Objective To summarize the operation experience of 1 case of ultra-long-distance single-port robotic-assisted laparoscopic renal cyst decortication using a domestic robotic system,and provide references for the development of long-distance telesurgery.Methods The procedure was performed using a domestically produced single-port robotic system.The distance between the main control end and the patient end was 2 400 km.The operation was conducted remotely via a 5G network and a 100 Mbps dedicated line provided by China Telecom.The surgeon controlled the robotic arm remotely.Results The surgery was completed smoothly within a duration of 32 min.The real-time latency was(90±20)ms.Blood loss during the operation was 10 mL,and no drainage tube was placed.The patient recovered smoothly and returned to the ward without any complications.Conclusion It is safe and feasible for the domestically produced single-port robotic system to implement ultra-long-distance telesurgery.This approach facilitates the decentralization of advanced medical resources and helps mitigate disparities in healthcare access.

This study aimed to comprehensively examine the association of gallstones, cholecystectomy, and cancer risk. Multivariable logistic regressions were performed to estimate the observational associations of gallstones and cholecystectomy with cancer risk, using data from a nationwide cohort involving 239 799 participants. General and gender-specific two-sample Mendelian randomization (MR) analysis was further conducted to assess the causalities of the observed associations. Observationally, a history of gallstones without cholecystectomy was associated with a high risk of stomach cancer (adjusted odds ratio (aOR)=2.54, 95% confidence interval (CI) 1.50-4.28), liver and bile duct cancer (aOR=2.46, 95% CI 1.17-5.16), kidney cancer (aOR=2.04, 95% CI 1.05-3.94), and bladder cancer (aOR=2.23, 95% CI 1.01-5.13) in the general population, as well as cervical cancer (aOR=1.69, 95% CI 1.12-2.56) in women. Moreover, cholecystectomy was associated with high odds of stomach cancer (aOR=2.41, 95% CI 1.29-4.49), colorectal cancer (aOR=1.83, 95% CI 1.18-2.85), and cancer of liver and bile duct (aOR=2.58, 95% CI 1.11-6.02). MR analysis only supported the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer. This study added evidence to the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer, highlighting the importance of cancer screening in individuals with gallstones.
Humans ; Mendelian Randomization Analysis ; Gallstones/complications* ; Female ; Male ; Cholecystectomy/statistics & numerical data* ; Middle Aged ; Risk Factors ; Aged ; Adult ; Neoplasms/etiology* ; Stomach Neoplasms/epidemiology*

OBJECTIVE: To investigate the effects of sodium valproate (VPA) in inhibiting Erastin-induced ferroptosis in bone marrow mesenchymal stem cells (BMSCs) and its underlying mechanisms. METHODS: BMSCs were isolated from bone marrow of 8-week-old Spragur Dawley rats and identified [cell surface antigens CD90, CD44, and CD45 were analyzed by flow cytometry, and osteogenic and adipogenic differentiation abilities were assessed by alizarin red S (ARS) and oil red O staining, respectively]. Cells of passage 3 were used for the Erastin-induced ferroptosis model, with different concentrations of VPA for intervention. The optimal drug concentration was determined using the cell counting kit 8 assay. The experiment was divided into 4 groups: group A, cells were cultured in osteogenic induction medium for 24 hours; group B, cells were cultured in osteogenic induction medium containing optimal concentration Erastin for 24 hours; group C, cells were cultured in osteogenic induction medium containing optimal concentration Erastin and VPA for 24 hours; group D, cells were cultured in osteogenic induction medium containing optimal concentration Erastin and VPA, and 8 μmol/L EX527 for 24 hours. The mitochondrial state of the cells was evaluated, including the levels of malondialdehyde (MDA), glutathione (GSH), and reactive oxygen species (ROS). Osteogenic capacity was assessed by alkaline phosphatase (ALP) activity and ARS staining. Western blot analysis was performed to detect the expressions of osteogenic-related proteins [Runt-related transcription factor 2 (RUNX2) and osteopontin (OPN)], ferroptosis-related proteins [glutathione peroxidase 4 (GPX4), ferritin heavy chain 1 (FTH1), and solute carrier family 7 member 11 (SLC7A11)], and pathway-related proteins [adenosine monophosphate-activated protein kinase (AMPK) and Sirtuin 1 (SIRT1)]. RESULTS: The cultured cells were identified as BMSCs. VPA inhibited Erastin-induced ferroptosis and the decline of osteogenic ability in BMSCs, acting through the activation of the AMPK/SIRT1 pathway. VPA significantly reduced the levels of ROS and MDA in Erastin-treated BMSCs and significantly increased GSH levels. Additionally, the expression levels of ferroptosis-related proteins (GPX4, FTH1, and SLC7A11) significantly decreased. VPA also upregulated the expressions of osteogenic-related proteins (RUNX2 and OPN), enhanced mineralization and osteogenic differentiation, and increased the expressions of pathway-related proteins (AMPK and SIRT1). These effects could be reversed by the SIRT1 inhibitor EX527. CONCLUSION VPA inhibits ferroptosis in BMSCs through the AMPK/SIRT1 axis and promotes osteogenesis.
Mesenchymal Stem Cells/metabolism* ; Ferroptosis/drug effects* ; Animals ; Valproic Acid/pharmacology* ; Rats ; Rats, Sprague-Dawley ; Sirtuin 1/metabolism* ; Cell Differentiation/drug effects* ; Cells, Cultured ; AMP-Activated Protein Kinases/metabolism* ; Osteogenesis/drug effects* ; Piperazines/pharmacology* ; Bone Marrow Cells/cytology* ; Reactive Oxygen Species/metabolism* ; Signal Transduction/drug effects*

