With the integration of 5G communication technology and robotic surgical systems, remote robot-assisted thoracic surgery is overcoming geographical barriers, offering an innovative approach to addressing the uneven distribution of medical resources. This study conducted a systematic literature review—using databases such as PubMed and CNKI, with the search period extending up to 2025—incorporating clinical studies, case reports, and review articles to comprehensively evaluate the clinical efficacy and safety of 5G-enabled remote robot-assisted thoracic surgery (5G-RRATS). The analysis also examined current technological limitations and potential future development trajectories. Existing evidence indicates that, given adequate technical support, 5G-RRATS can achieve perioperative outcomes comparable to those of conventional local robotic surgeries across procedures including pulmonary wedge resection, lobectomy, and esophagectomy. Furthermore, it demonstrates potential advantages in minimizing surgical incisions and reducing intraoperative blood loss. Nevertheless, challenges related to network stability, latency control, interdisciplinary collaboration between medical and engineering teams, and legal, regulatory, and ethical considerations continue to hinder widespread clinical adoption. Looking ahead, the emergence of a "one-to-many" remote surgical model, combined with the integration of artificial intelligence and augmented reality technologies, as well as advancements in low-orbit satellite communications, may enable 5G-RRATS to further advance precision and efficiency in thoracic surgery, thereby facilitating equitable access to high-quality care for a broader patient population.

ObjectiveTo investigate the expression of prefrontal cortical neurons， methyltransferase-like 3 （METTL3）， fat mass and obesity-associated gene （FTO）， and AlkB homolog 5 （ALKBH5） proteins in a mouse model of post-traumatic stress disorder （PTSD）. MethodsA PTSD mouse model was established using a single prolonged stress and foot shock stimulation （SPSS） method. The despair， anxiety， and learning and memory functions of PTSD mice were assessed through the open field test， Y-maze test， and forced swimming test. Neuronal damage was detected via HE and Nissl staining. The expression levels of METTL3， FTO， ALKBH5， and neuronal nuclear protein （NEUN） were assessed by Western blot and immunofluorescence staining. ResultsCompared to control group， PTSD mice subjected to SPSS exhibited signs of despair， anxiety， and impaired learning and memory. HE and Nissl staining results showed neuronal damage in the prefrontal cortex of PTSD mice. Western blot and immunofluorescence staining results showed that the expression of the m6A-related proteins METTL3 and FTO decreased， while the expression of ALKBH5 increased in the prefrontal cortex. Additionally， NEUN protein levels showed a declining trend. ConclusionThe pathogenesis of PTSD may be associated with neuronal damage in the prefrontal cortex and alterations in m6A methylation proteins.

Sanhuang Xiexintang （SHXXT）， originating from the Synopsis of the Golden Chamber （Jin Gui Yao Lue）， comprises three medicinal herbs： Rhei Radix et Rhizoma， Coptidis Rhizoma， and Scutellariae Radix. Renowned for its effects of purging fire， detoxifying， drying dampness， and draining heat， SHXXT primarily treats syndromes characterized by internal excess heat， dampness-heat stagnation， and reckless blood movement due to heat. Because of the concise formulation and remarkable efficacy of this formula， modern research has extensively explored the chemical composition， clinical applications， and pharmacological mechanisms of SHXXT， yielding significant advancements. As a modern derivative of SHXXT， Yiqing granules exemplify the transformation of classical formulas into convenient and precise applications， embodying the paradigm of modern development of classical formulas. This systematic review synthesizes recent research progress in SHXXT. Chemical analyses reveal that the active components—anthraquinones， alkaloids， and flavonoids—of SHXXT exert holistic therapeutic effects through multi-component synergy. Clinical studies demonstrate broad utility of this formula in managing digestive disorders， endocrine diseases， urinary tract infections， dermatological conditions， and systemic inflammatory diseases， highlighting its multi-system regulatory potential. Mechanism investigations elucidate its multi-target mechanism of action， including antimicrobial， anti-inflammatory， metabolic-regulatory， hepatoprotective， and gastrointestinal-modulating effects， reflecting an integrated multi-component， multi-target， multi-pathway mode of action. This review systematically summarizes the modern research progress in SHXXT， providing a theoretical foundation for deciphering the scientific essence of classical formulas and advancing their precision application in clinical practice.

