Objective:To investigate the feasibility and safety of implementing a domestic vehicle-mounted remote mobile robotic surgical system in thyroid surgery applications, integrated with 5G communication technology.Methods:Using the main system located on the vehicle-mounted mobile robot operating platform of the 960th Hospital of PLA Joint Logistics Support Force and the slave system of Weifang Traditional Chinese Hospital, the remote radical thyroidectomy 5G communication technology, and analyze the clinical and information transmission data of two female patients who underwent remote mobile robot thyroid cancer surgery on October 21, 2024 at Weifang Traditional Chinese Medicine Hospital.Results:The remote radical thyroidectomy was conducted by the robosurgeons utilizing a vehicle-mounted mobile robotic surgical system, and the procedure was successfully completed without necessitating intermediate open surgery. The operation durations for patient 1 and patient 2 were 135 minutes and 108 minutes, respectively, with 7 and 13 lymph nodes dissected, respectively. The average delay in surgical data transmission was recorded at 61.9 milliseconds, with no instances of signal interruption or frame loss. The procedure proceeded smoothly, without any jamming, and the audio and video transmissions were consistently clear. Follow up for 21 days after surgery showed no complications such as hoarseness, skin damage, or lymphatic fistula.Conclusion:The implementation of a vehicle-mounted remote mobile robotic surgery system for thyroid surgery has demonstrated safety and feasibility. Furthermore, the utilization of the 5G network offers rapid data transmission and minimal latency, closely approximating the therapeutic efficacy of traditional robotic thyroidectomy.

Objective:To analyze the clinical characteristics of patients with myeloproliferative neoplasms (MPN) complicated with portal hypertension and evaluate the efficacy of ruxolitinib treatment.Methods:A total of 42 patients with MPN complicated with portal hypertension and 84 patients with MPN without portal hypertension who were admitted to the Department of Hematology of the Zhongshan Hospital, Fudan University from January 2018 to December 2023 were retrospectively included. The clinical characteristics of the two groups were compared. The MPN combined with portal hypertension group was divided into the ruxolitinib group ( n=18) and the traditional treatment group ( n=24) according to different treatment methods. The baseline characteristics and therapeutic effects of the two groups were compared. Results:Compared with patients with MPN without portal hypertension, patients with MPN combined with portal hypertension were younger (median age 49 years vs 63 years), and were more common in females [54.76%(23/42) vs 41.67%(35/84)]. The proportion of JAK2V617F mutation was higher [88.09%(37/42) vs 70.23%(59/84)], and the incidence of portal vein thrombosis was higher [57.14%(24/42) vs 1.19%(1/84)]. The incidence of gastrointestinal bleeding was high [45.24%(19/42) vs 4.76%(4/84)], and the hemoglobin and platelet counts were lower (all P<0.05). In terms of MPN classification, the proportions of PrePMF (5/18) and Post-ET-MF (4/18) were relatively high in the ruxolitinib group, while the proportions of essential thrombocythemia (ET) [41.67%(10/24)] and polycythemia vera (PV) [25.00%(6/24)] were relatively high in the traditional treatment group. The distribution of driver genes showed that the JAK2V617F mutation rate in the ruxolitinib group was higher than that in the traditional treatment group (all P<0.05). The proportion of patients with spleen volume reduction ≥35%(SVR35) in the ruxolitinib group was 4/18, and that in the traditional treatment group was 8.33%(2/24), with no statistically significant difference ( P=0.21). The portal vein diameter in the ruxolitinib group decreased compared with the baseline [(14.2±2.1)mm vs (16.5±2.8)mm, P=0.02], while no improvement was observed in the traditional treatment group. Conclusions:Ruxolitinib can effectively improve the portal vein diameter of patients with MPN complicated with portal hypertension.

Methodological quality assessment is a pivotal link between primary studies and reliable evidence-based practice,and an essential pathway for operationalizing the core principles of the Guide on Methodological Standards in Pharmacoepidemiology(2nd edition).A prevalent challenge in practice,however,is the conflation of appraising methodological robustness(risk of bias assessment)with verifying reporting transparency(adherence to reporting guidelines).This paper systematically addresses this fundamental challenge,beginning with a clear distinction between the essence and boundaries of these two concepts.On this basis,the article provides a comprehensive review of mainstream quality assessment tools,covering the methodological features and evolutionary trajectory of numerous instruments for interventional(e.g.,RoB 2,ROBINS-I),observational(e.g.,NOS,the JBI/SIGN/NIH series),secondary(e.g.,AMSTAR 2),and other specific types of studies such as health economic evaluations.Furthermore,a complete case study is used to illustrate the practical application of the ROBINS-I tool.The paper's central thesis advocates for an"appraisal-informed design"philosophy,urging a conceptual shift from the retrospective critique of existing literature to the prospective quality control of new research by internalizing appraisal standards as design principles,while also exploring the emerging paradigm of artificial intelligence in assisting assessment.This paper provides a comprehensive methodological reference for researchers and practitioners to prudently select appropriate assessment tools and to conduct rigorous critical appraisals of pharmacoepidemiological evidence.