Objective:To explore the expression of YARS1, the subform of protein-based tRNA synthase ( YARS1), and its prognostic effect on the analysis of gene set enrichment in hepatocellular carcinoma Methods:The expressional condition of the YARS1 gene in tumor tissue samples (374 cases) and adjacent tissue samples (50 cases) of hepatocellular carcinoma patients was compared and recorded by mining the Cancer Genome Atlas database. Hepatocellular carcinoma patients were divided into high expression and low expression groups according to this data. Logistic regression was used to analyze the relationship between YARS1 and the clinical pathological characteristics of hepatocellular carcinoma patients. The effect of YARS1 expression on the prognosis of hepatocellular carcinoma patients was analyzed by the Kaplan-Meier method and log-rank test. The prognostic value of the YARS1 gene for hepatocellular carcinoma was analyzed by univariate and multivariate Cox regression. Gene set enrichment analysis was used to evaluate the gene pathways related to YARS1 in the occurrence and development of hepatocellular carcinoma. Results:The expression of the YARS1 gene was higher in hepatocellular carcinoma tissue than in normal tissue ( P<0.001). The expression level of YARS1 was correlated with the grade of patients ( P<0.05), but not with age, gender, TNM stage, and others ( P>0.05). The results of Kaplan-Meier method and log-rank test showed that the survival rate was lower in patients with high YARS1 gene expression than that of patients with low YARS1 gene expression ( P<0.001). The results of multivariate Cox regression analysis showed that YARS1 was used as an independent prognostic factor for hepatocellular carcinoma [hazard ratio=1.10, 95% confidence interval (1.050-1.156), P<0.001]. The results of gene set enrichment analysis showed that YARS1 was involved in pyrimidine metabolism, purine metabolism, aminoacyl tRNA biosynthesis, fatty acid metabolism, ppar signal transduction pathway, oocyte meiosis, amino acid and nucleotide sugar metabolism, RNA degradation, complement pathway, valine and isoleucine degradation, spliceosome, and other pathways. Conclusion:The high expression of YARS1 is associated with the progression and prognosis of hepatocellular carcinoma. Therefore, this gene is expected to become a novel biomarker and a sort of target for biological therapy in hepatocellular carcinoma.

