Objective:To summarize the initial experience on da Vinci robot breast surgery (RBS).Methods:The clinical data of 151 patients who underwent RBS-related surgical procedures at the First Affiliated Hospital of Zhengzhou University from Sep 2022 to Jan 2024 were retrospectively analyzed.Results:Forty patients underwent surgery using the da Vinci robot Si TM system, and 137 patients underwent surgery using the da Vinci robot Xi TM system. The postoperative follow-up time was (3±1) month,There was no necrosis of the nipple-areola complex and no serious perioperative complications in the patients except for 3 case of prosthesis loss.Most patients were satisfied with the postoperative aesthetic results. Conclusions:Although the currently available evidence is immature and the follow-up time is short, our preliminary results suggest that RBS provides better cosmetic results and may reduce the risk of nipple necrosis.

Objective:To explore the influencing factors for poor prognosis in patients with severe traumatic brain injury (TBI).Methods:A retrospective analysis was performed; the clinical data of 389 patients with severe TBI admitted to Department of Neurosurgery, 900 th Hospital of PLA Joint Logistics Team from January 2018 to December 2022 were collected. Glasgow Outcome Scale (GOS) was used to evaluate the prognoses 6 months after discharge. Differences in clinical data between the good prognosis group (GOS scores of 4-5) and poor prognosis group (GOS scores of 1-3) were compared. Multivariate Logistic regression was used to analyze the independent influencing factors for poor prognosis in severe TBI patients, and receiver operating characteristic (ROC) curve was used to analyze the predictive value of the regression model in severe TBI patients. Results:At 6 months after discharge, 182 patients (46.8%) had favorable prognosis and 207 patients (53.2%) had unfavorable prognosis. Compared with the good prognosis group, the poor prognosis group had significantly older age, lower Glasgow Coma Scale (GCS) scores, higher proportions of patients with subdural hematoma (SDH), cerebral hernia, cerebral infarction and encephalocele, higher blood glucose, lower albumin, lower K +, Ca 2+ and CO 2, higher international normalized ratio (INR) and C-reactive protein (CRP), lower lymphocyte/monocyte ratio (LMR), and higher neutrophil/lymphocyte ratio (NLR) and systemic immunoinflammatory index (SII, P<0.05). Multivariate Logistic regression analysis showed that age ( OR=1.045, 95% CI: 1.025-1.066, P<0.001), GCS score ( OR=0.487, 95% CI: 0.388-0.612, P<0.001), cerebral hernia ( OR=3.471, 95% CI: 1.604-7.511, P=0.002), blood glucose ( OR=1.109, 95% CI: 1.010-1.218, P=0.030), INR ( OR=8.073, 95% CI: 1.199-54.354, P=0.032) and high SII ( OR=8.311, 95% CI: 4.089-16.892, P<0.001) were independent influencing factors for poor prognosis in severe TBI patients. ROC curve showed that area under the curve of the regression model predicting poor prognosis in severe TBI patients was 0.935 (95% CI: 0.905-0.957, P<0.001), enjoying sensitivity of 88.89% and specificity of 85.16%. Conclusion:Severe TBI patients with advanced age, low GCS score, high INR and SII, elevated blood glucose, or cerebral hernia have poor prognosis.

