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 explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as "Xinjiang Region" ) in diagnosing fundus diseases.Methods:The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. Results:All the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination ( P<0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance ( P<0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance ( P<0.05). There was no significant correlation ( P>0.05) between the improvement of diagnostic level of participating physicians and educational background ( Rho=0.07), professional title ( Rho=0.13), age ( r=0.20), and working time of ophthalmofundus disease specialty ( r=0.26). Conclusions:Relying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.

Objective:To explore the feasibility and effect of remote medical education model using online film reading training to improve the ability of ophthalmologists in the Xinjiang Uygur Autonomous Region (hereinafter referred to as "Xinjiang Region" ) in diagnosing fundus diseases.Methods:The three-level film reading training system of Xinjiang Production and Construction Corps system division hospital-Corps Hospital-Peking Union Medical College Hospital was established. From June 2022 to January 2023, 4 159 posterior color fundus images were continuously collected from Department of Ophthalmology of Xinjiang Corps Hospital and 4 divisional hospitals in the Corps medical system. Among them, hypertensive retinopathy, diabetic retinopathy, exudative age-related macular degeneration (AMD), atrophic AMD and retinal vein occlusion were 3 073, 651, 43, 186 and 206 cases, respectively. The images were divided into 3 rounds (first, second and last) according to the proportion of diseases. The doctors who participated in the training (hereinafter referred to as the "training") were 15 ophthalmologists from the Corps Hospital of Xinjiang Region and the division hospital of the Corps system. There were 7 male and 8 female. Age was (38.1±4.0) years. The titles of senior, deputy senior, intermediate and junior are 1, 6, 5 and 3 respectively; Bachelor's degree and master's degree are 13 and 2 respectively. The working time of fundus disease specialty was (9.6±3.3) years. The film reading system training was conducted before the first round of labeling, and after each round of film reading, the doctors of Peking Union Medical College Hospital gave feedback and explanation on the film reading results. The diagnostic consistency, sensitivity and specificity were compared by paired sample t test. Spearman or Pearson correlation analysis was conducted between the improvement of diagnostic level and professional title, education, age and working hours of ocular fundus disease. Results:All the participating doctors completed the first, second and last reading. After each round of film reading, the film reading summary was carried out for 2 hours. The average diagnostic agreement rates of participating physicians were 53.0%, 67.0% and 75.0%, respectively. The sensitivity and specificity were 0.38, 0.69, 054 and 0.66, 0.85, 0.96, respectively. There was significant difference between the first and last examination ( P<0.001). The sensitivity of the second reading was significantly higher than that of the first reading, and the sensitivity of the last reading was significantly lower than that of the second reading, with statistical significance ( P<0.05). The specificity of the second reading was significantly higher than that of the first reading, and the last reading was significantly higher than that of the second reading, with statistical significance ( P<0.05). There was no significant correlation ( P>0.05) between the improvement of diagnostic level of participating physicians and educational background ( Rho=0.07), professional title ( Rho=0.13), age ( r=0.20), and working time of ophthalmofundus disease specialty ( r=0.26). Conclusions:Relying on the three-level online telemedicine training, it can improve the ability of ophthalmologists in Xinjiang region to diagnose fundus diseases. The preliminary telemedicine education model has demonstrated potential for feasibility and effectiveness in remote areas with inadequate medical resources.

Objective: To compare the clinical efficacy between endoscopic nipple-sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery. Methods: Totally 189 early-stage breast cancer patients admitted at Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University from January 2013 to December 2017 were enrolled. Among them, 104 patients underwent endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation (endoscopic group), with an age of (41.7±6.1) years (range: 25 to 51 years), and 85 patients underwent traditional open surgery (open group), with an age of (41.6±7.7) years (range: 27 to 65 years). The operative duration, the volume of intraoperative blood loss, the volume of drainage in 3 days after surgery, postoperative complications and patients′ satisfaction of breast reconstruction were compared between the two groups using t test, Mann-Whitney U test, χ² test or non-parametric test. Results: There were no statistically significant differences in postoperative complications, the rates of recurrence and overall survival between the two groups (P>0.05). The operative duration (sentinel lymph node biopsy: (178±80) minutes vs. (198±42) minutes, t=-2.082, P=0.039; axillary lymph node dissection: (204±79) minutes vs. (233±49) minutes, t=-2.952, P=0.004), the volume of drainage in three days postoperative ((183±141)ml vs. (237±104) ml, t=-2.938, P=0.004) in the open group were lower than endoscopic group. The volume of intraoperative blood loss in the endoscopic group was lower than that in the open group ((87±64) ml vs. (62±36) ml, t=3.210, P=0.002). Patients′ satisfaction of breast reconstruction in the endoscopic group was higher than that in the open group. Conclusions Both endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery are safe in oncology. Endoscopic surgery maybe more suitable alternative in breast reconstruction for early-stage breast cancer patients.

