Robot surgery has more precise and flexible operating characteristics than traditional endoscopic surgery, but robot thyroid surgery is far less widely carried out than endoscopic surgery. The reason for this is not only the high cost of robotic equipment and surgery, but also its own learning process that is different from endoscopic surgery. This article summarizes the technical points of robotic thyroid surgery based on our team's experience of 2800 cases over the past 10 years, including selection of surgical approach, exposure of surgical field, super-meticulous capsular dissection techniques for key structures such as parathyroid gland and recurrent laryngeal nerve protection during surgery, and prevention and treatment of complications during surgery, in order to promote the promotion and popularization of robotic thyroid surgery.

Robot surgery has more precise and flexible operating characteristics than traditional endoscopic surgery, but robot thyroid surgery is far less widely carried out than endoscopic surgery. The reason for this is not only the high cost of robotic equipment and surgery, but also its own learning process that is different from endoscopic surgery. This article summarizes the technical points of robotic thyroid surgery based on our team's experience of 2800 cases over the past 10 years, including selection of surgical approach, exposure of surgical field, super-meticulous capsular dissection techniques for key structures such as parathyroid gland and recurrent laryngeal nerve protection during surgery, and prevention and treatment of complications during surgery, in order to promote the promotion and popularization of robotic thyroid surgery.

Objective To identify the pathogenic bacteria such as Staphylococcus aureus and Enterococcus faecalis in bloodstream infec-tions with high confidence based on three deep learning models such as GoogleNet,ResNet101,and Vgg19,compare the performance and classification ability of these models,and explore the feasibility of applying the deep learning models for the rapid identification of pathogenic bacteria in bloodstream infections.Methods The preprocessed Gram-stained bacterial images,including 1 682 images for Staphylococcus aureus and 1 723 for Enterococcus faecalis,and 688 blank control microscopic images were input into three models for training and validation,respectively.Among them,1 344 images for Staphylococcus aureus,1 376 for Enterococcus faecalis,and 544 blank control images were used for training,and the remaining images were used for validation.The model with the best performance was identified according to the classification parameters between the models.Results The ResNet101 model had the lowest cross-en-tropy loss value(0.008 710 3),the largest Epoch value(93),and the highest accuracy rate(99％)for identifying the three types of validation set images.The cross-entropy loss value,Epoch value,and accuracy rate of the GoogleNet model were 0.063 89,86 and 98.6％,respectively,for identifying the three types of validation set images.Those of the Vgg19 model were 0.035 682,86 and 97.7％,respectively.Conclusion The ResNet101 model has the best performance in the classification of three kinds of images.The deep learning model may accurately,reliably and rapidly identify the Gram-stained images of pathogenic bacteria such as Staphylococcus aureus and Enterococcus faecalis in bloodstream infections.

Reducing the level of emotional expression conflict of patients is of great significance to promote the functional recovery of breast cancer patients,improve their prognosis and improve their quality of life.We introduce the research progress of ambivalence over emotional expression in breast cancer patients in terms of the connotation,measurement tools,influencing factors,and intervention methods.There is still a lack of research on measuring the emotional expression conflict of breast cancer patients in China,and it is still necessary to develop a measurement tool with cultural characteristics to obtain the true level of emotional expression conflict of patients.In clinical practice,complementary and alternative medicine,cognitive behavioral intervention,mindfulness training,expressive writing intervention,and other intervention strategies have achieved certain results in improving patients'negative emotions,but personalized intervention strategies still need further exploration.