ObjectiveTo investigate the therapeutic effect of paeoniflorin on metabolic dysfunction-associated fatty liver disease （MASLD） combined with insulin resistance （IR）， and to elucidate its regulatory mechanisms on the Toll-like receptor 4 （TLR4）/nuclear transcription factor （NF）-κB-insulin receptor substrate 1 （IRS1） inflammation-insulin signaling axis. MethodsMASLD mouse model was established using a 60% high-fat diet. Mice were randomly assigned to a normal control group， a MASLD model group， and paeoniflorin groups （low dose： 25 mg·kg^-1·d^-1， medium dose： 50 mg·kg^-1·d^-1， high dose： 100 mg·kg^-1·d^-1）， receiving intragastric administration for consecutive 12 weeks. Concurrently， a palmitic acid/oleic acid （PA/OA）-induced lipid deposition model was established in HepG2 cells. Cell counting kit-8 （CCK-8） assay was performed to determine the optimal concentrations of PA/OA and paeoniflorin for intervention. Mice body weight， liver index， and serum levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， triglycerides （TG）， and total cholesterol （TC） were measured. Fasting blood glucose （FBG） and fasting insulin （FINS） levels were measured， and the homeostatic model assessment of insulin resistance （HOMA-IR） was calculated， while an oral glucose tolerance test （OGTT） was performed to evaluate glucose metabolism. Hematoxylin and eosin （HE） staining was used to observe pathological changes and inflammatory cell infiltration in liver tissue， and oil red O staining was used to evaluate lipid droplet deposition in liver tissue and HepG2 cells. Potential targets were screened using network pharmacology and molecular docking. Western blot analysis was performed to detect the expression of HSP90AA1， TLR4， p-NF-κB p65， p-IRS1， and p-Akt proteins in liver tissue and HepG2 cells. ResultsCompared with the normal control group， mice in the MASLD model group exhibited significantly increased body weight， liver index， and serum levels of ALT， AST， TG， and TC， as well as markedly elevated FBG， FINS， and HOMA-IR， and impaired glucose tolerance （P<0.01）. HE staining revealed marked hepatic steatosis and inflammatory cell infiltration， while oil red O staining showed a significant increase in lipid droplet deposition. Compared with the MASLD model group， after intervention with various doses of paeoniflorin， the increase in body weight and liver index was reduced， serum ALT， AST， TG， and TC levels decreased， and FBG， FINS， and HOMA-IR were significantly lowered， with glucose tolerance markedly improved （P<0.05， P<0.01）， showing a certain dose-dependent trend. HE and oil red O staining results showed a marked reduction in hepatic steatosis and lipid deposition. In vitro experiments demonstrated that， compared with the control group， PA/OA treatment significantly induced increased lipid deposition in HepG2 cells. Compared with the model group， paeoniflorin intervention significantly reduced intracellular lipid droplets， and lipid deposition showed a dose-dependent decreasing trend. Mechanism studies indicated that， compared with the normal control group， the MASLD model group exhibited significantly elevated expression of TLR4， HSP90AA1， and p-NF-κB p65， while p-IRS1 （Ser307） expression was elevated and p-Akt （Ser473） expression was reduced （P<0.01）. Compared with the model group， the expression of the aforementioned proteins was significantly reversed in all treatment groups following intervention （P<0.05， P<0.01）. ConclusionPaeoniflorin significantly alleviates lipid deposition and insulin resistance in MASLD mice. Its mechanism of action may involve targeting HSP90AA1， TLR4， and NF-κB1 to regulate the TLR4/NF-κB-IRS1 inflammation-insulin signaling axis. This regulation suppresses inflammatory responses and restores insulin signaling， thereby ameliorating abnormalities in glucose and lipid metabolism.