Objective:To explore the effect of da Vinci robotic nipple sparing mastectomy and immediate breast reconstruction with gel implant in breast cancer.Methods:From September 2022 to May 2024, 116 female patients with breast cancer, aged 17-58 (42.1+ 7.2) years, with a body mass index (22.93+ 2.53) kg/m 2, who underwent unilateral da Vinci robotic nipple-areola preserving immediate prosthetic breast reconstruction in the Department of Breast Surgery, the First Afiliated Hospital of Zhengzhou University, and who fulfilled the inclusion criteria. were enrolled in this study. The clinicopathologic characteristics, robotic microscopy time, total operative time, and perioperative complications of the patients were collected and analyzed to determine the effectiveness and usefulness of the procedure. Results:The da Vinci robotic SI system was utilized in 14 patients, while the da Vinci robotic X system was employed in 102 patients. A total of 78 three-port, three-arm operations and 38 single-port. three-arm operations were conducted. The mean robotic operating time and total operating time were (115.95+ 58.10) minutes and (205.14+ 57.72) minutes, respectively. Additionally, the robotic preparation time was reduced from the initial 25 minutes to the current 5 minutes. At the postoperative follow-up time of three months, no nipple-areola complex necrosis was observed, and no serious perioperative complications were identified in 109 patients, with the exception of two cases of implants loss and five cases of heat steam induced skin damage. With the exception of two cases of prosthesis loss and five instances of thermal skin injury, 109 patients exhibited no significant perioperative complications and expressed satisfaction with the postoperative aesthetic outcomes.Conclusions:The da Vinci robotic nipple sparing mastectomy and immediate breast reconstruction with gel implant has the potential to provide superior aesthetic outcomes without significant perioperative complications for the female patients.

Objective:To understand the current knowledge, attitude, and practice (KAP) on influenza and influenza vaccine among pregnant women in Suzhou and to analyze its influencing factors to provide technical support data for public health strategies for promoting influenza vaccination in pregnant women.Methods:A questionnaire was designed, and a stratified sampling method was used to conduct a face-to-face survey among pregnant women at different stages of pregnancy who received antenatal examinations at different levels of medical institutions in Suzhou, Jiangsu Province, in 2023. KAP status and influencing factors were analyzed by χ2 test and logistic regression analysis. Results:A total of 2 195 valid questionnaires were collected in this survey. The M( Q1, Q3) of knowledge about influenza and influenza vaccine among pregnant women in Suzhou was 7.60 (5.23, 9.80) points, and the score range was 0.20-14.71 points, the passing rate was 34.12%, the awareness rate of influenza vaccine was 57.45%, and the vaccination rate of influenza vaccine was 1.91% within one year before the survey. The willingness to receive influenza vaccine during pregnancy was only 3.57%. Multivariate analysis of influenza and influenza vaccine-related knowledge scores showed that the passing rate was positively correlated with education level and gestational age. In contrast, family income was negatively correlated with living in rural areas, working as migrant workers, and having no medical insurance. Multivariate analysis of vaccination intention showed that decreased effectiveness of influenza vaccine and increased adverse reactions decreased vaccination intention during pregnancy. Conclusions:The pregnant women in Suzhou pay more attention to influenza, and vaccination rates and intentions are generally low. Pregnant women with early and second trimester of pregnancy, low education, living in rural areas, working as migrant workers, and not purchasing medical insurance are the key groups to popularize the knowledge about influenza and influenza vaccine.

This article reported a prenatally diagnosed case of complete ring chromosome 15. A 38-year-old woman who conceived by in vitro fertilization and frozen embryo transfer underwent amniocentesis for prenatal diagnosis at 18 +5 weeks of gestation due to advanced maternal age. The result of G-banding karyotyping was mos 46,XX,r(15)[88]/45,X,-15[11]/46,XX,r(15;15)[1]. No numerical abnormalities of chromosomes or definite pathogenic copy number variations (CNVs) were detected by chromosomal microarray analysis. Amniocentesis was performed again at 31 +6 weeks of gestation. The result of genome copy number variation sequencing indicated no pathogenic CNV and fluorescence in situ hybridization on cultured amniocytes revealed nuc ish(15q)×1[15]/(15q)×3[5]/(15q)×2[80]. Based on all the prenatal diagnosis results, it was suggested that the fetus carried a complete ring chromosome 15. As the peripheral blood chromosomes of the couple were normal and no obvious abnormalities were detected by the prenatal ultrasound either in our hospital or another hospital, the pregnant woman decided to continue the pregnancy after genetic counseling and delivered a baby girl at 41 weeks of gestation. The girl showed no physical abnormalities during a seven-month follow-up.

