Objective To evaluate the efficacy and safety of robot-assisted laparoscopic pyeloplasty(RALP)in the treatment of obstructive hydronephrosis at ureteropelvic junction in infants≤6 months old.Methods Clinical data of 44 infants with ureteropelvic junction obstruction(UPJO)and hydronephrosis treated by RALP from January 2021 to December 2023 were analyzed retrospectively.The average age was(72.3±49.7)d(range,5 d-6 months old),and the average weight was(5.7±1.6)kg(range,2.9-8.5 kg).Preoperative ultrasonography showed that the anteroposterior diameter was(30.2±9.5)mm and the thinnest part of the renal parenchyma was(2.6±1.2)mm.By using the da Vinci Xi robotic operating system,the narrow segment of the ureteropelvic junction was fully exposed,the renal pelvis and ureter were trimmed with scissors,and the ureter was anastomosed with 6-0 single strands.Results All the 44 operations were completed successfully without conversion to traditional laparoscopic or open surgery.No intraoperative complications occurred.The operation time was 105-245 min(mean,179.8 min),and the intraoperative blood loss was 2-10 ml(mean,4.9 ml).Re-examinations of ultrasonography at 6 months after removal of double J tube showed that the anteroposterior diameter was(10.5±6.3)mm,which was significantly decreased than that before operation(paired t test,t=19.985,P=0.000),and the thinnest part of the renal parenchyma was(6.8±1.7)mm,which was significantly increased than that before operation(paired t test,t=18.420,P=0.000).The patients were followed up for 6-12 months after removal of double J tube.There were no complications such as anastomotic stricture,urine leakage,or recurrence of obstruction.Conclusion RALP is safe and effective in the treatment of UPJO and hydronephrosis in infants younger than 6 months old.

Objective To explore application effect of modified three-port robotic-assisted single-port multi-channel laparoscopic surgery in radical operation for choledochal cysts in children.Methods From March 2022 to June 2024,20 children with congenital choledochal cysts in our department underwent modified three-port robotic-assisted radical resection of choledochal cysts combined with Roux-en-Y anastomosis of the hepatic duct and jejunum.A single-port multi-channel laparoscopic device was inserted through an umbilical incision,and 8 mm trocars were respectively inserted under the right and left costal margins for robotic arm operation.Before the robot docking,the jejunum-jejunum anastomosis was completed outside the body through the umbilical single-port device.After docking,operations of cyst resection and anastomosis and reconstruction of the hepatic duct and jejunum were completed under the robotic laparoscope.Results The operations of 20 children were successfully completed without conversion to open surgery or intraoperative blood transfusion.The operation time was(269.8±23.3)min,the robotic operation time was(123.8±11.1)min,and the intraoperative blood loss was(8.3±3.9)ml.The postoperative exhaust time was(30.8±9.8)h,the abdominal drainage tube was removed at 5-6 d after operation,and the postoperative hospital stay was 7-8 d.On the 7th day after surgery,10 out of 11 children with elevated preoperative liver function transaminase(ALT and AST)levels decreased to normal,while 4 out of 6 children with elevated preoperative bilirubin(TBIL,DBIL,and IBIL)levels returned to normal.Abdominal ultrasound showed no anastomotic stenosis,cholangitis,or other serious complications during follow-ups for 3-6 months in the 20 children.Conclusion The robotic-assisted single-port multi-channel laparoscopic surgery(modified three-port method)is safe and feasible for the treatment of choledochal cysts in children.

