BACKGROUND: Telesurgery has the potential to overcome spatial limitations for surgeons, which depends on surgical robot and the quality of network communication. However, the influence of network latency and bandwidth on telesurgery is not well understood. METHODS: A telesurgery system capable of dynamically adjusting image compression ratios in response to bandwidth changes was established between Beijing and Sanya (Hainan province), covering a distance of 3000 km. In total, 108 animal operations, including 12 surgical procedures, were performed. Total latency ranging from 170 ms to 320 ms and bandwidth from 15-20 Mbps to less than 1 Mbps were explored using designed surgical tasks and hemostasis models for renal vein and internal iliac artery rupture bleeding. Network latency, jitter, frame loss, and bit rate code were systemically measured during these operations. National Aeronautics and Space Administration Task Load Index (NASA-TLX) and a self-designed scale measured the workload and subjective perception of surgeons. RESULTS: All 108 animal telesurgeries, conducted from January 2023 to June 2023, were performed effectively over a total duration of 3866 min. The operations were completed with latency up to 320 ms and bandwidths as low as 1-5 Mbps. Hemostasis for vein and artery rupture bleeding models was effectively achieved under these low bandwidth conditions. The NASA-TLX results indicated that latency significantly impacted surgical performance more than bandwidth and image clarity reductions. CONCLUSIONS This telesurgery system demonstrated safety and reliability. A total of 320 ms latency is acceptable for telesurgery operations. Reducing image clarity can effectively mitigate the potential latency increase caused by decreased bandwidth, offering a new method to reduce the impact of latency on telesurgery.
Animals ; Robotic Surgical Procedures/methods* ; Laparoscopy/methods*

Objective:To evaluate the efficacy and feasibility of a domestically developed robotic surgical system based on fiber-optic dedicated line communication in cross-regional urological telesurgery.Methods:This was multicenter，single-arm，retrospective case series study. The data of patients who underwent urological telesurgeries using the telesurgical system between January 2023 and December 2024 were analyzed. The cohort included 59 patients from seven hospitals across China. Among the patients，47 were male（79.7%）and 12 were female（20.3%），with a median age of 63.0（56.0，68.0）years and a body mass index of（24.7 ± 3.0）kg/m 2. Surgical procedures included 32 radical prostatectomies，24 partial nephrectomies，one radical nephrectomy，one adrenalectomy，and one ureteral reconstruction. The perioperative indicators，pathological results and postoperative complications were analyzed. The network monitoring data were collected，and the perioperative data of patients，remote system monitoring data and costs were compared between the two communication modes of optical transport network（OTN）and cloud-connect network（CCN）. Results:All 59 remote surgeries were successfully completed，with a mean operative time of（138.0 ± 54.0）minutes，median intraoperative blood loss of 50.0（30.0，100.0）ml and a postoperative hospital stay of 5.0（4.0，6.0）days. No cases required reoperation，Clavien-Dindo grade ≥3 complications，or readmission. The geographical distance between the primary and remote surgical sites ranged from 450 to 2 800 km. Network monitoring revealed increased bidirectional latency with distance increasing：the shortest latency time（Hefei-Hangzhou，450 km）was（16.59 ± 0.80）ms，while the longest（Harbin-Hangzhou，2 200 km）latency time was（53.31 ± 0.31）ms. Average frame loss per procedure was 0?1.27 frames. The results of subgroup analysis comparing OTN and CCN communication modes showed no significant differences in operative time［（130.7 ± 70.5）minutes vs.（142.1 ± 42.9）minutes， P = 0.442］，postoperative hospitalization［6.0（4.0，8.0）d vs. 5.0（4.0，6.0）d， P = 0.581］，or readmission rates（0 vs. 0）. However，CCN demonstrated significant cost advantages with 500 RMB per operation vs. 3 000 RMB per operation for OTN. Conclusions:Urological telesurgery using fiber-optic communication is feasible. The CCN mode，with its cost-effectiveness，excellent usability，and multi-point interconnection flexibility，is currently the preferred communication model for telesurgical applications.