ObjectiveTo investigate the therapeutic effect of paeoniflorin on metabolic dysfunction-associated fatty liver disease （MASLD） combined with insulin resistance （IR）， and to elucidate its regulatory mechanisms on the Toll-like receptor 4 （TLR4）/nuclear transcription factor （NF）-κB-insulin receptor substrate 1 （IRS1） inflammation-insulin signaling axis. MethodsMASLD mouse model was established using a 60% high-fat diet. Mice were randomly assigned to a normal control group， a MASLD model group， and paeoniflorin groups （low dose： 25 mg·kg^-1·d^-1， medium dose： 50 mg·kg^-1·d^-1， high dose： 100 mg·kg^-1·d^-1）， receiving intragastric administration for consecutive 12 weeks. Concurrently， a palmitic acid/oleic acid （PA/OA）-induced lipid deposition model was established in HepG2 cells. Cell counting kit-8 （CCK-8） assay was performed to determine the optimal concentrations of PA/OA and paeoniflorin for intervention. Mice body weight， liver index， and serum levels of alanine aminotransferase （ALT）， aspartate aminotransferase （AST）， triglycerides （TG）， and total cholesterol （TC） were measured. Fasting blood glucose （FBG） and fasting insulin （FINS） levels were measured， and the homeostatic model assessment of insulin resistance （HOMA-IR） was calculated， while an oral glucose tolerance test （OGTT） was performed to evaluate glucose metabolism. Hematoxylin and eosin （HE） staining was used to observe pathological changes and inflammatory cell infiltration in liver tissue， and oil red O staining was used to evaluate lipid droplet deposition in liver tissue and HepG2 cells. Potential targets were screened using network pharmacology and molecular docking. Western blot analysis was performed to detect the expression of HSP90AA1， TLR4， p-NF-κB p65， p-IRS1， and p-Akt proteins in liver tissue and HepG2 cells. ResultsCompared with the normal control group， mice in the MASLD model group exhibited significantly increased body weight， liver index， and serum levels of ALT， AST， TG， and TC， as well as markedly elevated FBG， FINS， and HOMA-IR， and impaired glucose tolerance （P<0.01）. HE staining revealed marked hepatic steatosis and inflammatory cell infiltration， while oil red O staining showed a significant increase in lipid droplet deposition. Compared with the MASLD model group， after intervention with various doses of paeoniflorin， the increase in body weight and liver index was reduced， serum ALT， AST， TG， and TC levels decreased， and FBG， FINS， and HOMA-IR were significantly lowered， with glucose tolerance markedly improved （P<0.05， P<0.01）， showing a certain dose-dependent trend. HE and oil red O staining results showed a marked reduction in hepatic steatosis and lipid deposition. In vitro experiments demonstrated that， compared with the control group， PA/OA treatment significantly induced increased lipid deposition in HepG2 cells. Compared with the model group， paeoniflorin intervention significantly reduced intracellular lipid droplets， and lipid deposition showed a dose-dependent decreasing trend. Mechanism studies indicated that， compared with the normal control group， the MASLD model group exhibited significantly elevated expression of TLR4， HSP90AA1， and p-NF-κB p65， while p-IRS1 （Ser307） expression was elevated and p-Akt （Ser473） expression was reduced （P<0.01）. Compared with the model group， the expression of the aforementioned proteins was significantly reversed in all treatment groups following intervention （P<0.05， P<0.01）. ConclusionPaeoniflorin significantly alleviates lipid deposition and insulin resistance in MASLD mice. Its mechanism of action may involve targeting HSP90AA1， TLR4， and NF-κB1 to regulate the TLR4/NF-κB-IRS1 inflammation-insulin signaling axis. This regulation suppresses inflammatory responses and restores insulin signaling， thereby ameliorating abnormalities in glucose and lipid metabolism.