Objective:To investigate the relationship between lipid levels and cognitive impairment in the elderly Chinese population using prospective cohort data.Methods:Based on the China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) cohort, this study included 24 380 individuals aged ≥60 years who participated in the cognitive function follow-up survey from 2018 to 2019. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), with cognitive impairment defined according to different educational levels: MMSE ≤17 for illiterate individuals, MMSE ≤20 for those with primary education and MMSE ≤24 for those with secondary education or above. Multivariable linear regression and logistic regression models were employed to examine the associations between six baseline lipid indicators and cognitive scores, as well as cognitive impairment. Additionally, restricted cubic splines were used to explore the exposure-dose relationship between lipid levels and cognitive function.Results:The study population had a median follow-up time of 11.6 years, with a baseline age of (59.7±6.8) years. Among the participants, 9 510 (39.0%) were males, and the mean MMSE score was 24.7±6.8. A total of 3 887 individuals (15.9%) were identified as cognitively impaired. The results of multivariable linear regression and logistic regression indicated that total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) levels were not only significantly positively associated with cognitive scores but also significantly associated with a lower risk of cognitive impairment. Each 1 mmol/L increase in these lipid levels corresponded to β values (95% CI) of 0.267 (0.173-0.361), 0.385(0.271-0.499) and 0.331(0.231-0.431), respectively. Each 1 mmol/L increase in these lipid levels corresponded to odds ratio ( OR) (95% CI) values of 0.915 (0.876-0.956), 0.875 (0.830-0.923) and 0.886 (0.848-0.927), respectively. The dose-response curve demonstrated that the negative association was primarily observed within the guideline-recommended optimal lipid level range. Specifically, when LDL-C was less than 3.4 mmol/L and non-HDL-C was less than 4.1 mmol/L, the corresponding OR (95% CI) values were 0.859 (0.796-0.926) and 0.876 (0.818-0.939). Conclusion:Lipid levels exhibit a certain linear negative association with cognitive impairment in elderly Chinese adults, with LDL-C and non-HDL-C demonstrating a stronger effect, particularly within the guideline-recommended optimal range.

Objective To use AI-assisted motor dysfunction assessment for quantitative evaluation of motor function in Parkinson's disease(PD)and multiple system atrophy-Parkinsonian type(MSA-P)in order to achieve accurate differential diagnosis.Methods A total of 105 participants aged ≥60 years were consecutively enrolled from the First and Third Medical Centers of Chinese PLA General Hospital between January and September 2024.Based on diagnostic criteria,they were divided into a PD group(48 cases),a MSA-P group(31 cases),and a control group(26 cases).The general information was collected,and the motor function was evaluated with Move-ment Dysfunction Assessment Software in order to assess the diagnostic value of the AI-assisted assessment in differentiating between PD and MSA-P.Results Significantly differences were observed among the three groups in terms of facial expression indicators,bilateral finger tapping frequency,bilateral hand movement frequency,right hand movement amplitude change rate,bilat-eral palm flipping frequency,bilateral toe tapping frequency,freezing load of bilateral toe tapping,bilateral leg flexibility frequency,right leg flexibility amplitude change rate,freezing load of bilat-eral leg flexibility,upright extension angular velocity,turnaround time,forward step frequency,backward step frequency,forward average stride length,backward average stride length,forward average walking speed,backward average walking speed,forward average step width,backward average step width,bilateral postural tremor frequency,bilateral postural tremor maximum am-plitude,bilateral action tremor frequency,bilateral action tremor maximum amplitude,and com-parison of bilateral resting tremor frequency(P＜0.05,P＜0.01).The MSA-P group exhibited significantly lower blink frequency,maximum amplitude and frequency of facial tremors,upright extension angular velocity,and step frequency,while higher ratio of mouth opening duration and longer turnaround time when compared with the PD group(P＜0.05,P＜0.01).The AUC value of the combined nine motor function indicators and the five facial expression indicators in differ-entiating PD from MSA-P was 0.943(95％CI:0.895-0.991,P=0.000)and 0.925(95％CI:0.870-0.981,P=0.000),respectively,both better than that of individual indicators.Conclusion Combi-nation assessment of facial expression,posture,gait with AI assistance can contribute to the dif-ferential diagnosis of PD and MSA-P.