Polyethylene terephthalate (PET) fibers are characterized by exceptional mechanical strength, and textiles blended with cotton fibers combine both comfort and durability, showcasing widespread use in daily applications. However, improper disposal of discarded polyester-cotton textiles has resulted in severe environmental pollution, necessitating urgent and effective mitigation strategies. Enzymatic recycling of textiles offers superior environmental benefits and holds greater potential for industrial applications than alternative recycling methods. This study aims to explore a large-scale solution for the treatment of waste textiles, particularly addressing the challenge of resource recovery from polyester-cotton blended fabrics. An innovative enzymatic depolymerization process has been developed to achieve the recovery of high-purity terephthalic acid monomers. Experiments were conducted on three different textile blends with polyester-to-cotton ratios of 65/35, 70/30, and 80/20, and the influences of different colors on the process were investigated. Initially, the textiles were pretreated through mechanical grinding, which was followed by depolymerization of cotton fibers with commercial cellulase. The crystallinity of PET in the textiles was reduced through a rapid heating and cooling process. Subsequently, the PET was depolymerized by the engineered PET hydrolase. The results demonstrated that after decolorization and separation of terephthalic acid (TPA) from the reaction system, the monomer recovery rates for the three textile blends (65/35, 70/30, and 80/20) reached 90%, 91%, and 92%, respectively. Characterization analysis by nuclear magnetic resonance (NMR) confirmed that the purity of the recovered TPA was greater than 99%. In conclusion, the fully enzymatic recycling process developed in this study shows considerable promise for large-scale industrial applications and is anticipated to significantly advance the adoption and development of enzymatic recycling technologies for PET in industrial processes.
Phthalic Acids/chemistry* ; Polyesters/chemistry* ; Textiles ; Cotton Fiber ; Polyethylene Terephthalates/chemistry* ; Cellulase/chemistry* ; Recycling/methods* ; Polymerization

Objective:To evaluate the efficacy and feasibility of a domestically developed robotic surgical system based on fiber-optic dedicated line communication in cross-regional urological telesurgery.Methods:This was multicenter，single-arm，retrospective case series study. The data of patients who underwent urological telesurgeries using the telesurgical system between January 2023 and December 2024 were analyzed. The cohort included 59 patients from seven hospitals across China. Among the patients，47 were male（79.7%）and 12 were female（20.3%），with a median age of 63.0（56.0，68.0）years and a body mass index of（24.7 ± 3.0）kg/m 2. Surgical procedures included 32 radical prostatectomies，24 partial nephrectomies，one radical nephrectomy，one adrenalectomy，and one ureteral reconstruction. The perioperative indicators，pathological results and postoperative complications were analyzed. The network monitoring data were collected，and the perioperative data of patients，remote system monitoring data and costs were compared between the two communication modes of optical transport network（OTN）and cloud-connect network（CCN）. Results:All 59 remote surgeries were successfully completed，with a mean operative time of（138.0 ± 54.0）minutes，median intraoperative blood loss of 50.0（30.0，100.0）ml and a postoperative hospital stay of 5.0（4.0，6.0）days. No cases required reoperation，Clavien-Dindo grade ≥3 complications，or readmission. The geographical distance between the primary and remote surgical sites ranged from 450 to 2 800 km. Network monitoring revealed increased bidirectional latency with distance increasing：the shortest latency time（Hefei-Hangzhou，450 km）was（16.59 ± 0.80）ms，while the longest（Harbin-Hangzhou，2 200 km）latency time was（53.31 ± 0.31）ms. Average frame loss per procedure was 0?1.27 frames. The results of subgroup analysis comparing OTN and CCN communication modes showed no significant differences in operative time［（130.7 ± 70.5）minutes vs.（142.1 ± 42.9）minutes， P = 0.442］，postoperative hospitalization［6.0（4.0，8.0）d vs. 5.0（4.0，6.0）d， P = 0.581］，or readmission rates（0 vs. 0）. However，CCN demonstrated significant cost advantages with 500 RMB per operation vs. 3 000 RMB per operation for OTN. Conclusions:Urological telesurgery using fiber-optic communication is feasible. The CCN mode，with its cost-effectiveness，excellent usability，and multi-point interconnection flexibility，is currently the preferred communication model for telesurgical applications.

Telesurgery, which utilizes remote communication technology and surgical robots for operations, is an emerging method that breaks the constraints of space on surgical procedures and is an important development direction for future surgery. With a vast territory, telesurgery has the potential to become a candidate method to improve the uneven distribution of regional medical resources. In recent years, with the development and maturity of China′s domestic surgical robot technology and communication technology, China has made rapid progress in the field of telesurgery, but is still in the primary stage of development, facing many challenges and also taking advantage of opportunities. The next 20 years will be a golden opportunity for the development of telesurgery worldwide, and it is a hopeful view that Chinese surgeons will seize the opportunity and face the challenges to lead the development of telesurgery.

Endoscopic ultrasonography(EUS)can not only directly observe the morphology of the lumens of the digestive tract through the endoscope,but also perform real-time dynamic ultrasound scanning to obtain the layers of the lumen and the structure of surrounding organs.With the wide application and technical improvement of EUS,we gradually realize that it plays an important role in the diagnosis and treatment of cholangiocarcinoma.This article reviews the application of EUS in the diagnosis and treatment of cholangiocarcinoma.

Telesurgery, which utilizes remote communication technology and surgical robots for operations, is an emerging method that breaks the constraints of space on surgical procedures and is an important development direction for future surgery. With a vast territory, telesurgery has the potential to become a candidate method to improve the uneven distribution of regional medical resources. In recent years, with the development and maturity of China′s domestic surgical robot technology and communication technology, China has made rapid progress in the field of telesurgery, but is still in the primary stage of development, facing many challenges and also taking advantage of opportunities. The next 20 years will be a golden opportunity for the development of telesurgery worldwide, and it is a hopeful view that Chinese surgeons will seize the opportunity and face the challenges to lead the development of telesurgery.

