The profound integration of novel qualitative productive forces throughout the entire process of diagnosing and treating gastrointestinal cancer has catalyzed innovative advance-ments in surgical techniques and postoperative rehabilitation. In the field of minimally invasive resection, technological innovations, from laparoscopic surgery to robot-assisted surgical systems that transcend traditional visual and operational limitations, and further to the integration of artificial intelligence and 5G technologies that overcome spatiotemporal barriers for real-time decision-making and telemedicine, have significantly enhanced the precision and safety of gastrointestinal tumor surgery. Concurrently, the development of innovative medical devices plays a pivotal role in improving perioperative and postoperative rehabilitation efficiency. Functional device design focuses on addressing the holistic needs of patients throughout their clinical journey, systematically resolving efficiency and safety bottlenecks inherent in conventional diagnostic and therapeutic approaches. Technological progress has further enabled non-invasive, convenient remote health management for patients. Novel qualitative productive forces not only redefine surgical paradigms but also deliver efficient, safe, and patient-centered diagnostic and therapeutic experiences through comprehensive innovation across all treatment phases. This evolution marks a critical breakthrough in modern medicine's transition toward intelligence and systematization, heralding a new era of intelligent healthcare delivery.

Background and Aims:Biliary tract cancers(BTCs)are highly aggressive malignancies with dismal prognosis,for which radical resection remains the only potentially curative treatment.Laparoscopic surgery has demonstrated superiority over open surgery in perioperative safety and recovery,yet it is technically limited in complex operations.Robot-assisted laparoscopy,with its high-definition three-dimensional vision and enhanced instrument dexterity,may overcome these limitations.However,comparative evidence balancing baseline differences between laparoscopic and robot-assisted laparoscopic radical resections for BTCs is still lacking.This study aimed to evaluate and compare their short-term safety using propensity score matching(PSM).Methods:A total of 151 patients with biliary tract cancers who underwent radical resection were retrospectively enrolled from the Chinese Biliary Tract Tumor Collaborative Group database,including 128 in the laparoscopic group and 23 in the robotic-assisted laparoscopic group.To balance baseline differences,an initial 1∶1 PSM was performed,yielding 19 laparoscopic and 19 robotic cases.Subsequently,using the robotic group as the reference,a 1∶2 PSM was conducted,resulting in 36 laparoscopic and 18 robotic cases.Primary outcomes(conversion to open surgery,ICU admission,and postoperative complications)and secondary outcomes(operative time,intraoperative blood loss,transfusion,postoperative hospital stay,reoperation,readmission,and hospitalization costs)were compared between the two groups.Multivariate regression analyses were performed to explore factors associated with conversion to open surgery and postoperative hospital stay.Results:After matching,baseline characteristics were well balanced between groups.For primary outcomes,the conversion rate to open surgery was significantly higher in the laparoscopic group than in the robotic group(41.7％vs.0,P=0.001),while ICU admission,overall postoperative complications,and Clavien-Dindo graded complications showed no significant differences(all P＞0.05).For secondary outcomes,the postoperative hospital stay was significantly more extended in the laparoscopic group compared with the robotic group(18.5 d vs.8.0 d,P=0.005),whereas operative time,intraoperative blood loss,transfusion,reoperation,readmission,and hospitalization costs were comparable(all P＞0.05).Logistic regression for conversion did not identify statistically significant predictors,but moderately differentiated tumors,elevated preoperative CA19-9,and higher harvested lymph node counts showed trends toward increased risk.Multivariate linear regression revealed that robotic-assisted surgery was an independent factor for reduced postoperative hospital stay(P=0.024),while preoperative total bilirubin(P=0.020),longer operative time(P=0.000),postoperative complications(P=0.006),and reoperation(P=0.005)were found to be associated with a prolonged hospital stay.Conclusion:Robot-assisted laparoscopic radical resection for BTCs is not inferior to conventional laparoscopy in short-term safety and may further reduce conversion rates and hospital stay.Its technical advantages may be particularly valuable in anatomically complex or challenging cases.Nonetheless,cost-effectiveness and resource allocation should be considered for wider adoption.