Objective:To explore the serum miRNA-144-5p (miR-144-5p) level in liver cancer patients and its relationship with clinical characteristics, as well as the target genes of miR-144-5p and the possible pathogenic mechanisms.Methods:The morning fasting serum samples were retrospectively collected from 100 newly diagnosed liver cancer patients (liver cancer group) before any treatment in Shanxi Province Cancer Hospital from June 2019 to June 2020, as well as 100 healthy individuals (healthy control group) during physical examinations in the same period. The real-time fluorescence quantitative polymerase chain reaction method was used to measure the transcription level expression of miR-144-5p in serum. The high and low expressions of miR-144-5p in patients were determined based on the median relative expression level of miR-144-5p; the distribution differences between patients with high and low expressions of miR-144-5p among different clinical pathological features were compared. The online tools miRDB, TargetScan 8.0 and miRWalk were used to predict potential target genes for miR-144-5p, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed through a bioinformatics platform, and complementary sequences between miR-144-5p and target genes were analyzed using RNA22 software.Results:The median age of the liver cancer group was 54 years old, ranging from 38 to 74 years old, including 80 males (80.0%) and 20 females (20.0%); the median age of the healthy control group was 46 years old, ranging from 34 to 66 years old, including 69 males (69.0%) and 31 females (31.0%); there was no statistically significant difference in age and gender composition between the two groups (both P > 0.05). The median transcription level relative expression of miR-144-5p in liver cancer patients was lower than that in the healthy control group [ M ( Q1, Q3)] [0.311 (0.066, 2.270) vs. 1.067 (0.263, 3.620)], and the difference was statistically significant ( Z = -4.16, P < 0.001). The proportion of patients with low expression of miR-144-5p was higher in the group with maximum diameter of tumor > 5 cm compared to the group with maximum diameter of tumor ≤5 cm [59.3% (35/59) vs. 36.6% (15/41)] and in the group with metastasis compared to the group without metastasis [60.4% (29/48) vs. 40.4% (21/52)], and the differences were statistically significant (both P < 0.05). There was no statistically significant difference in the distribution of patients with high and low expressions of miR-144-5p among different subgroups based on gender, age >55 years, presence of hepatitis, cirrhosis, alpha fetoprotein >400 μ g/L, and differentiation degree (all P > 0.05). According to predictions, there were 34 miR-144-5p target genes shared by the three bioinformatics online tools. GO and KEGG enrichment analyses showed that these target genes were associated with ubiquitination, primarily enriched in the ubiquitin-mediated proteolysis pathway (hsa04120) and the mTOR signaling pathway (hsa04150). RNA22 software analysis showed that miR-144-5p mainly had complementary sequences with 3' untranslated regions of UBR5 and UBE4A genes. Conclusions:The serum miR-144-5p level in liver cancer patients is relatively low, and its expression level may be related to tumor size and metastasis. miR-144-5p may affect the occurrence and development of liver cancer by regulating ubiquitination level through target genes such as UBR5 and UBE4A.

Objective:To investigate the relationship between lipid levels and cognitive impairment in the elderly Chinese population using prospective cohort data.Methods:Based on the China-PAR (Prediction for Atherosclerotic Cardiovascular Disease Risk in China) cohort, this study included 24 380 individuals aged ≥60 years who participated in the cognitive function follow-up survey from 2018 to 2019. Cognitive function was assessed using the Mini-Mental State Examination (MMSE), with cognitive impairment defined according to different educational levels: MMSE ≤17 for illiterate individuals, MMSE ≤20 for those with primary education and MMSE ≤24 for those with secondary education or above. Multivariable linear regression and logistic regression models were employed to examine the associations between six baseline lipid indicators and cognitive scores, as well as cognitive impairment. Additionally, restricted cubic splines were used to explore the exposure-dose relationship between lipid levels and cognitive function.Results:The study population had a median follow-up time of 11.6 years, with a baseline age of (59.7±6.8) years. Among the participants, 9 510 (39.0%) were males, and the mean MMSE score was 24.7±6.8. A total of 3 887 individuals (15.9%) were identified as cognitively impaired. The results of multivariable linear regression and logistic regression indicated that total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) levels were not only significantly positively associated with cognitive scores but also significantly associated with a lower risk of cognitive impairment. Each 1 mmol/L increase in these lipid levels corresponded to β values (95% CI) of 0.267 (0.173-0.361), 0.385(0.271-0.499) and 0.331(0.231-0.431), respectively. Each 1 mmol/L increase in these lipid levels corresponded to odds ratio ( OR) (95% CI) values of 0.915 (0.876-0.956), 0.875 (0.830-0.923) and 0.886 (0.848-0.927), respectively. The dose-response curve demonstrated that the negative association was primarily observed within the guideline-recommended optimal lipid level range. Specifically, when LDL-C was less than 3.4 mmol/L and non-HDL-C was less than 4.1 mmol/L, the corresponding OR (95% CI) values were 0.859 (0.796-0.926) and 0.876 (0.818-0.939). Conclusion:Lipid levels exhibit a certain linear negative association with cognitive impairment in elderly Chinese adults, with LDL-C and non-HDL-C demonstrating a stronger effect, particularly within the guideline-recommended optimal range.