ObjectiveTo investigate the prevalence of coronary microvascular dysfunction （CMD） during the perioperative period of elective percutaneous coronary intervention （PCI） and the incidence of deterioration in coronary microvascular function using angiography-derived microcirculatory resistance （AMR）， and to explore the influencing factors associated with PCI-related coronary microvascular injury. MethodsPatients who underwent elective PCI on the left anterior descending coronary artery at Beijing Hospital of Traditional Chinese Medicine， Capital Medical University， from January 1， 2021 to December 31， 2024 were retrospectively enrolled. AMR values of the target vessel before and after PCI were calculated to evaluate the prevalence of postoperative CMD and the incidence of microvascular functional deterioration. Multivariate analysis was performed to explore the influencing factors associated with coronary microvascular injury during the periprocedural period of PCI. ResultsA total of 204 patients were finally included. Postoperative AMR of the target vessel were significantly higher than preoperative values （P＜0.001）. The prevalence of CMD was 31.86% （65/204）， and the incidence of microvascular functional deterioration was 69.61% （142/204）. In-stent restenosis （P = 0.004） and post-balloon dilation （P = 0.002） were risk factors for CMD. Traditional Chinese medicine （TCM） syndrome elements phlegm-turbidity （P = 0.004） and blood stasis （P = 0.013）， a higher diameter stenosis rate of the target lesion （P = 0.006）， larger stent/balloon diameter （P = 0.009）， and a greater number of balloon inflations （P = 0.029） were risk factors for microvascular functional deterioration. Preoperative use of Chinese herbal decoctions with actions of resolving phlegm and activating blood （P = 0.014） was a protective factor against microvascular functional deterioration， while intraoperative use of Kuanxiong Aerosol （宽胸气雾剂） was a protective factor against both CMD （P = 0.007） and microvascular functional deterioration （P = 0.030）. ConclusionCMD and microvascular functional deterioration are relatively common during the perio-perative period of elective PCI. Target lesion characteristics， PCI procedural features， and the TCM syndrome elements of phlegm-turbidity and blood stasis are associated with an increased risk of coronary microvascular injury during the perioperative period， whereas TCM treatment may reduce this risk.

Objective To investigate the correlation between apathy and imaging markers in pa-tients with aCSVD.Methods A total of 143 patients diagnosed with aCSVD and hospitalized in the Department of Neurology of the First Affiliated Hospital of Baotou Medical College,Inner Mongolia University of Science and Technology from August 2023 to August 2024 were continu-ously included as the study objects.According to MAES,they were divided into an apathetic group(MAES score＞14,68 cases)and a non-apathetic group(MAES score ≤14,75 cases).The clinical data and imaging markers were compared between the two groups.Results The apathetic group had significantly older age and larger ratio of hypertension,but shorter years of education and lower MAES score than the non-apathetic group(P＜0.05,P＜0.01).The apathetic group also had notably higher Fazekas score of white matter hyperintensity(WMH),larger recent small sub-cortical infarct(RSSI),lacunar infarct(LI),and perivascular space(PVS)in the basal ganglia and the centrum semiovale,more obvious cerebral atrophy and cerebral microbleed(CMB),and high-er total imaging burden score when compared with the non-apathetic group(P＜0.01).In the aCSVD patients,the MAES score was positively correlated with WMH Fazekas score,RSSI,LI,basal ganglia PVS,centrum semiovale PVS,cerebral atrophy,CMB,and total imaging burden score(P＜0.01).WMH Fazekas score was an independent risk factor for apathy in the aCSVD patients(OR=2.218,95％CI:1.343-3.664,P=0.002).Conclusion The higher the score of ima-ging markers in patients with aCSVD,the more severe the apathy.

In liver tumor surgery, owing to the characteristics such as the abundant blood supply of the liver and the abnormal hyperplasia of tumor blood vessels, the risk of intraoperative hemorrhage is significantly elevated. Frequently, it is necessary to rely on allogeneic blood transfusion to maintain hemodynamic stability. It is well established that allogeneic blood transfusion poses risks such as immunosuppression and transmission of infectious agents, which may compromise postoperative recovery and long-term patient outcomes. Intraoperative autologous blood transfusion (IOABT) serves as a crucial strategy for blood conservation. The use of allogeneic blood can be effectively reduced by recovering, washing, and centrifuging blood from the patient's surgical field before transfusion to the patient. This article provides an overview of the application and research advancements in IOABT technology within the context of liver tumor surgery. It outlines the evolution of blood salvage techniques, core operational principles, and strategies to mitigate tumor cell dissemination, including the use of leukocyte filters and irradiation. Furthermore, it examines the clinical efficacy and safety of IOABT in both liver resection and liver transplantation, with particular attention to the potential risk of tumor cell reinfusion. Current evidence does not indicate an increased risk of tumor recurrence associated with this technique. Looking ahead, the integration of emerging technologies such as artificial intelligence, nanobiotechnology, and immunotherapy holds promise for further enhancing IOABT, ultimately enabling safer and more precise perioperative blood management strategies for patients undergoing liver tumor surgery.