Objective To investigate the temporal expression patterns of the related transcription factors and target genes in cardiomyocyte hypertrophy,and provide valuable clues for further researches on cardiomyocyte hypertrophy.Methods Isoproterenol (ISO) was used to induce ventricular myocytes hypertrophy in neonatal mice.The survival rate of cardiomyocyte was detected by CCK-8,and the average diameters and surface areas of cells were measured by computer photograph analysis system.The mRNA and protein expression levels of related genes were respectively measured by RT-PCR and Western blotting.Results The model of cardiomyocyte hypertrophy stimulated by ISO was constructed successfully.The expression levels of GATA4,MEF2C,GATA5,BNP and ANP increased 24 hours after ISO treatment,the expression levels of P300,α-MHC and TBX5 increased 12 hours after ISO treatment,and of SRF and β-MHC mRNA increased 6 hours after ISO treatment (P＜0.05).The expression levels of GATA4,α-MHC,β-MHC,SRF and P300 mRNA increased firstly,and then decreased in cardiomyocytes induced by ISO.The expression levels of GATA4,SRF,α-MHC,β-MHC and P300 mRNA were still higher than normal (P＜0.05),but of MEF2C decreased to normal (P＞0.0S) 72 hours after ISO treatment.The expression levels continuously elevated of GATA5,TBX5,ANP and BNP mRNA than that of controls (P＜0.05),while no fluctuation was found in NKX2.5 mRNA expression (P＞0.05).The expression of GATA4 protein increased,while of HEY2 protein decreased 48 hours after ISO treatment (P＜0.05).Conclusions In hypertrophic cardiomyocytes,the expression pattern of MEF2C is similar to,but the patterns of GATA5,GATA4,TBX5 and SRF are different with that in the development of heart,implying these genes are important during the process from compensatory stage to decompensation stage.The expression patterns of GATA4,MEF2C and SRF are similar to that of acetylase P300,implying the temporal expressions could be regulated by P300 in cardiomyocyte hypertrophy.

Objective To preliminarily understand the genotype characteristics of Toxoplasma gondii in blood of HIV?posi?tive persons in Lincang City,Yunnan Province. Method Two segments of SAG2 gene of T. gondii from blood samples of HIV?positive persons in Lincang City were extracted and amplified by using the nested PCR method and the genotype was identified and compared with the standard strain(Type I)of Toxoplasma gondii. Results Thirty?five SAG2 genes(241 bp)and 35 SAG2 genes(221 bp)of T. gondii were amplified from 170 blood samples of the HIV?positive people,and 4 of each case were selected and digested with enzyme,then 2 aim gene fragments of each case were chosen and compared with the standard strain (Type I)of T. gondii. The digestion of SAG2 gene(241 bp)showed the genotype of the blood samples was Type I or Type II, and the digestion of SAG2 gene(221 bp)confirmed that the genotype was Type I. Conclusion It is preliminarily confirmed that the genotype of T. gondii in blood of HIV?positive persons in Lincang City,Yunnan Province is Type I.

Objective To comparatively analyze Toxoplasma gondii separated from HIV-positive people and RH strain GRA6 gene. Methods By using the nested PCR the amplification of Dali HIV-positive blood samples and RH strains of Toxo-plasma GRA6 genome was performed. The GRA6 gene amplification positive product was selected and the electrophoresis imag-ing was performed by being digested with the Mse I endonuclease and the gene sequences were measured and analyzed. Re-sults The GRA6 gene fragment 800 bp was successfully amplified and about 600 bp and 200 bp bands were got by Mse I. The sequencing results showed that T. gondii GRA6 gene positive samples had 2 nucleotide variation compared with T. gondii strain RH namely 447 base pair at C becoming G and 623 base pair at G becoming T. At 146 bp and 690 bp the Mse I restric-tion sites TTAA were found. Conclusion The preliminary judgment shows that the Dali HIV-positive T. gondii genotype is consistent with RH strain belonging to genotype I.