Objective To use AI-assisted motor dysfunction assessment for quantitative evaluation of motor function in Parkinson's disease(PD)and multiple system atrophy-Parkinsonian type(MSA-P)in order to achieve accurate differential diagnosis.Methods A total of 105 participants aged ≥60 years were consecutively enrolled from the First and Third Medical Centers of Chinese PLA General Hospital between January and September 2024.Based on diagnostic criteria,they were divided into a PD group(48 cases),a MSA-P group(31 cases),and a control group(26 cases).The general information was collected,and the motor function was evaluated with Move-ment Dysfunction Assessment Software in order to assess the diagnostic value of the AI-assisted assessment in differentiating between PD and MSA-P.Results Significantly differences were observed among the three groups in terms of facial expression indicators,bilateral finger tapping frequency,bilateral hand movement frequency,right hand movement amplitude change rate,bilat-eral palm flipping frequency,bilateral toe tapping frequency,freezing load of bilateral toe tapping,bilateral leg flexibility frequency,right leg flexibility amplitude change rate,freezing load of bilat-eral leg flexibility,upright extension angular velocity,turnaround time,forward step frequency,backward step frequency,forward average stride length,backward average stride length,forward average walking speed,backward average walking speed,forward average step width,backward average step width,bilateral postural tremor frequency,bilateral postural tremor maximum am-plitude,bilateral action tremor frequency,bilateral action tremor maximum amplitude,and com-parison of bilateral resting tremor frequency(P＜0.05,P＜0.01).The MSA-P group exhibited significantly lower blink frequency,maximum amplitude and frequency of facial tremors,upright extension angular velocity,and step frequency,while higher ratio of mouth opening duration and longer turnaround time when compared with the PD group(P＜0.05,P＜0.01).The AUC value of the combined nine motor function indicators and the five facial expression indicators in differ-entiating PD from MSA-P was 0.943(95％CI:0.895-0.991,P=0.000)and 0.925(95％CI:0.870-0.981,P=0.000),respectively,both better than that of individual indicators.Conclusion Combi-nation assessment of facial expression,posture,gait with AI assistance can contribute to the dif-ferential diagnosis of PD and MSA-P.

Objective To evaluate the efficacy and safety of robot-assisted laparoscopic pyeloplasty(RALP)in the treatment of obstructive hydronephrosis at ureteropelvic junction in infants≤6 months old.Methods Clinical data of 44 infants with ureteropelvic junction obstruction(UPJO)and hydronephrosis treated by RALP from January 2021 to December 2023 were analyzed retrospectively.The average age was(72.3±49.7)d(range,5 d-6 months old),and the average weight was(5.7±1.6)kg(range,2.9-8.5 kg).Preoperative ultrasonography showed that the anteroposterior diameter was(30.2±9.5)mm and the thinnest part of the renal parenchyma was(2.6±1.2)mm.By using the da Vinci Xi robotic operating system,the narrow segment of the ureteropelvic junction was fully exposed,the renal pelvis and ureter were trimmed with scissors,and the ureter was anastomosed with 6-0 single strands.Results All the 44 operations were completed successfully without conversion to traditional laparoscopic or open surgery.No intraoperative complications occurred.The operation time was 105-245 min(mean,179.8 min),and the intraoperative blood loss was 2-10 ml(mean,4.9 ml).Re-examinations of ultrasonography at 6 months after removal of double J tube showed that the anteroposterior diameter was(10.5±6.3)mm,which was significantly decreased than that before operation(paired t test,t=19.985,P=0.000),and the thinnest part of the renal parenchyma was(6.8±1.7)mm,which was significantly increased than that before operation(paired t test,t=18.420,P=0.000).The patients were followed up for 6-12 months after removal of double J tube.There were no complications such as anastomotic stricture,urine leakage,or recurrence of obstruction.Conclusion RALP is safe and effective in the treatment of UPJO and hydronephrosis in infants younger than 6 months old.

