pathogens in ARIs cases in Luohe City, Henan Province, from 2017 to 2022. Multiple types of RV co-circulate without any apparent dominant type.

Objective:To understand the epidemiological characteristics of human respiratory syncytial virus (HRSV) among acute respiratory infection (ARI) cases in 16 provinces of China from 2009 to 2023.Methods:The data of this study were collected from the ARI surveillance data from 16 provinces in China from 2009 to 2023, with a total of 28 278 ARI cases included in the study. The clinical specimens from ARI cases were screened for HRSV nucleic acid from 2009 to 2023, and differences in virus detection rates among cases of different age groups, regions, and months were analyzed.Results:A total of 28 278 ARI cases were enrolled from January 2009 to September 2023. The age of the cases ranged from<1 month to 112 years, and the age M ( Q1, Q3) was 3 years (1 year, 9 years). Among them, 3 062 cases were positive for HRSV nucleic acid, with a total detection rate of 10.83%. From 2009 to 2019, the detection rate of HRSV was 9.33%, and the virus was mainly prevalent in winter and spring. During the Corona Virus Disease 2019 (COVID-19) pandemic, the detection rate of HRSV fluctuated between 6.32% and 18.67%. There was no traditional winter epidemic peak of HRSV from the end of 2022 to the beginning of 2023, and an anti-seasonal epidemic of HRSV occurred from April to May 2023. About 87.95% (2 693/3 062) of positive cases were children under 5 years old, and the difference in the detection rate of HRSV among different age groups was statistically significant ( P<0.001), showing a decreasing trend of HRSV detection rate with the increase of age ( P<0.001). Among them, the HRSV detection rate (25.69%) was highest in children under 6 months. Compared with 2009-2019, the ranking of HRSV detection rates in different age groups changed from high to low between 2020 and 2023, with the age M (Q1, Q3) of HRSV positive cases increasing from 1 year (6 months, 3 years) to 2 years (11 months, 3 years). Conclusion:Through 15 years of continuous HRSV surveillance analysis, children under 5 years old, especially infants under 6 months old, are the main high-risk population for HRSV infection. During the COVID-19 pandemic, the prevalence and patterns of HRSV in China have changed.

Objective:To delve into the intricate relationship between common genetic variations across the entire genome and the risk of non-syndromic cleft lip with or without cleft palate(NSCL/P).Methods:Utilizing summary statistics data from genome-wide association studies(GW AS),a thorough investigation to evaluate the impact of common variations on the genome were undertook.This involved assessing single nucleotide polymorphism(SNP)heritability across the entire genome,as well as within specific genomic regions.To ensure the robustness of our analysis,stringent quality control measures were applied to the GWAS summary statistics data.Criteria for inclusion encompassed the absence of missing values,a minor allele frequency≥1％,P-values falling within the range of 0 to 1,and clear SNP strand orientation.SNP meeting these stringent criteria were then meticulously included in our analy-sis.The SNP heritability of NSCL/P was calculated using linkage disequilibrium score regression.Addi-tionally,hierarchical linkage disequilibrium score regression to partition SNP heritability within coding re-gions,promoters,introns,enhancers,and super enhancers were employed,and the enrichment levels within different genomic regions using LDSC(v1.0.1)software were further elucidated.Results:Our study drew upon GWAS summary statistics data obtained from 806 NSCL/P trios,comprising a total of 2 418 individuals from the Chinese population.Following rigorous quality control procedures,490 593 out of 492 993 SNP were deemed suitable for inclusion in SNP heritability calculations.The observed SNP heritability of NSCL/P was 0.55(95％CI:0.28-0.82).Adjusting for the elevated disease pre-valence within our sample,the SNP heritability scaled down to 0.37(95％CI:0.19-0.55)based on the prevalence observed in the general Chinese population.Notably,our enrichment analysis unveiled significant enrichment of SNP heritability within enhancer regions(15.70,P=0.04)and super enhan-cer regions(3.18,P=0.03).Conclusion:Our study sheds light on the intricate interplay between common genetic variations and the risk of NSCL/P in the Chinese population.By elucidating the SNP heritability landscape across different genomic regions,we contribute valuable insights into the genetic basis of NSCL/P.The significant enrichment of SNP heritability within enhancer and super enhancer re-gions underscores the potential role of these regulatory elements in shaping the genetic susceptibility to NSCL/P.This paves the way for further research aimed at uncovering novel genetic pathogenic factors un-derlying NSCL/P pathogenesis.