Objective:To analyze the genetic characteristics of hemagglutinin（HA）and neuraminidase（NA）of influenza A（H1N1）pdm09 viruses in Kunming during the 2022-2023 influenza season.Methods:A total of 15 strains of A（H1N1）pdm09 influenza virus isolated from sentinel hospital surveillance and from outbreaks from April 2022 to March 2023 in Kunming were chosen for sequencing. The genetic analysis，which included sequence alignment，homology analysis，construction of phylogenetic tree and amino-acid mutations analysis，was carried out using MAFFT version 7，MegAlign and MEGA 11.Results:Fourteen strains isolated during the 2022-2023 influenza season in Kunming belong to clade 6B.1A.5a.2a，and A/Kunming/284/2023 belonged to clade 6B.1A.5a.2a.1. They all diverged from the northern hemisphere vaccine strain A/Wisconsin/588/2019 in clade 6B.1A.5a.2 recommended by WHO during the 2022-2023 influenza season. Comparing with the HA of the vaccine strain：A186T and Q189E，which might cause the reduction of vaccine protection，were identified in Sb of 14 strains；P137S，K142R in Ca and A186T，Q189E in Sb were identified in A/Kunming/284/2023 and two strains isolated from Thailand. The four mutations at tow antigenic sites identified immune escape at the molecular level. Q189E in the 190-helix and E224A in the 220-loop，which might change the pathogenicity of A（H1N1）pdm09 viruses，were identified in 15 strains. Comparing with NA of the vaccine strain：S200N in 14 strains and S339L in 1 strain were identified in antigenic sites. The two mutations might reduce the protection of antibodies induced by NA.Conclusion:Strengthening influenza surveillance and timely detecting new variants in Kunming contributes to preventing the importation of foreign strains and issuing early warnings for influenza outbreaks.

Objective:Through anatomical observations, anatomical data on the radial perforating vessels around the neck of first metacarpus were observed and classified, hence to provide an anatomical evidence for clinical application of the flap based on the perforating vessels.Methods:From July 2022 to June 2023, 15 fresh adult upper limb specimens were studied at the Department of Hand Surgery, Northwest University First Hospital. All perforators within the zone for flap design around the neck of radial first metacarpus were observed. The number, origin and outer calibre of the perforators were recorded. Perforators with an outer diameter greater than 0.13 mm were defined as dominant arteries. SPSS 20.0 statistical software was used to count the number and outer diameter of cutaneous branches originating from the radial artery of the first metacarpal bone, the radial palmar proper artery of thumb and other arteries. The results were expressed as mean ± standard deviation ( ± s), with P<0.05 indicating statistical significance. From July 2023 to May 2024, 14 patients (10 males, 4 females and aged 27-53 years) with digital soft tissue defects were treated. The defects were of 3 thumbs, 4 index fingers, 5 middle fingers, 1 ring finger and 1 little finger, and sized from 2.5 cm × 2.0 cm to 4.0 cm × 2.5 cm. The perforator flaps of the neck of radial first metacarpus (3.0 cm × 2.5 cm - 4.5 cm × 3.0 cm) were harvested and donor sites were closed directly in the emergency surgery. Follow-up through the visits of outpatient clinic and via telephone and WeChat interviews to assess the flap survival, digital function and aesthetics of the flap. Results:In the specimens, it was found that about 75% of dominant perforators were originated from the first metacarpal radial artery. There were statistical significance in the number and outer calibre of the perforators between the first metacarpal radial artery, radial proper palmar digital artery of thumb and other arteries ( P<0.05). Postoperative follow-up lasted for 5-12 (mean 10.1) months, all flaps survived after surgery. Sensation regained according to the British Medical Research Council (BMRC), and they were: S 2 in 6 flaps and S 3 in 8 flaps. According to Evaluation Trial Standards of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association, 11 digits were excellent and 3 in good. Scar evaluation scored 3-4 (mean 3.43) points according to the Vancouver Scar Scale (VSS). Conclusion:The perforator flap around the neck of first radial metacarpus is primarily supplied by the radial artery of the first metacarpus. This flap achieves satisfactory functional and aesthetic outcomes with good sensory recovery, therefore it is an ideal flap for reconstruction of digital soft tissue defect.