Interarterial subtype of coronary artery with anomalous aortic origin is a rare and congenital cardiovascular malformation,manifested by chest pain and syncope after exertion or activity,which can lead to decreased cardiac contractility,myocardial infarction,and even sudden death.Here we report a case of an adolescent patient,who presented with chest pain during activity accompanied by syncope and lost consciousness.Initially diagnosed with acute myocardial infarction,the patient was subsequently diagnosed as interarterial subtype of a coronary artery originating from anomalous aorta after echocardiography,coronary angiography,coronary CT angiography examinations.After anomalous coronary artery correction and coronary angioplasty,the paitent recovered well.

Objective:Currently,patients with pre-exsiting donor-specific antibody(DSA)are prone to antibody-mediated rejection(AMR)after surgery and are at a relatively high risk of postoperative complications and graft failure.The risk of postoperative complications and graft failure is relatively high.This study aims to discuss the clinical outcome of DSA-positive kidney transplantation and analyze the role and safety of preoperative pretreatment in DSA-positive kidney transplantation,providing single-center treatment experience for DSA-positive kidney transplantation. Methods:We retrospectively analyzed the clinical data of 15 DSA-positive kidney transplants in the Department of Renal Transplantation of First Affiliated Hospital of Zhengzhou University from August 2017 to July 2022.Eight cases were organ donation after citizen's death(DCD)kidney transplant recipients,of which 3 cases in the early stage were not treated with preoperative desensitisation therapy(DCD untreated group,n=3),and 5 recipients were treated with preoperative rituximab desensitisation(DCD preprocessing group,n=5).The remaining 7 cases were living related donors recipients(LRD)who received preoperative desensitisation treatment with rituximab and plasma exchange(LRD preprocessing group,n=7).We observed and recorded the incidence of complications with changes in renal function and DSA levels in the recipients and the survival of the recipients and transplanted kidneys at 1,3 and 5 years,and to compare the differences in recovery and postoperative complications between 3 groups. Results:All 15 recipients were positive for preoperative panel reactive antibody(PRA)and DSA and were treated with methylprednisolone+rabbit anti-human thymocyte immunoglobulin induction before kidney transplantation.DCD untreated group all suffered from DSA level rebound,delayed renal graft function(DGF)and rejection reaction after surgery.After the combined treatment,DSA level was reduced and the graft renal function returned to normal.The DCD preprocessing group were all without antibody rebound,1 recipient developed DGF and the renal function returned to normal after plasmapheresis,and the remaining 4 recipients recovered their renal function to normal within 2 weeks after the operation.In the LRD preprocessing group,2 cases had antibody rebound and 1 case had rejection,but all of them recovered to normal after treatment,and DSA was maintained at a low level or even disappeared.The incidence of DGF and rejection in the DCD untreated group were significantly higher than that in the DCD preprocessing group and the LRD preprocessing group;and there were no significant difference in the incidence of postoperative haematuria,proteinuria,bacterial and fungal infections,and BK virus infection between the 3 groups(all P>0.05).A total of 11 of the 15 recipients were followed up for more than 1 year,6 for more than 3 years,and 1 for more than 5 years,and the survival rates of both the recipients and the transplanted kidneys were 100%. Conclusion:Effective preoperative pretreatment with desensitization therapy can effectively prevent antibody rebound in DSA-positive kidney transplantation and reduce perioperative complications.

Objective To investigate the clinical effects and influencing factors of remote ischemic post-conditioning RIPostC in the patients with post stroke fatigue(PSF).Methods Eighty patients with PSF were ran-domly divided into experimental group(n = 40)and control group(n = 40).Patients in both groups received routine drug therapy and rehabilitation training for stroke.The experimental group were additionally given RIPostC for four weeks.They were evaluated with National Institute of Health Stroke Scale(NIHSS),Barthel Index(BI),Mini-mental State Examination(MMSE),fatigue severity scale(FSS),Hamilton Anxiety Scale(HAMA),and Hamilton Depression Scale(HAMD).Results The score of NIHSS,FSS,HAMA and HAMD in the both groups were decreased,while the score of BI and MMSE were increased(P<0.01).The difference in the score of NIHSS,BI,MMSE,FSS,HAMA and HAMD between the two groups before and after treatment showed statistical significance(P<0.01)and the difference in the score was more significant in the experimental group.The risk factors of FSS were MMSE and HAMA.Conclusion RIPostC can effectively improve the neurological deficits,daily activity ability and cog-nitive function,alleviate fatigue,anxiety and depression in the patients of PSF.The influencing factors of PSF are cognitive function and anxiety.