Objective:To understand the infection status and molecular types of rhinovirus (RV) among cases of Acute Respiratory Infections (ARIs) in Luohe City, Henan Province, from 2017 to 2022.Methods:From October 2017 to June 2022, clinical and epidemiological data were collected from 2 270 cases of ARIs at Luohe Central Hospital in Henan Province. Throat swab specimens were obtained from these cases. Real-time quantitative polymerase chain reaction (qPCR) was used to screen for RV-positive specimens. Subsequently, the positive samples were subjected to nested reverse transcription polymerase chain reaction (nested RT-PCR) to amplify the full-length VP1 region. Using the MEGA software, along with 169 RV reference strains recommended by the International Committee on Taxonomy of Viruses, a phylogenetic tree was constructed to determine RV types.Results:Among the 2 270 cases of ARIs, there were 1 283 male cases (56.52%). The median age ( Q 1, Q 3) was 3 (1, 6) years, with the population under 5 years old accounting for 68.59% (1 557/2 270). RV was detected in 137 cases (6.04%), of which 68 cases (49.64%) showed co-detection with other viruses, with the most common being co-detection with enterovirus, accounting for 14.60% (20/137). The RV detection rates in the age groups of 0-4 years, 5-14 years, 15-59 years, and≥60 years were 6.42% (100/1 557), 4.69% (21/448), 3.80% (6/158), and 9.35% (10/107), respectively, with no statistically significant differences ( χ2=5.310, P=0.150). The overall detection rates of RV before (2017-2019) and during (2020-2022) the COVID-19 pandemic showed no statistically significant difference ( χ2=1.823, P=0.177). A total of 109 VP1 sequences were obtained, including 62 types. Among them, RV-A, RV-B, and RV-C had 42, 3, and 17 types respectively. Conclusion:RV is one of the predominant pathogens in ARIs cases in Luohe City, Henan Province, from 2017 to 2022. Multiple types of RV co-circulate without any apparent dominant type.

Objective:To understand the epidemiological characteristics of human respiratory syncytial virus (HRSV) among acute respiratory infection (ARI) cases in 16 provinces of China from 2009 to 2023.Methods:The data of this study were collected from the ARI surveillance data from 16 provinces in China from 2009 to 2023, with a total of 28 278 ARI cases included in the study. The clinical specimens from ARI cases were screened for HRSV nucleic acid from 2009 to 2023, and differences in virus detection rates among cases of different age groups, regions, and months were analyzed.Results:A total of 28 278 ARI cases were enrolled from January 2009 to September 2023. The age of the cases ranged from<1 month to 112 years, and the age M ( Q1, Q3) was 3 years (1 year, 9 years). Among them, 3 062 cases were positive for HRSV nucleic acid, with a total detection rate of 10.83%. From 2009 to 2019, the detection rate of HRSV was 9.33%, and the virus was mainly prevalent in winter and spring. During the Corona Virus Disease 2019 (COVID-19) pandemic, the detection rate of HRSV fluctuated between 6.32% and 18.67%. There was no traditional winter epidemic peak of HRSV from the end of 2022 to the beginning of 2023, and an anti-seasonal epidemic of HRSV occurred from April to May 2023. About 87.95% (2 693/3 062) of positive cases were children under 5 years old, and the difference in the detection rate of HRSV among different age groups was statistically significant ( P<0.001), showing a decreasing trend of HRSV detection rate with the increase of age ( P<0.001). Among them, the HRSV detection rate (25.69%) was highest in children under 6 months. Compared with 2009-2019, the ranking of HRSV detection rates in different age groups changed from high to low between 2020 and 2023, with the age M (Q1, Q3) of HRSV positive cases increasing from 1 year (6 months, 3 years) to 2 years (11 months, 3 years). Conclusion:Through 15 years of continuous HRSV surveillance analysis, children under 5 years old, especially infants under 6 months old, are the main high-risk population for HRSV infection. During the COVID-19 pandemic, the prevalence and patterns of HRSV in China have changed.