Methodological quality assessment is a pivotal link between primary studies and reliable evidence-based practice,and an essential pathway for operationalizing the core principles of the Guide on Methodological Standards in Pharmacoepidemiology(2nd edition).A prevalent challenge in practice,however,is the conflation of appraising methodological robustness(risk of bias assessment)with verifying reporting transparency(adherence to reporting guidelines).This paper systematically addresses this fundamental challenge,beginning with a clear distinction between the essence and boundaries of these two concepts.On this basis,the article provides a comprehensive review of mainstream quality assessment tools,covering the methodological features and evolutionary trajectory of numerous instruments for interventional(e.g.,RoB 2,ROBINS-I),observational(e.g.,NOS,the JBI/SIGN/NIH series),secondary(e.g.,AMSTAR 2),and other specific types of studies such as health economic evaluations.Furthermore,a complete case study is used to illustrate the practical application of the ROBINS-I tool.The paper's central thesis advocates for an"appraisal-informed design"philosophy,urging a conceptual shift from the retrospective critique of existing literature to the prospective quality control of new research by internalizing appraisal standards as design principles,while also exploring the emerging paradigm of artificial intelligence in assisting assessment.This paper provides a comprehensive methodological reference for researchers and practitioners to prudently select appropriate assessment tools and to conduct rigorous critical appraisals of pharmacoepidemiological evidence.

Objective:To analyze the clinical characteristics of patients with myeloproliferative neoplasms (MPN) complicated with portal hypertension and evaluate the efficacy of ruxolitinib treatment.Methods:A total of 42 patients with MPN complicated with portal hypertension and 84 patients with MPN without portal hypertension who were admitted to the Department of Hematology of the Zhongshan Hospital, Fudan University from January 2018 to December 2023 were retrospectively included. The clinical characteristics of the two groups were compared. The MPN combined with portal hypertension group was divided into the ruxolitinib group ( n=18) and the traditional treatment group ( n=24) according to different treatment methods. The baseline characteristics and therapeutic effects of the two groups were compared. Results:Compared with patients with MPN without portal hypertension, patients with MPN combined with portal hypertension were younger (median age 49 years vs 63 years), and were more common in females [54.76%(23/42) vs 41.67%(35/84)]. The proportion of JAK2V617F mutation was higher [88.09%(37/42) vs 70.23%(59/84)], and the incidence of portal vein thrombosis was higher [57.14%(24/42) vs 1.19%(1/84)]. The incidence of gastrointestinal bleeding was high [45.24%(19/42) vs 4.76%(4/84)], and the hemoglobin and platelet counts were lower (all P<0.05). In terms of MPN classification, the proportions of PrePMF (5/18) and Post-ET-MF (4/18) were relatively high in the ruxolitinib group, while the proportions of essential thrombocythemia (ET) [41.67%(10/24)] and polycythemia vera (PV) [25.00%(6/24)] were relatively high in the traditional treatment group. The distribution of driver genes showed that the JAK2V617F mutation rate in the ruxolitinib group was higher than that in the traditional treatment group (all P<0.05). The proportion of patients with spleen volume reduction ≥35%(SVR35) in the ruxolitinib group was 4/18, and that in the traditional treatment group was 8.33%(2/24), with no statistically significant difference ( P=0.21). The portal vein diameter in the ruxolitinib group decreased compared with the baseline [(14.2±2.1)mm vs (16.5±2.8)mm, P=0.02], while no improvement was observed in the traditional treatment group. Conclusions:Ruxolitinib can effectively improve the portal vein diameter of patients with MPN complicated with portal hypertension.