[Objective]To summarize Professor LIAN Jianwei's differentiation and treatment characteristics and clinical experience in treating various post-epidemic syndromes.[Methods]By analyzing the etiology,pathogenesis and treatment characteristics of Professor LIAN's treatment of"post-epidemic syndrome",summarize his academic experience in treating"post-epidemic syndrome"and list a post-epidemic cough case for analysis.[Results]Professor LIAN believes that the"various syndromes after the epidemic"have reached the stage of disease recovery,during which the residual pathogens may not be cleared or the body may be deficient and lack nourishment.When treating,the first step is to distinguish between deficiency and excess,and the characteristic of diagnosis and treatment is based on"flat pulse differentiation".He believes that when infected with an epidemic,the first thing affected is the function of the spleen and stomach,so pulse diagnosis often starts with"Guan pulse"and focuses on the deficiency and excess of"Guan pulse".Based on the correlation between the rise and fall of the left and right meridians,and combined with tongue diagnosis,prescription medication is determined.In terms of treatment,it closely follows the post-epidemic syndrome and pathogenesis,either eliminating evil or supporting the body,without relying on pulse diagnosis.It uses a wide range of drugs and learns from others'strengths,following the past without being confused.The attached medical case featured the above treatment throughout the entire process and achieved good therapeutic effects.[Conclusion]Professor LIAN Jianwei mainly takes"flat pulse syndrome differentiation"as the characteristic of syndrome differentiation.According to the etiology,pathogenesis and clinical characteristics of the disease,he performs syndrome differentiation and treatment according to ancient times,with distinct clinical characteristics and remarkable therapeutic effect,which is worthy of clinical reference and promotion.

Objective To investigate the correlations of resting electrocardiogram ST-T abnormality and stress hyperglycemia ratio(SHR)with short-term prognosis of acute left heart failure(ALHF).Methods The clinical data of 125 patients with ALHF were analyzed.According to the prognosis within 30 days after onset,the patients were divided into good prognosis group(n=59),poor prognosis group(n=42)and death group(n=24).The resting electrocardiogram indications,admission blood glucose and glycosylated hemoglobin at fasting on the next day were collected,and SHR was calculated for exploring the correlations of resting electrocardiogram ST-T abnormality and SHR with short-term prognosis of ALHF.Results and conclusion The differences in gender,blood pressure and other general data among 3 groups were trivial(P>0.05),but death group was at an older age as compared with good prognosis group(P<0.05).The resting electrocardiogram ST-T abnormality rate,QRS wave duration and QTc interval were lower/shorter in good prognosis group than in the other two group(P<0.05),and the above indicators were lower/shorter in poor prognosis group than in death group(P<0.05).Good prognosis group had the lowest SHR,followed by poor prognosis group and death group(P<0.05).Multivariate Logistic regression analysis revealed that ST-T abnormality,prolonged QRS wave duration,prolonged QTc interval and high SHR were independent risk factors for poor prognosis in ALHF patients(P<0.05).Resting electrocardiogram ST-T abnormality and SHR were significantly and positively correlated with ALHF short-term prognosis.

Renal carcinoma，a common malignant tumor of the urinary system，poses a significant disease burden . With innovations in artificial intelligence（AI）deep learning algorithms and the expanded clinical use of domestically developed surgical robots，renal carcinoma diagnosis and treatment have seen multi-dimensional breakthroughs. In molecular imaging and pathology diagnosis，AI drives multi-omics fusion diagnosis，while molecular imaging guides precise treatment. In surgical technology，5G-enabled telesurgery transcends geographical limits，and immersive virtual reality technology boosts surgical accuracy. Targeted therapy and immunotherapy revolutionizes advanced renal carcinoma treatment and opens up new therapeutic frontiers. Radiotherapy and energy therapy have become more precise. Despite these advances，bottlenecks persist in diagnosis and treatment. Future progress requires focusing on technological integration，clinical translation，and exploration of energy-based therapies to transition from "precise" to "intelligence" in renal carcinoma diagnosis and treatment.