Objective To explore application effect of modified three-port robotic-assisted single-port multi-channel laparoscopic surgery in radical operation for choledochal cysts in children.Methods From March 2022 to June 2024,20 children with congenital choledochal cysts in our department underwent modified three-port robotic-assisted radical resection of choledochal cysts combined with Roux-en-Y anastomosis of the hepatic duct and jejunum.A single-port multi-channel laparoscopic device was inserted through an umbilical incision,and 8 mm trocars were respectively inserted under the right and left costal margins for robotic arm operation.Before the robot docking,the jejunum-jejunum anastomosis was completed outside the body through the umbilical single-port device.After docking,operations of cyst resection and anastomosis and reconstruction of the hepatic duct and jejunum were completed under the robotic laparoscope.Results The operations of 20 children were successfully completed without conversion to open surgery or intraoperative blood transfusion.The operation time was(269.8±23.3)min,the robotic operation time was(123.8±11.1)min,and the intraoperative blood loss was(8.3±3.9)ml.The postoperative exhaust time was(30.8±9.8)h,the abdominal drainage tube was removed at 5-6 d after operation,and the postoperative hospital stay was 7-8 d.On the 7th day after surgery,10 out of 11 children with elevated preoperative liver function transaminase(ALT and AST)levels decreased to normal,while 4 out of 6 children with elevated preoperative bilirubin(TBIL,DBIL,and IBIL)levels returned to normal.Abdominal ultrasound showed no anastomotic stenosis,cholangitis,or other serious complications during follow-ups for 3-6 months in the 20 children.Conclusion The robotic-assisted single-port multi-channel laparoscopic surgery(modified three-port method)is safe and feasible for the treatment of choledochal cysts in children.

Objective:To explore the serum miRNA-144-5p (miR-144-5p) level in liver cancer patients and its relationship with clinical characteristics, as well as the target genes of miR-144-5p and the possible pathogenic mechanisms.Methods:The morning fasting serum samples were retrospectively collected from 100 newly diagnosed liver cancer patients (liver cancer group) before any treatment in Shanxi Province Cancer Hospital from June 2019 to June 2020, as well as 100 healthy individuals (healthy control group) during physical examinations in the same period. The real-time fluorescence quantitative polymerase chain reaction method was used to measure the transcription level expression of miR-144-5p in serum. The high and low expressions of miR-144-5p in patients were determined based on the median relative expression level of miR-144-5p; the distribution differences between patients with high and low expressions of miR-144-5p among different clinical pathological features were compared. The online tools miRDB, TargetScan 8.0 and miRWalk were used to predict potential target genes for miR-144-5p, and Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were performed through a bioinformatics platform, and complementary sequences between miR-144-5p and target genes were analyzed using RNA22 software.Results:The median age of the liver cancer group was 54 years old, ranging from 38 to 74 years old, including 80 males (80.0%) and 20 females (20.0%); the median age of the healthy control group was 46 years old, ranging from 34 to 66 years old, including 69 males (69.0%) and 31 females (31.0%); there was no statistically significant difference in age and gender composition between the two groups (both P > 0.05). The median transcription level relative expression of miR-144-5p in liver cancer patients was lower than that in the healthy control group [ M ( Q1, Q3)] [0.311 (0.066, 2.270) vs. 1.067 (0.263, 3.620)], and the difference was statistically significant ( Z = -4.16, P < 0.001). The proportion of patients with low expression of miR-144-5p was higher in the group with maximum diameter of tumor > 5 cm compared to the group with maximum diameter of tumor ≤5 cm [59.3% (35/59) vs. 36.6% (15/41)] and in the group with metastasis compared to the group without metastasis [60.4% (29/48) vs. 40.4% (21/52)], and the differences were statistically significant (both P < 0.05). There was no statistically significant difference in the distribution of patients with high and low expressions of miR-144-5p among different subgroups based on gender, age >55 years, presence of hepatitis, cirrhosis, alpha fetoprotein >400 μ g/L, and differentiation degree (all P > 0.05). According to predictions, there were 34 miR-144-5p target genes shared by the three bioinformatics online tools. GO and KEGG enrichment analyses showed that these target genes were associated with ubiquitination, primarily enriched in the ubiquitin-mediated proteolysis pathway (hsa04120) and the mTOR signaling pathway (hsa04150). RNA22 software analysis showed that miR-144-5p mainly had complementary sequences with 3' untranslated regions of UBR5 and UBE4A genes. Conclusions:The serum miR-144-5p level in liver cancer patients is relatively low, and its expression level may be related to tumor size and metastasis. miR-144-5p may affect the occurrence and development of liver cancer by regulating ubiquitination level through target genes such as UBR5 and UBE4A.