Objective:To analyze the clinical efficacy and learning curve of robotic-assisted Warshaw procedure using the da Vinci system.Methods:Clinical data of 91 consecutive patients with pancreatic body and tail lesions undergoing robotic-assisted Warshaw procedure at Qingdao University Affiliated Hospital from October 2021 to April 2023 were retrospectively analyzed, including 21 males and 70 females, aged (50.2±14.3) years. Patient characteristics, operative time, and intraoperative blood loss were recorded. The learning curve was constructed using cumulative sum (CUSUM) analysis, with case number on the x-axis and CUSUM values on the y-axis. Linear fitting was performed, and the model with the highest determination coefficient was selected as the optimal fitting model. The learning process was divided into two phases based on the inflection point of the CUSUM learning curve: the learning phase and the proficiency phase. Perioperative outcomes were compared between these two phases.Results:All 91 procedures were successfully completed using the da Vinci robotic system with R0 resection margins. There were no perioperative mortalities or reoperations due to postoperative splenic infarction. The operative time was (227.84±76.68) min. The optimal fitting equation for the CUSUM learning curve was: CUSUM=0.005 640X 3-1.501X 2+ 92.59X-183.1. The CUSUM learning curve showed an inflection point at case 39, dividing the learning process into the learning phase (cases 1-39) and proficiency phase (cases 40-91). Compared to the learning phase, the proficiency phase demonstrated significantly shorter operative time [(203.0±75.6) min vs. (260.9±65.5) min], less intraoperative blood loss [50.0 (20.0, 50.0) ml vs. 100.0 (50.0, 100.0) ml], and reduced postoperative drainage duration [(8.7±2.4) d vs. (10.8±3.2) d] (all P<0.05). Conclusion:The robotic-assisted Warshaw procedure feasible for patients with pancreatic body and tail lesions. Surgeons require approximately 39 cases to complete the learning curve and achieve proficiency in this procedure.

Objective: To explore the prevalence of screening myopia and depressive symptom among primary and secondary school students in Xuzhou, and to explore the association of sleep and screen time on the coexistence of screening myopia and depressive symptom, so as to provide scientific references for developing intervention strategies to address the development of myopia and promote mental health in children and adolescents. Methods: From September to October 2024, a stratified cluster random sampling method was used to select 6 605 students in grade 4 to 12 in 2 urban and 2 suburban districts in Xuzhou. The students health condition and influencing factors questionnaire were used to assess students basic information, sleep time, and screen time. The Center for Epidemiological Studies Depression Scale (CES-D) was used to assess primary and secondary school students depressive symptom.Unaided distance visual acuity examination was conducted, and refractive assessment was performed using an automated refractometer without cycloplegic agents. The Chi-square test and multiple Logistic regression analysis were used to evaluate the association of sleep and screen time with the coexistence of screening myopia and depressive symptom. Results: The detection rates of screening myopia, depressive symptom, and screening myopia and depressive symptoms co morbidity among primary and secondary school students in Xuzhou were 60.35%, 4.45% and 18.61% respectively. Results from the multinomial Logistic regression analysis, using the healthy group as the reference and after adjusting for confounding factors, showed that students with insufficient sleep duration were more likely to have depressive symptom ( OR=1.57, 95%CI =1.08-2.27) and the coexistence of screening myopia and depressive symptom ( OR=1.85, 95%CI =1.45-2.36). Students with daily screen time≥2 h were more likely to have depressive symptom only ( OR=1.41, 95%CI =1.04-1.93) and the coexistence of screening myopia and depressive symptom ( OR=1.31, 95%CI =1.06-1.61). Further stratified analysis based on sufficient and insufficient sleep duration revealed that only in the insufficient sleep duration group, students with daily screen time≥2 h had an increased risk of depressive symptom only ( OR=1.49, 95%CI =1.07-2.07) and the coexistence of screening positive myopia and depressive symptom ( OR=1.40, 95%CI =1.11- 1.77 ) (all P <0.05). Conclusions Primary and secondary school students with insufficient sleep duration and daily screen time≥2 h have higher risks of depressive symptoms and the coexistence of screening myopia and depressive symptoms. It is recommended to ensure adequate sleep duration and limit screen time for children and adolescents.

Objective:To analyze the clinical efficacy and learning curve of robotic-assisted Warshaw procedure using the da Vinci system.Methods:Clinical data of 91 consecutive patients with pancreatic body and tail lesions undergoing robotic-assisted Warshaw procedure at Qingdao University Affiliated Hospital from October 2021 to April 2023 were retrospectively analyzed, including 21 males and 70 females, aged (50.2±14.3) years. Patient characteristics, operative time, and intraoperative blood loss were recorded. The learning curve was constructed using cumulative sum (CUSUM) analysis, with case number on the x-axis and CUSUM values on the y-axis. Linear fitting was performed, and the model with the highest determination coefficient was selected as the optimal fitting model. The learning process was divided into two phases based on the inflection point of the CUSUM learning curve: the learning phase and the proficiency phase. Perioperative outcomes were compared between these two phases.Results:All 91 procedures were successfully completed using the da Vinci robotic system with R0 resection margins. There were no perioperative mortalities or reoperations due to postoperative splenic infarction. The operative time was (227.84±76.68) min. The optimal fitting equation for the CUSUM learning curve was: CUSUM=0.005 640X 3-1.501X 2+ 92.59X-183.1. The CUSUM learning curve showed an inflection point at case 39, dividing the learning process into the learning phase (cases 1-39) and proficiency phase (cases 40-91). Compared to the learning phase, the proficiency phase demonstrated significantly shorter operative time [(203.0±75.6) min vs. (260.9±65.5) min], less intraoperative blood loss [50.0 (20.0, 50.0) ml vs. 100.0 (50.0, 100.0) ml], and reduced postoperative drainage duration [(8.7±2.4) d vs. (10.8±3.2) d] (all P<0.05). Conclusion:The robotic-assisted Warshaw procedure feasible for patients with pancreatic body and tail lesions. Surgeons require approximately 39 cases to complete the learning curve and achieve proficiency in this procedure.

