Colorectal cancer (CRC) ranks among the most prevalent malignant tumors globally and poses a severe threat to human health. Surgical resection remains the cornerstone of CRC treatment. With the rapid advancement of minimally invasive techniques, the Da Vinci surgical robot has been increasingly adopted in CRC management. This article will systematically review the current application of the Da Vinci robotic system in minimally invasive CRC treatment, analyzes its advantages and limitations, and discusses future prospects, aiming to provide references for clinical practice and further research.

OBJECTIVE: Recent studies have overturned the traditional concept of the lung as a "sterile organ" revealing that pulmonary microbiota dysbiosis and abnormal surfactant proteins (SPs) expression are involved in the progression of silicosis. This study aimed to investigate the relationship between abnormal SPs expression and dysbiosis of lung microbiota in silica-induced lung fibrosis, providing insights into mechanisms of silicosis. METHODS: Lung pathology, SPs expression, and microbiota composition were evaluated in silica-exposed mice. A mouse model of antibiotic-induced microbiota depletion was established, and alveolar structure and SPs expression were assessed. The roles of the lung microbiota and SPs in silicosis progression were further evaluated in mice with antibiotic-induced microbiota depletion, both with and without silica exposure. RESULTS: Silica exposure induced lung inflammation and fibrosis, along with increased expression of SP-A expression. Antibiotics (Abx)-induced microbiota depletion elevated SP-A and SP-D expression. Furthermore, silica exposure altered lung microbiota composition, enriching potentially pathogenic taxa. However, antibiotic-induced microbiota depletion prior to silica exposure reduced silica-mediated lung fibrosis and inflammation. CONCLUSION Lung microbiota is associated with silica-induced lung injury. Overproduction of SP-A and SP-D, induced by Abx-induced microbiota depletion, may enhance the resistance of mouse lung tissue to silica-induced injury.
Animals ; Silicosis/prevention & control* ; Lung/metabolism* ; Mice ; Anti-Bacterial Agents/pharmacology* ; Microbiota/drug effects* ; Silicon Dioxide/toxicity* ; Mice, Inbred C57BL ; Male ; Pulmonary Surfactant-Associated Proteins/genetics*

OBJECTIVE: To explore the application effect of self-developed anatomical main nail insertion guide in proximal femoral nail antirotation (PFNA) internal fixation for the treatment of intertrochanteric fractures (IFF) in elderly patients. METHODS: A retrospective analysis was performed on 62 patients with AO31-A2 intertrochanteric fractures who underwent PFNA surgery and met the inclusion criteria from January 2022 to December 2024. They were divided into the conventional PFNA insertion group (conventional operation group) and the anatomical main nail insertion guide-assisted PFNA insertion group(guide group). The conventional operation group (PFNA) included 31 patients, 14 males and 17 females, the age ranged from 64 to 90 with an average of (75.2±11.6) years old;the guide group (PFNA) included 31 patients, 10 males and 21 females, the age ranged fron 67 to 97 with an average of (78.6±13.4) years old. The incision length of the main nail entry, the number of fluoroscopies from satisfactory reduction to before main nail insertion, operation time, intraoperative blood loss, 3-day postoperative VAS score, postoperative hip function Harris score, complications, etc. were observed and compared between the two groups. RESULTS: All patients were followed up for a period ranging from 4 to 12 months, with an average follow-up duration of (6.8±1.6) months. Compared with the guide group, the conventional operation group showed significant differences in the following parameters:the entrance length of the main screw was (6.74±3.77) cm vs. (5.13±1.31) cm, the number of fluoroscopies before the insertion of the main screw was (10.32±3.08) times vs. (7.71±2.41) times, the operation time was (150.45±53.47) minutes vs. (127.48±30.37) minutes, and the intraoperative blood loss was (196.77±121.06) ml vs. (140.97±86.00) ml, with P<0.05 indicating statistical significance.There was no statistically significant difference in 3-day postoperative VAS between the two groups (P>0.05). There was a statistically significant difference in the Harris scores between the conventional operation group and the guided operation group one month post-surgery (60.61±6.60) vs. (65.48±5.19) points (P<0.05). and there was no statistically significant difference in hip Harris scores between the two groups at 3 months after operation (P>0.05). During the 3-month follow-up after operation, neither group had incision infection, screw loosening, cutting, pressure sores, deep vein thrombosis, etc., and there was no statistically significant difference in the complication rate between the two groups. CONCLUSION It is quickly and accurately to implant PFNA assisted by the anatomical major nail implant guide in treatment of osteoporotic intertrochanteric fracture in the elderly.Compared with the traditional operation, it can shorten the operation time and reduce the surgical and X-ray trauma, and beneficial to the rapid rehabilitation of patients.
Humans ; Male ; Female ; Aged ; Hip Fractures/surgery* ; Bone Nails ; Retrospective Studies ; Aged, 80 and over ; Middle Aged ; Fracture Fixation, Intramedullary/instrumentation* ; Fracture Fixation, Internal/instrumentation*