Objective To compare the clinical efficacy between endoscopic nipple?sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery. Methods Totally 189 early?stage breast cancer patients admitted at Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University from January 2013 to December 2017 were enrolled. Among them, 104 patients underwent endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation (endoscopic group), with an age of (41.7±6.1) years (range: 25 to 51 years), and 85 patients underwent traditional open surgery (open group), with an age of (41.6±7.7) years (range: 27 to 65 years). The operative duration, the volume of intraoperative blood loss, the volume of drainage in 3 days after surgery, postoperative complications and patients′satisfaction of breast reconstruction were compared between the two groups using t test, Mann?Whitney U test, χ2 test or non?parametric test. Results There were no statistically significant differences in postoperative complications, the rates of recurrence and overall survival between the two groups (P>0.05). The operative duration (sentinel lymph node biopsy: (178± 80) minutes vs. (198±42) minutes, t=-2.082, P=0.039; axillary lymph node dissection: (204±79) minutes vs. (233±49) minutes, t=-2.952, P=0.004), the volume of drainage in three days postoperative ((183±141)ml vs. (237 ± 104) ml, t=-2.938, P=0.004) in the open group were lower than endoscopic group. The volume of intraoperative blood loss in the endoscopic group was lower than that in the open group ((87±64) ml vs. (62± 36) ml, t=3.210, P=0.002). Patients′satisfaction of breast reconstruction in the endoscopic group was higher than that in the open group. Conclusions Both endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery are safe in oncology. Endoscopic surgery maybe more suitable alternative in breast reconstruction for early?stage breast cancer patients.

Objective To compare the clinical efficacy between endoscopic nipple?sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery. Methods Totally 189 early?stage breast cancer patients admitted at Department of Breast and Thyroid Surgery, Southwest Hospital, Third Military Medical University from January 2013 to December 2017 were enrolled. Among them, 104 patients underwent endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation (endoscopic group), with an age of (41.7±6.1) years (range: 25 to 51 years), and 85 patients underwent traditional open surgery (open group), with an age of (41.6±7.7) years (range: 27 to 65 years). The operative duration, the volume of intraoperative blood loss, the volume of drainage in 3 days after surgery, postoperative complications and patients′satisfaction of breast reconstruction were compared between the two groups using t test, Mann?Whitney U test, χ2 test or non?parametric test. Results There were no statistically significant differences in postoperative complications, the rates of recurrence and overall survival between the two groups (P>0.05). The operative duration (sentinel lymph node biopsy: (178± 80) minutes vs. (198±42) minutes, t=-2.082, P=0.039; axillary lymph node dissection: (204±79) minutes vs. (233±49) minutes, t=-2.952, P=0.004), the volume of drainage in three days postoperative ((183±141)ml vs. (237 ± 104) ml, t=-2.938, P=0.004) in the open group were lower than endoscopic group. The volume of intraoperative blood loss in the endoscopic group was lower than that in the open group ((87±64) ml vs. (62± 36) ml, t=3.210, P=0.002). Patients′satisfaction of breast reconstruction in the endoscopic group was higher than that in the open group. Conclusions Both endoscopic nipple sparing mastectomy with immediat reconstruction using prosthesis implantation and open surgery are safe in oncology. Endoscopic surgery maybe more suitable alternative in breast reconstruction for early?stage breast cancer patients.