Objective:To investigate the effect of using " Four-Quadrant Pre-Positioning Method" combined with synchronous CT imaging to assist color doppler ultrasound in establishing an ideal puncture access for percutaneous nephrolithotomy (PCNL).Methods:A retrospective analysis was conducted on 113 patients with renal stones treated at the First Affiliated Hospital of Zhengzhou University from May 2021 to July 2023. Patients were divided into two groups based on the surgical method: the study group and the control group. The study group consisted of 64 patients who, from June 2022 to July 2023, underwent PCNL with the assistance of the four-quadrant pre-positioning method and color doppler ultrasound for puncture point localization. The control group consisted of 49 patients who underwent PCNL from May 2021 to May 2022. Based on the distribution of stones, both groups were further divided into three subgroups: subgroup 1: single renal pelvis or single renal calyx stones (study group: 27 patients, control group: 20 patients). Stone length was (34.27±7.69) mm vs. (39.77±11.34) mm, respectively. Subgroup 2: renal pelvis combined with a single renal calyx stone, or multiple stones in more than two renal calyces (study group: 19 patients, control group: 15 patients). Stone length was (45.77±9.50) mm vs.(40.94±11.34) mm, respectively. Subgroup 3: staghorn or cast stones (study group: 20 patients, control group: 17 patients). Stone length was (60.03±11.59) mm vs. (58.41±15.01) mm, respectively. There were no significant differences in gender, age, height, weight, side of the stone, stone length, or stone CT values between the subgroups ( P>0.05).The use of four-quadrant pre-positioning method results from multi-slice spiral CT imaging and the patient's anatomical characteristics. The 12th rib apex is taken as the origin, and the body's transverse and longitudinal axes are defined as the X and Y axes, respectively, to create the " Four Quadrants." The ideal puncture point is located within these quadrants. During the procedure, based on surface markings of the 12th rib apex, the " Four Quadrants" and ideal puncture point are identified on the patient's body surface, assisting the color doppler ultrasound in guiding the establishment of the puncture access. The puncture access establishment time, puncture first calyx success rate (criteria: for single renal pelvis or calyx stones, the first puncture access should achieve a stone-free rate >90%; for multiple renal calyx stones or staghorn stones, the first puncture access should achieve a stone-free rate >50%), surgical time, intraoperative blood loss, stone-free rate, and postoperative complications were compared between the study and control groups in each subgroup. Results:In subgroup 1, the puncture access establishment time was (4.74±2.25) minutes in the study group vs. (7.00±3.13) minutes in the control group ( P=0.006). In subgroup 2, the puncture access establishment time was (6.94±2.12) minutes in the study group vs. (9.80±2.83) minutes in the control group ( P=0.002), with the first calyx success rate being 94.7% (18/19) in the study group vs. 60.0% (9/15) in the control group ( P=0.028). The surgical time was (97.68±26.22) minutes vs. (136.29±33.00) minutes ( P=0.001).In subgroup 3, the puncture access establishment time was (8.00±2.69) minutes in the study group vs. (12.59±3.54) minutes in the control group ( P=0.001), with the first calyx success rate being 100.0% (20/20) in the study group vs. 76.5% (13/17) in the control group ( P=0.036). Intraoperative blood loss was (238.00±176.74) ml vs. (388.57±219.89) ml ( P=0.043). No significant differences were found between the two groups in terms of immediate postoperative stone-free rate (subgroup 1: 92.6% (25/27) vs. 95.0% (19/20), P=0.739; subgroup 2: 78.9% (15/19) vs. 73.3% (11/15), P=1.000; subgroup 3: 75.0% (15/20) vs. 70.5% (12/17), P=0.703) or complication rates (subgroup 1: 25.9% (7/27) vs. 25.0% (5/20), P=0.943; subgroup 2: 26.3% (5/19) vs. 40.0% (6/15), P=0.475; subgroup 3: 40.0% (8/20) vs. 41.2% (7/17), P=1.000). Conclusions:The four-quadrant pre-positioning method effectively assists in the use of color doppler ultrasound to establish an ideal puncture access during PCNL, reducing puncture access establishment time and improving the rationality of the puncture path. It also significantly reduces intraoperative blood loss, particularly for complex renal stones such as those in multiple renal calyces or staghorn stones, thereby enhancing the safety of the procedure.