l-Heptopyranoses are important components of bacterial polysaccharides and biological active secondary metabolites like septacidin (SEP), which represents a group of nucleoside antibiotics with antitumor, antifungal, and pain-relief activities. However, little is known about the formation mechanisms of those l-heptose moieties. In this study, we deciphered the biosynthetic pathway of the l,l-gluco-heptosamine moiety in SEPs by functional characterizing four genes and proposed that SepI initiates the process by oxidizing the 4'-hydroxyl of l-glycero-α-d-manno-heptose moiety of SEP-328 ( 2) to a keto group. Subsequently, SepJ (C5 epimerase) and SepA (C3 epimerase) shape the 4'-keto-l-heptopyranose moiety by sequential epimerization reactions. At the last step, an aminotransferase SepG installs the 4'-amino group of the l,l-gluco-heptosamine moiety to generate SEP-327 ( 3). An interesting phenomenon is that the SEP intermediates with 4'-keto-l-heptopyranose moieties exist as special bicyclic sugars with hemiacetal-hemiketal structures. Notably, l-pyranose is usually converted from d-pyranose by bifunctional C3/C5 epimerase. SepA is an unprecedented monofunctional l-pyranose C3 epimerase. Further in silico and experimental studies revealed that it represents an overlooked metal dependent-sugar epimerase family bearing vicinal oxygen chelate (VOC) architecture.

Methods:From Jan 2019 to Nov 2021, 20 patients underwent 3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique and branched stents for the EVAR at the three hospitals. The clinical data patients were collected and analyzed.Results:All the 20 cases underwent 3D printed template assisted pre-fenestration of stent graft according to the data of pre-operative the computed tomographic angiography (CTA). EVAR was successfully performed in all patients(included 2 cases with one fenestration,5 cases with 2 fenestration,10 cases with 3 fenestration and 3 cases with 4 fenestration). Fifty-four reinforced fenestrations (20 in right renal artery, 18 in left renal artery, 13 in superior mesenteric artery and 3 in celiac artery) were performed. During the follow-up period (mean 14.6 months), 1 case died, and the one-stage patency rate of splanchnic artery branch stent was 98.1%. Four patients had endoleak, 1 patient died of intracranial hemorrhage during postoperative period. None of patients had postoperative paraplegia or organ ischemia.Conclusions:3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique is feasible for EVAR in the treatment of complex abdominal aortic aneurysms and dissections. The technique is capable to reinforce the blood supply of visceral arteries with satisfied short-term effectiveness.Ojective:To evaluate 3D printed template assisted pre-fenestration of stent graft with reducing-diameter tie technique and branched stents for the endovascular aortic aneurysm repair (EVAR).

Objective:To explore the influencing factors of seasonal influenza among pregnant woman in Suzhou from 2015 to 2018.Methods:Based on the data of the influenza follow-up cohort of pregnant women in Suzhou from 2015 to 2018, the basic and clinical characteristics of the cohort were described, and the influencing factors of laboratory-confirmed influenza cases in pregnant women were analyzed by unconditional logistic regression.Results:A total of 19 006 pregnant women were recruited, in whom 479 cases of influenza were laboratory confirmed. Influenza A (H3N2) (42.8%) was the main sub-type. In pregnant women with exposure risk in influenza season, unconditional univariate logistic analysis showed that pregnant women or their husbands had registered permanent residence in Suzhou, pregnant women worked as childminder or nanny, had more than 2 permanent residents in the family except themselves, had medical insurance in Suzhou, had fertility insurance in Suzhou, were in the third trimester at the time of enrollment, had cough in the past month, were pregnant for the first time, had children, before and after pregnancy, spent more time outdoors than before, wore masks more often than before and had changed the frequency of gathering were all related to influenza virus infection in pregnant women. Among them, the first pregnancy, increasing the time of outdoor activity, increasing the frequency of wearing masks, and changing the frequency of gathering were important protective factors. Unconditional multivariate logistic regression analysis showed that the number of permanent residents at home was >2 (a OR=1.24, 95% CI: 1.01-1.52) and being in the third trimester, (a OR=1.56, 95% CI: 1.26-1.91) were the risk factors for maternal infection with influenza virus. Conclusion:Pregnant women with a large number of permanent residents and late pregnancy should pay attention to preventing seasonal influenza.