Objective To explore the mechanism of in myocardial damage due to daunorubicin (DNR)in rats. Methods SD rats were divided into the control group and the DNR group using a random-digital table,each group comprised 15 rats. The rats in the DNR group received intraperitoneal injection of daunorubicin 3. 5 mg/kg once a week for 4 weeks. The rats in the control group received intraperitoneal injection of same volume of 0. 9% sodium chloride solution once a week for 4 weeks. The rats′behavior changes in the 2 groups were observed. The electrocardiographic examination,expression of sarcoplasmic reticulum Ca2﹢-ATP enzyme( SERCA2a)and histopathological test were performed at the end of 1,3 and 4 weeks of the experiment on 5 rats in the 2 groups,respectively. Results The subacute myocardial injury rat model could be reproduced by DNR intraperitoneal injection. The rats in the DNR group developed lassitude,drumble and drowsiness from the second week. The control group rats′activity, body weight and feeding were normal. The electrocardiographic examination in DNR group showed the following results:voltage of QRS wave decreased by more than 30% compared with the normal,ST segment elevation,and P wave peaked. Myocardial tissue histopathological examination revealed turbid cytoplasm, vacuolation,disordered arrangement of muscle fiber,and broadened fiber gaps. The expression of SERCA2a were moderately positive in both groups at the end of the first week. The expression of SERCA2a were weakly positive in the DNR group at the end of the third and fourth weeks. The number of SERCA2a positive cells in the DNR group at the end of the third and fourth weeks was significantly less than that in the control group at the same time points[(42. 2 ± 1. 2)vs(65. 30 ± 1. 6),(35. 2 ± 6. 0)vs(66. 7 ± 1. 5),all P﹤0. 05]. Conclusion DNR may inhibit the expression of SERCA2a in myocardial tissue and it may be one of the mechanisms of DNR′s myocardial toxicity.

Objective To explore the mechanism of in myocardial damage due to daunorubicin (DNR)in rats. Methods SD rats were divided into the control group and the DNR group using a random-digital table,each group comprised 15 rats. The rats in the DNR group received intraperitoneal injection of daunorubicin 3. 5 mg/kg once a week for 4 weeks. The rats in the control group received intraperitoneal injection of same volume of 0. 9% sodium chloride solution once a week for 4 weeks. The rats′behavior changes in the 2 groups were observed. The electrocardiographic examination,expression of sarcoplasmic reticulum Ca2﹢-ATP enzyme( SERCA2a)and histopathological test were performed at the end of 1,3 and 4 weeks of the experiment on 5 rats in the 2 groups,respectively. Results The subacute myocardial injury rat model could be reproduced by DNR intraperitoneal injection. The rats in the DNR group developed lassitude,drumble and drowsiness from the second week. The control group rats′activity, body weight and feeding were normal. The electrocardiographic examination in DNR group showed the following results:voltage of QRS wave decreased by more than 30% compared with the normal,ST segment elevation,and P wave peaked. Myocardial tissue histopathological examination revealed turbid cytoplasm, vacuolation,disordered arrangement of muscle fiber,and broadened fiber gaps. The expression of SERCA2a were moderately positive in both groups at the end of the first week. The expression of SERCA2a were weakly positive in the DNR group at the end of the third and fourth weeks. The number of SERCA2a positive cells in the DNR group at the end of the third and fourth weeks was significantly less than that in the control group at the same time points[(42. 2 ± 1. 2)vs(65. 30 ± 1. 6),(35. 2 ± 6. 0)vs(66. 7 ± 1. 5),all P﹤0. 05]. Conclusion DNR may inhibit the expression of SERCA2a in myocardial tissue and it may be one of the mechanisms of DNR′s myocardial toxicity.

ObjectiveTo study the correlation between the etiology and clinical features of erythroderma.MethodsThe clinical data on 182 patients with erythroderma were retrospectively collected and analyzed.ResultsThe male-to-female ratio was 2.8 ∶ 1 and the average age at onset was 58.6 ± 14.6 years.Of the 182 cases,135 (74.2％) were due to pre-existing dermatoses,14 (7.7％) to drug reaction,8 (4.4％) to malignancies,while 25(13.7％) had no obvious precipitating factors.The most frequent triggering factor was systemic consumption of drugs(52 patients,28.6％ ),and glucocorticosteroid was the most prevalent causative drug.Seventy-six patients were followed up,recurrence was observed in 14 patients but not in 58 patients,and 5 patients died,2 patients with idiopathic erythroderma were finally diagnosed with mycosis fungoides (MF)after multiple skin biopsies.ConclusionsPre-existing dermatoses are the most frequent cause of erythroderma.Idiopathic erythroderma is liable to relapse,possibly associated with malignancies,and should be closely followed up.