Background and Aims:Biliary tract cancers(BTCs)are highly aggressive malignancies with dismal prognosis,for which radical resection remains the only potentially curative treatment.Laparoscopic surgery has demonstrated superiority over open surgery in perioperative safety and recovery,yet it is technically limited in complex operations.Robot-assisted laparoscopy,with its high-definition three-dimensional vision and enhanced instrument dexterity,may overcome these limitations.However,comparative evidence balancing baseline differences between laparoscopic and robot-assisted laparoscopic radical resections for BTCs is still lacking.This study aimed to evaluate and compare their short-term safety using propensity score matching(PSM).Methods:A total of 151 patients with biliary tract cancers who underwent radical resection were retrospectively enrolled from the Chinese Biliary Tract Tumor Collaborative Group database,including 128 in the laparoscopic group and 23 in the robotic-assisted laparoscopic group.To balance baseline differences,an initial 1∶1 PSM was performed,yielding 19 laparoscopic and 19 robotic cases.Subsequently,using the robotic group as the reference,a 1∶2 PSM was conducted,resulting in 36 laparoscopic and 18 robotic cases.Primary outcomes(conversion to open surgery,ICU admission,and postoperative complications)and secondary outcomes(operative time,intraoperative blood loss,transfusion,postoperative hospital stay,reoperation,readmission,and hospitalization costs)were compared between the two groups.Multivariate regression analyses were performed to explore factors associated with conversion to open surgery and postoperative hospital stay.Results:After matching,baseline characteristics were well balanced between groups.For primary outcomes,the conversion rate to open surgery was significantly higher in the laparoscopic group than in the robotic group(41.7％vs.0,P=0.001),while ICU admission,overall postoperative complications,and Clavien-Dindo graded complications showed no significant differences(all P＞0.05).For secondary outcomes,the postoperative hospital stay was significantly more extended in the laparoscopic group compared with the robotic group(18.5 d vs.8.0 d,P=0.005),whereas operative time,intraoperative blood loss,transfusion,reoperation,readmission,and hospitalization costs were comparable(all P＞0.05).Logistic regression for conversion did not identify statistically significant predictors,but moderately differentiated tumors,elevated preoperative CA19-9,and higher harvested lymph node counts showed trends toward increased risk.Multivariate linear regression revealed that robotic-assisted surgery was an independent factor for reduced postoperative hospital stay(P=0.024),while preoperative total bilirubin(P=0.020),longer operative time(P=0.000),postoperative complications(P=0.006),and reoperation(P=0.005)were found to be associated with a prolonged hospital stay.Conclusion:Robot-assisted laparoscopic radical resection for BTCs is not inferior to conventional laparoscopy in short-term safety and may further reduce conversion rates and hospital stay.Its technical advantages may be particularly valuable in anatomically complex or challenging cases.Nonetheless,cost-effectiveness and resource allocation should be considered for wider adoption.

The profound integration of novel qualitative productive forces throughout the entire process of diagnosing and treating gastrointestinal cancer has catalyzed innovative advance-ments in surgical techniques and postoperative rehabilitation. In the field of minimally invasive resection, technological innovations, from laparoscopic surgery to robot-assisted surgical systems that transcend traditional visual and operational limitations, and further to the integration of artificial intelligence and 5G technologies that overcome spatiotemporal barriers for real-time decision-making and telemedicine, have significantly enhanced the precision and safety of gastrointestinal tumor surgery. Concurrently, the development of innovative medical devices plays a pivotal role in improving perioperative and postoperative rehabilitation efficiency. Functional device design focuses on addressing the holistic needs of patients throughout their clinical journey, systematically resolving efficiency and safety bottlenecks inherent in conventional diagnostic and therapeutic approaches. Technological progress has further enabled non-invasive, convenient remote health management for patients. Novel qualitative productive forces not only redefine surgical paradigms but also deliver efficient, safe, and patient-centered diagnostic and therapeutic experiences through comprehensive innovation across all treatment phases. This evolution marks a critical breakthrough in modern medicine's transition toward intelligence and systematization, heralding a new era of intelligent healthcare delivery.