Objective To explore the effect of carbon nanoparticles-epirubicin suspension on proliferation and apoptosis in human breast cancer MCF-7 cells.Methods MCF-7 cells were cultured with different concentrations of CNP-EPI in vitro.CCK-8 assay was used for determinate inhibition effect of CNP-EPI on the proliferation of MCF-7 cells at different concentration and different time.According to the determination of IC90,5 μg/ml CNP-EPI was selected,and cell morphology and cell apoptosis rates were observed after 24 h.Results The inhibition effect of the CNP-EPI was stronger significantly in CNP-EPI group than in normal control group within 24 h,48 h,72 h when the concentration was from 1 μg/ml to 200 μg/ml (P＜0.01).The inhibition of CNP-EPI on the proliferation of MCF-7 cells was gradually strengthened in a dose-dependent relation within the same time,and the inhibition effect is reduced in the same concentration of drugs with the time extension,but it still has a strong inhibitory effect in 72 h,and the inhibition effect of different concentration of CNP was not obvious on MCF-7 cells.Obvious changes of cell morphology were observed under inverted microscope such as:a lot of dead cells,cell adherent growth poor,cell morphology became round and karyopycnosis etc,in 5 μg/ml CNP-EPI group after 24 h.However,no obvious abnormity of cell norphology was observed in normal control group and corresponding CNP group.Late apoptosis rate was (14.57±2.41) ％,the mortality rate could reach (78.63±-20.55)％ in 5 μg/ml CNP-EPI group after 24 h.The mortality rate and apoptosis rate of cells was higher significantly in CNP-EPI group than in CNP group and normal control group (P＜0.05).Conclusion CNP-EPI can obviously inhibit the proliferation or kill human breast cancer MCF-7cells,and the inhibition effect of CNP-EPI on proliferation of breast cancer cells might be the result of delayed releasing of EPI.

Objective To discuss the safety and effectiveness of robot-assisted thyroidectomy using Da Vinci system.Methods Endoscopic thyroidectomy assisted by Da Vinci system was performed in 20 patients,including 5 cases of thyroidadenoma,4 cases of nodular goiter,and 11 cases of thyroid carcinoma.The max diameter of thyroid lump is 5.33 cm.Among 9 cases of benign thyroid neoplasm,5 cases underwent unilateral subtotal lobectomy,and 4 cases underwent unilateral near total thyroidectomy.Among 11 cases of thyroid carcinoma,7 cases underwent bilateral near total thyroidectomy,and 4 cases underwent bilateral total thyroidectomy,at the same time,all the 11 cases underwent central region lymph node dissection.Results The robot-assisted endoscopic thymidectomy was successfully carried out in 20 cases.The mean operation time was 206.4 (105～372)min.The mean operative blood loss was 27.3 ml.The draining tube was moved 3 to 6 days after surgery.The mean postoperative hospital stay was 4.9 days.The mean hospital expense was 60 172 yuan RMB.No complication occurred.20 patients were satisfied with the cosmetic effect and compararive curative effect.Conclusions The robot-assisted endoscopic thymidectomy is an efective method for thyroid diseases.The methed can get more clear vision,higher safety,and good cosmetic efect.

Penicillin expandase, also known as deacetoxycephalosporin C synthase (DAOCS), is an essential enzyme involved in cephalosporin C biosynthesis. To evaluate the catalytic behaviors of penicillin expandase under high penicillin G concentration and to identify mutants suitable for industrial applications, the specific activities of wild-type DAOCS and several mutants with increased activities toward penicillin G were determined by HPLC under high penicillin G concentrations. Their specific activity profiles were compared with theoretical predictions by different catalytic dynamics models. We evaluated the specific activities of wild-type DAOCS and previous reported high-activity mutants H4, H5, H6 and H7 at concentrations ranging from 5.6 to 500 mmol/L penicillin G. The specific activities of wild-type DAOCS and mutant H4 increased as penicillin G concentration increased, but decreased when concentrations of substrate go above 200 mmol/L. Other mutants H5, H6 and H7 showed more complex behaviors under high concentration of penicillin G. Among all tested enzymes, mutant H6 showed the highest activity when concentration of penicillin G is above 100 mmol/L. Our results revealed that the substrate inhibition to wild-type DAOCS' by penicillin G is noncompetitive. Other DAOCS mutants showed more complex trends in their specific activities at high concentration of penicillin G (>100 mmol/L), indicating more complex substrate inhibition mechanism might exist. The substrate inhibition and activity of DAOCS mutants at high penicillin G concentration provide important insight to help select proper mutants for industrial application.
Catalysis ; Intramolecular Transferases ; genetics ; Mutation ; Penicillin G ; pharmacology ; Penicillin-Binding Proteins ; genetics ; Streptomyces ; enzymology ; genetics