Objective:To understand the reinfection rate of 2019-nCoV in the previously infected population in Suzhou and compare the illness severity and prognosis of the reinfection cases with the first-time infection cases.Methods:A questionnaire survey was conducted in the persons with previous 2019-nCoV infection reported in Suzhou from January 22, 2020 to November 8, 2022 to collect the information about the incidence of reinfection of 2019-nCoV in this population from December 8, 2022 to January 18, 2023. The persons who were infected with 2019-nCoV for the first time were selected by marching the residence, age and gender at ratio of 1∶2 from 2019-nCoV infection community follow-up cohort of Suzhou. By χ2 test, the clinical symptoms and prognosis of the reinfection case and the first-time infection cases were compared. Results:The reinfection rate of 2019-nCoV was 13.01% (147/1 130) in Suzhou. No reinfection was found within 1-6 months after the first-time infection, the rate of reinfection was 10.59% (95/897) in those with interval of 7-12 months between the reinfection and the first-time infection and 45.61% (52/114) in those with the interval ≥24 months. The lowest reinfection rate was 9.09% (1/11) in those who had completed 4 doses of 2019-nCoV vaccination. The main symptoms of the reinfection cases were similar to those of the first-time infection cases. Except for dry cough, nausea/poor appetite and other symptoms, there were significant differences in other clinical symptoms between the two groups ( P<0.05). In the reinfection cases, fever had shorter duration with lower body temperature. The hospital visit rate in the reinfection cases was 4.08% (6/147), lower than that in the cases with the first-time infection (11.56%, 34/294). The time for negative nucleic acid (antigen) test result and recovery from illness after the reinfection were shorter than those after the first-time infection. Conclusions:Reinfection occurred in some people who had been infected with 2019-nCoV. The interval between the reinfection and the first-time infection and the completion of the 4 doses of booster vaccination were the factors influencing the reinfection rate. The hospital visit rate in the reinfection cases was lower than that in the cases with the first-time infection. The reinfection had similar symptoms and shorter illness duration compared with the first-time infection.

Objective To investigate the etiology and epidemic characteristics of infectious diarrhea in children in Suzhou, and to provide a basis for accurate prevention and control. Methods Active surveillance of infectious diarrhea pathogens was carried out in a national sentinel surveillance hospital in Suzhou from 2018 to 2020. Epidemiological investigation was completed and stool samples were collected. All samples were detected and classified for 5 viruses and 6 types of bacteria. Results A total of 999 cases of infectious diarrhea were included, the detection rate of pathogen was 36.34%, virus was 31.41%, bacteria was 6.31%, and multi-pathogen mixed infection was 4.8%. The top three pathogens were rotavirus (17.92%), norovirus (12.51%) and Salmonella (3.4%). Both rotavirus diarrhea and norovirus diarrhea occurred most frequently in children aged 7-24 months, with peak incidence in winter and early spring. There was no obvious seasonal and age distribution of bacterial diarrhea. The multi-pathogen mixed infection was mainly virus-virus. G9[P]8 was the dominant genotype of rotavirus, while type 2 was the dominant type of norovirus in the cases of infectious diarrhea. Conclusion Infectious diarrhea in children under 5 years old in Suzhou area from 2018 to 2020 is mainly caused by viruses, among which rotavirus and norovirus are the dominant pathogens. Viral diarrhea has obvious population distribution and seasonal characteristics. The dominant pathogens of bacterial diarrhea are Salmonella and diarrheagenic Escherichia coli.