OBJECTIVE: The patient monitors were used to explore the alarm actuality in a ICU and NICU to investigate the awareness and reaction of medical staff to alarms. METHODS: A series of surveys and interviews were taken to acquire clinicians' feelings and attitudes to monitoring alarms. The researchers were scheduled to track the alarms with annotations, and collect the alarm data of patient monitors using central monitoring system. RESULTS: A total of 235 387 and 67 783 alarms occurred in ICU and NICU respectively. The average alarm rate was about 142 alarms/patient-day in ICU and 96 alarms/patient-day in NICU. CONCLUSIONS There remains alarm fatigue in ICU and NICU, the main reason is the large number of false alarms and clinically irrelevant alarms. In addition, patient monitor is still in the level of threshold alarms or combined alarms, the data integrity and intelligence level need to be improved in future.
Clinical Alarms ; Electrocardiography ; Humans ; Infant, Newborn ; Intensive Care Units, Neonatal ; Monitoring, Physiologic

OBJECTIVE: In order to solve alarm fatigue, the algorithm optimization strategies were researched to reduce false and worthless alarms. METHODS: A four-lead arrhythmia analysis algorithm, a multiparameter fusion analysis algorithm, an intelligent threshold reminder, a refractory period delay technique were proposed and tested with collected 28 679 alarms in multi-center study. RESULTS: The sampling survey indicate that the 80.8% of arrhythmia false alarms were reduced by the four-lead analysis, the 55.9% of arrhythmia and pulse false alarms were reduced by the multi-parameter fusion analysis, the 28.0% and 29.8% of clinical worthless alarms were reduced by the intelligent threshold and refractory period delay techniques respectively. Finally, the total quantity of alarms decreased to 12 724. CONCLUSIONS To increase the dimensionality of parametric analysis and control the alarm limits and delay time are conducive to reduce alarm fatigue in intensive care units.
Alert Fatigue, Health Personnel/prevention & control* ; Arrhythmias, Cardiac/diagnosis* ; Clinical Alarms ; Humans ; Intensive Care Units ; Monitoring, Physiologic

Objective: To investigate whether lipopolysaccharide induced parkin expression and mitophagy in macrophages.Methods:The murine peritoneal primary macrophages were aseptically isolated from Kunming mice and cultured in complete medium.The mitochondrial membrane potential of macrophages was detected by flow cytometry,after the cells were stimulated with 200 ng/ml LPS and labeled mitochondria with JC-1.The parkin mRNA level of macrophages was detected by RT-PCR, protein levels of parkin and autophagic related protein LC3 Ⅱ and LC3 Ⅰ were determined by Western blot.The distribution and co-localization of parkin with LC3 and mitochondria in macrophages were respectively observed by laser scanning confocal microscope, before and after the cells were treated with LPS.Results: Flow cytometry results after JC-1 staining showed that mitochondrial membrane potential in macrophages was declined after stimulation with 200 ng/ml LPS, and continuously decreased with prolonged treatment time.The mRNA levels of parkin were increased slightly within 6 h after LPS stimulation,but parkin proteins were increased significantly within 6 h after LPS stimulation.The results of parkin distribution showed that parkin was evenly distributed in the cytoplasm at normal status, but became the obvious punctate distribution after LPS stimulation in macrophages.Western blot results showed LC3 Ⅱ/LC3 Ⅰ levels were increased after LPS stimulation, indicating the appearance of macrophage autophagy.Confocal microscopy showed that there were co-localization of parkin,LC3 and mitochondrial in macrophages after LPS stimulation.Conclusion:Parkin expression is increased significantly and mediated mitochondrial autophagy in macrophages after LPS stimulation, which is involved in the clearance of damaged mitochondria,thereby playing a role in regulating macrophage inflammatory response.

Aim To study the effect of simvastatin on the production of reactive oxygen species ( ROS ) and the secretion of interleukin-1 beta ( IL-1β) in oxidized low density lipoprotein ( oxLDL )-induced macropha-ges. Methods After the murine macrophage J774A. 1 was treated with 0,50,100,200 mg·L-1 oxLDL, the contents of aggregated lipid in macrophages were ob-served and determined by oil red O staining. Then, the oxLDL-primed macrophages were treated with 0 . 5 ,1 . 0μmol·L-1 simvastatin, the production of ROS was de-termined by flow cytometry and the expressions of pro-caspase-1 , cleaved caspase-1 and mature IL-1βon pro-tein level were determined by Western blot. Results The oil red O staining results showed that oxLDL could induce obvious lipid aggregation in macrophages, and reached the saturation point with 100 mg·L-1 concen-tration. Flow cytometry results indicated that oxLDL could induce the production of ROS in macrophages, up to 167% ± 0. 47%, and ROS level decreased to 139% ± 0. 97% in a dose-dependent manner after treatment with simvastatin. Western blot indicated that simvastatin could inhibit the expression of cleaved caspase-1 and mature IL-1β in macrophages triggered by oxLDL;compared with oxLDL group, the expression of cleaved caspase-1 and mature IL-1β decreased in simvastatin treated group, and all results had statistical significance ( P<0. 05 ) . Conclusion In the lipid ag-gregation model of macrophages induced by oxLDL, simvastatin can inhibit the production of ROS, caspase-1 activation, and secretion of IL-1β in macrophages.