Objective:To investigate the expression,function,and clinical significance of CD24 in testicular germ cell tumors(TGCT).Methods:This study included 204 testicular germ cell tumor(TGCT)patients from the TCGA database and the TGCT-Changhai testicular germ cell tumor cohort(Changhai Hospital cohort).Prognostic analysis and multivariate analysis were employed to evaluate the association between CD24 expression and clinical characteristics.Immunohistochemistry(IHC)staining of tumor tissues was used to elucidate the mechanism by which CD24 regulated the tumor immune microenvironment(TIME)in TGCT.Finally,by analyzing the diffrences in PD-L1 expression levels and tumor-associated macrophage(TAM)M2-type cell infiltration rates between CD24 high-expression and low-expression groups,and employing the TIDE algorithm,we investigated the correlation between CD24 expression levels and immune escape scores as well as immunotherapy response rates.Results:Analysis of the TCGA database revealed that CD24 expression was significantly upregulated in TGCT with high clinical staging and M-stage(P<0.05).Compared to adjacent normal tissues,CD24 expression was significantly elevated in both primary and metastatic TGCT tissues(P<0.05).Significant differences in CD24 expression levels were observed across TNM stages and tumor progression statuses(all P<0.05).Univariate logistic regression analysis identified CD24 as a predictive factor for clinical outcomes in TGCT patients(OR=0.135,95%CI[0.035,0.516],P=0.003),and multivariate analysis further confirmed its role as an independent predictor(OR=0.057,95%CI[0.005,0.624],P=0.019).In TGCT tissues,CD24 mRNA levels correlated with immune cell markers CD206 and CD70(all P<0.05).Additionally,CD24 expression levels demonstrated significant predictive value in immune escape scoring and immunotherapy response rate assessments.Conclusions:CD24 is highly expressed in TGCT tissues and its expression is significantly correlated with the prognosis of TGCT patients,which makes it a potential new target point of biotherapy for testicular germ cell tumor patients.

Renal carcinoma，a common malignant tumor of the urinary system，poses a significant disease burden . With innovations in artificial intelligence（AI）deep learning algorithms and the expanded clinical use of domestically developed surgical robots，renal carcinoma diagnosis and treatment have seen multi-dimensional breakthroughs. In molecular imaging and pathology diagnosis，AI drives multi-omics fusion diagnosis，while molecular imaging guides precise treatment. In surgical technology，5G-enabled telesurgery transcends geographical limits，and immersive virtual reality technology boosts surgical accuracy. Targeted therapy and immunotherapy revolutionizes advanced renal carcinoma treatment and opens up new therapeutic frontiers. Radiotherapy and energy therapy have become more precise. Despite these advances，bottlenecks persist in diagnosis and treatment. Future progress requires focusing on technological integration，clinical translation，and exploration of energy-based therapies to transition from "precise" to "intelligence" in renal carcinoma diagnosis and treatment.

[Objective]To summarize Professor LIAN Jianwei's differentiation and treatment characteristics and clinical experience in treating various post-epidemic syndromes.[Methods]By analyzing the etiology,pathogenesis and treatment characteristics of Professor LIAN's treatment of"post-epidemic syndrome",summarize his academic experience in treating"post-epidemic syndrome"and list a post-epidemic cough case for analysis.[Results]Professor LIAN believes that the"various syndromes after the epidemic"have reached the stage of disease recovery,during which the residual pathogens may not be cleared or the body may be deficient and lack nourishment.When treating,the first step is to distinguish between deficiency and excess,and the characteristic of diagnosis and treatment is based on"flat pulse differentiation".He believes that when infected with an epidemic,the first thing affected is the function of the spleen and stomach,so pulse diagnosis often starts with"Guan pulse"and focuses on the deficiency and excess of"Guan pulse".Based on the correlation between the rise and fall of the left and right meridians,and combined with tongue diagnosis,prescription medication is determined.In terms of treatment,it closely follows the post-epidemic syndrome and pathogenesis,either eliminating evil or supporting the body,without relying on pulse diagnosis.It uses a wide range of drugs and learns from others'strengths,following the past without being confused.The attached medical case featured the above treatment throughout the entire process and achieved good therapeutic effects.[Conclusion]Professor LIAN Jianwei mainly takes"flat pulse syndrome differentiation"as the characteristic of syndrome differentiation.According to the etiology,pathogenesis and clinical characteristics of the disease,he performs syndrome differentiation and treatment according to ancient times,with distinct clinical characteristics and remarkable therapeutic effect,which is worthy of clinical reference and promotion.