Objective To summarise the best evidence for postpartum follow-up acquired from patients with gestational diabetes mellitus so as to provide an evidence-based reference for establishment of a postpartum follow-up program.Methods Literature on postpartum blood glucose follow-up in patients with gestational diabetes mellitus was retrieved from 17 major databases including BMJ Best Practice,UpToDate,Joanna Briggs Institute(JBI),International Guide Collaboration Network,National Institute for Health and Care Excellence(NICE),American Diabetes Association website,Medlive,Cochrane Library,Embase,OVID,PubMed,Web of Science,Quanfang local PubMed,CNKI,Wanfang Data,VIP,and Sinomed from the inception of databases to July 2023.The literature to be retrieved included guidelines,expert consensus,evidence summaries,systematic reviews,clinical decisions,and the original studies.Results A total of 9 articles,five practice guidelines,a systematic review,an evidence summaries,an expert consensus and a clinical decisions,were included.Totally,17 pieces of best evidence were summarised from the five aspects:postpartum blood glucose,lifestyle guidance,breastfeeding,drug treatment and health education.Conclusions The summarised best evidences can provide evidence-based references for postpartum follow-up of patients with gestational diabetes.Nursing staff in hospitals and community health centres should formulate relevant follow-up plans according to the actual postpartum conditions of patients in order to prevent the incidence of postpartum Type Ⅱ diabetes.

Social assistance robots are multi-functional robots integrating science and technology, psychology and medical services, which can provide care according to the needs of different groups. This article reviews the concept, role and function of social assistance robots and their application status in care for the elderly frail population, analyzes the existing problems and countermeasures of social assistance robots in care for the elderly frail population, in order to promote the application of social assistance robots in the elderly frail population in China and enrich the nursing intervention programs for the elderly frail population.

Objective:To investigate the significance of menstrual abnormalities in polycystic ovary syndrome (PCOS) for the prediction of future combined metabolic syndrome (MS) and compare the differences in intestinal flora structure between patients with MS and those without.Methods:A case-control study was used to select 111 patients with PCOS who attended the outpatient clinic of the Department of Obstetrics and Gynecology of Jinshan Hospital affiliated to Fudan University between February 2021 and December 2023, and they were divided into the group of PCOS not combined with MS ( n=74, recorded as the NMS group) and the group of PCOS combined with MS ( n=37, recorded as the MS group). The menstrual-related information and stool specimens of all cases were collected to analyze the menstrual characteristics of the two groups and their predictive significance for PCOS combined with MS; and the intestinal flora of the two groups were analyzed by 16S rDNA high-throughput sequencing. Results:The age of menstrual changes [(23.47±4.73) years], time of menstrual changes occurring after menarche [(9.85±5.11) years], and duration of menstrual changes [(3.43±2.78) years] in the NMS group were statistically significantly different when compared with those in the MS group [(20.71±3.61) years, P=0.020; (7.04±3.34) years, P=0.025; (7.63±3.47) years, P<0.001]. The rate of menstrual abnormality, scanty menstruation and amenorrhea were higher in the MS group than in the NMS group, and the difference in the ratio of the composition of the menstrual pattern between the two groups was statistically significant ( P=0.036). The differences in the rates of menstrual abnormalities 8 years later after menarche between the two groups were statistically significant (all P<0.05), and the ORs from 8 to 13 years after menarche were 2.76 (95% CI: 1.07-7.11), 3.68 (95% CI: 1.28-10.56), 3.27 (95% CI: 1.13-9.41), 3.07 (95% CI: 1.06-8.87), 4.20 (95% CI: 1.16-15.21), 11.57 (95% CI: 1.48-90.49), respectively; the difference in the rate of menstrual abnormality between the two groups with menstrual alteration duration of more than 4 years was also statistically significant (all P<0.05), and the ORs for menstrual alteration duration of 4-9 years were 8.89 (95% CI: 2.14-36.99), 11.88 (95% CI: 3.07-46.02), 16.56 (95% CI: 4.15-66.13), 11.25 (95% CI: 2.88-32.95), 7.80 (95% CI: 2.04-29.84), and 10.00 (95% CI: 1.91-52.48), respectively. The α-diversity index of intestinal flora was lower in the MS group than in the NMS group, but the difference was not statistically significant ( P>0.05). At the phylum level, there was a statistically significant difference in the abundance of intestinal flora between the two groups ( P<0.001), the abundance of Bacteroidetes was lower in the MS group than in the NMS group, and the abundance of the Firmicutes was similar in the two groups. At the genus level, there was a statistically significant difference in the abundance of intestinal flora between the two groups ( P<0.001), the abundance of Bifidobacterium decreased and the abundance of Streptococcus and Escherichia increased in the MS group compared with those in the NMS group. Conclusion:Abnormal menstruation 8 years later after menarche in patients with PCOS is predictive of future MS, and its predictive effect increases with age, but does not change significantly with the duration of disease in abnormal menstruation. The structure of the intestinal flora of patients with MS in PCOS is indeed significantly different from that of those without MS.