Objective:To analyze the correlation between serum vitamin D level and ovarian artery blood flow index and ovarian reserve function in women.Methods:A retrospective cohort study was conducted. Women aged from 18 to 40 years who were admitted to the Department of Obstetrics and Gynecology of the Second Affiliated Hospital of Harbin Medical University from September 2020 to November 2021 and had regular sexual life were selected as subjects. The data of age, height and weight were collected. And the indexes of vitamin D, anti-Müllerian hormone (AMH), luteinizing hormone and follicle-stimulating hormone were detected in the laboratory. Color Doppler ultrasound was used to measure antral follicle count and bilateral ovarian interstitial artery blood stream resistance index (RI) and plusatility index (PI) in early follicular phase. Multiple linear regression was used to analyze the related factors of serum vitamin D level.Results:A total of 218 women were included in the study, including 137 cases of vitamin D deficiency, accounting for 62.8%, 39 cases of vitamin D insufficiency, accounting for 17.9%, 42 cases of normal vitamin D, accounting for 19.3%. Multiple linear regression analysis showed that there was a negative correlation between serum vitamin D level and ovarian blood flow ( P=0.024), but no correlation with other indexes (all P>0.05). Conclusion:Serum vitamin D level affected ovarian interstitial artery blood flow RI to some extent, but had no significant correlation with ovarian interstitial artery blood flow PI, serum AMH level and other indexes related to ovarian reserve function.

Objective:To analyze the correlation between serum vitamin D level and ovarian artery blood flow index and ovarian reserve function in women.Methods:A retrospective cohort study was conducted. Women aged from 18 to 40 years who were admitted to the Department of Obstetrics and Gynecology of the Second Affiliated Hospital of Harbin Medical University from September 2020 to November 2021 and had regular sexual life were selected as subjects. The data of age, height and weight were collected. And the indexes of vitamin D, anti-Müllerian hormone (AMH), luteinizing hormone and follicle-stimulating hormone were detected in the laboratory. Color Doppler ultrasound was used to measure antral follicle count and bilateral ovarian interstitial artery blood stream resistance index (RI) and plusatility index (PI) in early follicular phase. Multiple linear regression was used to analyze the related factors of serum vitamin D level.Results:A total of 218 women were included in the study, including 137 cases of vitamin D deficiency, accounting for 62.8%, 39 cases of vitamin D insufficiency, accounting for 17.9%, 42 cases of normal vitamin D, accounting for 19.3%. Multiple linear regression analysis showed that there was a negative correlation between serum vitamin D level and ovarian blood flow ( P=0.024), but no correlation with other indexes (all P>0.05). Conclusion:Serum vitamin D level affected ovarian interstitial artery blood flow RI to some extent, but had no significant correlation with ovarian interstitial artery blood flow PI, serum AMH level and other indexes related to ovarian reserve function.

Objective To evaluate the effect of propofol pretreatment on nuclear factor kappa B (NF-κB)activity during hepatic ischemia-reperfusion(I∕R)injury in rats. Methods Twenty-four patho-gen-free healthy male Sprague-Dawley rats, aged 2 months, weighing 200-250 g, were divided into 3 groups(n=8 each)using a random number table:sham operation group(group S),group I∕R and propofol pretreatment group(group P).Hepatic I∕R injury was induced by 45 min occlusion of the hepatic artery and portal vein entering the middle and left lobes of the liver followed by reperfusion. In group P, propofol 12 mg·kg-1·h-1was infused via the femoral vein until the end of ischemia starting from 30 min before ische-mia in group P. Blood samples were collected from the inferior vena cava at 120 min of reperfusion for deter-mination of the levels of serum alanine aminotransferase(ALT),aspartate aminotransferase(AST),tumor necrosis factor-α(TNF-α)and interleukin-1β(IL-1β). The rats were then sacrificed and livers were re-moved for determination of phosphorylated NF-κB p65(p-NF-κB p65)expression in liver tissues(by West-ern blot)and apoptosis in hepatocytes(by TUNEL).Apoptosis index(AI)was calculated. Results Com-pared with group S, the levels of ALT, AST, TNF-α and IL-1β in serum and AI were significantly in-creased,and the expression of p-NF-κB p65 in liver tissues was up-regulated in I∕R and P groups(P<005). Compared with group I∕R,the levels of ALT,AST,TNF-α and IL-1β in serum and AI were signifi-cantly decreased,and the expression of p-NF-κB p65 in liver tissues was down-regulated in group P(P<005). Conclusion The mechanism by which propofol pretreatment reduces hepatic I∕R injury is associat-ed with inhibiting NF-κB activity in rats.