Objective:To investigate the effect of using " Four-Quadrant Pre-Positioning Method" combined with synchronous CT imaging to assist color doppler ultrasound in establishing an ideal puncture access for percutaneous nephrolithotomy (PCNL).Methods:A retrospective analysis was conducted on 113 patients with renal stones treated at the First Affiliated Hospital of Zhengzhou University from May 2021 to July 2023. Patients were divided into two groups based on the surgical method: the study group and the control group. The study group consisted of 64 patients who, from June 2022 to July 2023, underwent PCNL with the assistance of the four-quadrant pre-positioning method and color doppler ultrasound for puncture point localization. The control group consisted of 49 patients who underwent PCNL from May 2021 to May 2022. Based on the distribution of stones, both groups were further divided into three subgroups: subgroup 1: single renal pelvis or single renal calyx stones (study group: 27 patients, control group: 20 patients). Stone length was (34.27±7.69) mm vs. (39.77±11.34) mm, respectively. Subgroup 2: renal pelvis combined with a single renal calyx stone, or multiple stones in more than two renal calyces (study group: 19 patients, control group: 15 patients). Stone length was (45.77±9.50) mm vs.(40.94±11.34) mm, respectively. Subgroup 3: staghorn or cast stones (study group: 20 patients, control group: 17 patients). Stone length was (60.03±11.59) mm vs. (58.41±15.01) mm, respectively. There were no significant differences in gender, age, height, weight, side of the stone, stone length, or stone CT values between the subgroups ( P>0.05).The use of four-quadrant pre-positioning method results from multi-slice spiral CT imaging and the patient's anatomical characteristics. The 12th rib apex is taken as the origin, and the body's transverse and longitudinal axes are defined as the X and Y axes, respectively, to create the " Four Quadrants." The ideal puncture point is located within these quadrants. During the procedure, based on surface markings of the 12th rib apex, the " Four Quadrants" and ideal puncture point are identified on the patient's body surface, assisting the color doppler ultrasound in guiding the establishment of the puncture access. The puncture access establishment time, puncture first calyx success rate (criteria: for single renal pelvis or calyx stones, the first puncture access should achieve a stone-free rate >90%; for multiple renal calyx stones or staghorn stones, the first puncture access should achieve a stone-free rate >50%), surgical time, intraoperative blood loss, stone-free rate, and postoperative complications were compared between the study and control groups in each subgroup. Results:In subgroup 1, the puncture access establishment time was (4.74±2.25) minutes in the study group vs. (7.00±3.13) minutes in the control group ( P=0.006). In subgroup 2, the puncture access establishment time was (6.94±2.12) minutes in the study group vs. (9.80±2.83) minutes in the control group ( P=0.002), with the first calyx success rate being 94.7% (18/19) in the study group vs. 60.0% (9/15) in the control group ( P=0.028). The surgical time was (97.68±26.22) minutes vs. (136.29±33.00) minutes ( P=0.001).In subgroup 3, the puncture access establishment time was (8.00±2.69) minutes in the study group vs. (12.59±3.54) minutes in the control group ( P=0.001), with the first calyx success rate being 100.0% (20/20) in the study group vs. 76.5% (13/17) in the control group ( P=0.036). Intraoperative blood loss was (238.00±176.74) ml vs. (388.57±219.89) ml ( P=0.043). No significant differences were found between the two groups in terms of immediate postoperative stone-free rate (subgroup 1: 92.6% (25/27) vs. 95.0% (19/20), P=0.739; subgroup 2: 78.9% (15/19) vs. 73.3% (11/15), P=1.000; subgroup 3: 75.0% (15/20) vs. 70.5% (12/17), P=0.703) or complication rates (subgroup 1: 25.9% (7/27) vs. 25.0% (5/20), P=0.943; subgroup 2: 26.3% (5/19) vs. 40.0% (6/15), P=0.475; subgroup 3: 40.0% (8/20) vs. 41.2% (7/17), P=1.000). Conclusions:The four-quadrant pre-positioning method effectively assists in the use of color doppler ultrasound to establish an ideal puncture access during PCNL, reducing puncture access establishment time and improving the rationality of the puncture path. It also significantly reduces intraoperative blood loss, particularly for complex renal stones such as those in multiple renal calyces or staghorn stones, thereby enhancing the safety of the procedure.