Objective To investigate the efficacy of transcranial direct current stimulation(tDCS)on sleep disorder in patients with Parkinson's disease(PD).Methods From July 2021 to July 2023,patients with PD and sleep disorders in the Department of Neurosurgery of the Second People's Hospital of Guangdong Province were selected.The enrolled patients were divided into sham stimulation group(n=28)and true stimulation group(tDCS)(n=29)according to the inclusion and exclusion criteria.MDS-UPDRS,PDSS and other rating scales were used to evaluate the patients.Before and after tDCS treatment,MS-11 was used for intelligent sleep monitor-ing.The baseline and improvement of sleep disorders in the two groups before and after treatment were analyzed.Results Before tDCS treatment,there was no significant difference in general conditions and scale scores between the two groups(P＞0.05).There was no significant difference in polysomnographic monitoring results between the two groups before treatment(P＞0.05).Compared with pre-treatment,there was no significant difference in sleep monitoring results in the sham stimulation group(P＞0.05),while the sleep duration and sleep efficiency signifi-cantly increased,the nighttime awakening duration,nighttime awakening frequency,MDS-UPDRS-Ⅲ score,and LEDD dose significantly decreased in the true stimulation group,with statistical significance(P＜0.05).Conclusion Pharmacological treatment combined with tDCS treatment is effective for sleep disorders and motor function in patients with PD,which could increase the sleep duration and sleep efficiency of PD patients with sleep disorders to a certain extent,reduce the nighttime awakening duration and frequency,thereby improving the fatigue symp-toms during the daytime,and improving the efficacy of conventional pharmacological treatment for PD.

Objective:To investigate the significance of menstrual abnormalities in polycystic ovary syndrome (PCOS) for the prediction of future combined metabolic syndrome (MS) and compare the differences in intestinal flora structure between patients with MS and those without.Methods:A case-control study was used to select 111 patients with PCOS who attended the outpatient clinic of the Department of Obstetrics and Gynecology of Jinshan Hospital affiliated to Fudan University between February 2021 and December 2023, and they were divided into the group of PCOS not combined with MS ( n=74, recorded as the NMS group) and the group of PCOS combined with MS ( n=37, recorded as the MS group). The menstrual-related information and stool specimens of all cases were collected to analyze the menstrual characteristics of the two groups and their predictive significance for PCOS combined with MS; and the intestinal flora of the two groups were analyzed by 16S rDNA high-throughput sequencing. Results:The age of menstrual changes [(23.47±4.73) years], time of menstrual changes occurring after menarche [(9.85±5.11) years], and duration of menstrual changes [(3.43±2.78) years] in the NMS group were statistically significantly different when compared with those in the MS group [(20.71±3.61) years, P=0.020; (7.04±3.34) years, P=0.025; (7.63±3.47) years, P<0.001]. The rate of menstrual abnormality, scanty menstruation and amenorrhea were higher in the MS group than in the NMS group, and the difference in the ratio of the composition of the menstrual pattern between the two groups was statistically significant ( P=0.036). The differences in the rates of menstrual abnormalities 8 years later after menarche between the two groups were statistically significant (all P<0.05), and the ORs from 8 to 13 years after menarche were 2.76 (95% CI: 1.07-7.11), 3.68 (95% CI: 1.28-10.56), 3.27 (95% CI: 1.13-9.41), 3.07 (95% CI: 1.06-8.87), 4.20 (95% CI: 1.16-15.21), 11.57 (95% CI: 1.48-90.49), respectively; the difference in the rate of menstrual abnormality between the two groups with menstrual alteration duration of more than 4 years was also statistically significant (all P<0.05), and the ORs for menstrual alteration duration of 4-9 years were 8.89 (95% CI: 2.14-36.99), 11.88 (95% CI: 3.07-46.02), 16.56 (95% CI: 4.15-66.13), 11.25 (95% CI: 2.88-32.95), 7.80 (95% CI: 2.04-29.84), and 10.00 (95% CI: 1.91-52.48), respectively. The α-diversity index of intestinal flora was lower in the MS group than in the NMS group, but the difference was not statistically significant ( P>0.05). At the phylum level, there was a statistically significant difference in the abundance of intestinal flora between the two groups ( P<0.001), the abundance of Bacteroidetes was lower in the MS group than in the NMS group, and the abundance of the Firmicutes was similar in the two groups. At the genus level, there was a statistically significant difference in the abundance of intestinal flora between the two groups ( P<0.001), the abundance of Bifidobacterium decreased and the abundance of Streptococcus and Escherichia increased in the MS group compared with those in the NMS group. Conclusion:Abnormal menstruation 8 years later after menarche in patients with PCOS is predictive of future MS, and its predictive effect increases with age, but does not change significantly with the duration of disease in abnormal menstruation. The structure of the intestinal flora of patients with MS in PCOS is indeed significantly different from that of those without MS.