Azvudine and nirmatrelvir/ritonavir (Paxlovid) are recommended for COVID-19 treatment in China, but their safety and efficacy in the elderly population are not fully known. In this multicenter, retrospective, cohort study, we identified 5131 elderly hospitalized COVID-19 patients from 32,864 COVID-19 patients admitted to nine hospitals in Henan Province, China, from December 5, 2022, to January 31, 2023. The primary outcome was all-cause death, and the secondary outcome was composite disease progression. Propensity score matching (PSM) was performed to control for confounding factors, including demographics, vaccination status, comorbidities, and laboratory tests. After 2:1 PSM, 1786 elderly patients receiving azvudine and 893 elderly patients receiving Paxlovid were included. Kaplan-Meier and Cox regression analyses revealed that compared with Paxlovid group, azvudine could significantly reduce the risk of all-cause death (log-rank P = 0.002; HR: 0.71, 95% CI: 0.573-0.883, P = 0.002), but there was no difference in composite disease progression (log-rank P = 0.52; HR: 1.05, 95% CI: 0.877-1.260, P = 0.588). Four sensitivity analyses verified the robustness of above results. Subgroup analysis suggested that a greater benefit of azvudine over Paxlovid was observed in elderly patients with primary malignant tumors (P for interaction = 0.005, HR: 0.32, 95% CI: 0.18-0.57) compared to patients without primary malignant tumors. Safety analysis revealed that azvudine treatment had a lower incidence of adverse events and higher lymphocyte levels than Paxlovid treatment. In conclusion, azvudine treatment is not inferior to Paxlovid treatment in terms of all-cause death, composite disease progression and adverse events in elderly hospitalized COVID-19 patients.

Eightly-four novel thioheterocyclic nucleoside derivatives were designed, synthesized, and evaluated for antitumor activity in vitro and in vivo. Most of the compounds inhibited the growth of HCT116 and HeLa cancer cells in vitro, among them 33a and 36b exhibited potent activity against HCT116 cells (IC₅₀ = 0.27 and 0.49 μmol/L, respectively). Both compounds 33a and 36b inhibited cell metastasis, arrested the cell cycle in the G₂/M phase, and induced apoptosis in vitro. Mechanistic studies revealed that 33a and 36b increased ROS levels, led to DNA damage, ER stress, and mitochondrial dysfunction, and inhibited autophagy in HCT116 cells. Biological information analysis, RNA-sequencing, Gene Set Enrichment Analysis (GSEA), drug affinity responsive target stability (DARTS) assay, cellular thermal shift assay (CETSA), and SPR experiments identified that compounds 33a and 36b showed antitumor activity by suppressing the c-MYC pathway. c-MYC silencing assays indicated that c-MYC proteins participated in 33a-mediated anticancer activities in HCT116 cells. More importantly, compound 33a presented favorable pharmacokinetic properties in mice (T _1/2 = 6.8 h) and showed significant antitumor efficacy in vivo without obvious toxicity, showing promising potential for further clinical development.

OBJECTIVE: To assess the association of single nucleotide polymorphisms of rs700519 and rs4646 loci of cytochrome P450 19A1 (CYP19A1) gene with risk of Breast cancer. METHODS: Two hundred patients with breast cancer treated at Xinxiang Central Hospital between January 2019 and January 2024 and 100 healthy individuals were enrolled as the study group and control group, respectively. The genotypes of the CYP19A1 gene at the rs700519 and rs4646 loci were determined by direct sequencing. The general data, distribution of CYP19A1 genotypes and alleles were compared between the two groups. This study has been approved by the Medical Ethics Committee of Xinxiang Central Hospital (Ethics No. 2021-182). RESULTS: No significant difference was found in age, body mass index, times of conception and proportion of menopause between the two groups (P > 0.05). The frequencies of AA genotype and A allele at the rs700519 locus, and the CC genotype and C allele at the rs4646 locus in the study group were significantly higher than those of the control group (P < 0.05). The frequencies of AA genotype at the rs700519 locus and CC genotype at the rs4646 locus in patients with breast cancer at stages III-IV were significantly higher than those at stage I-II (P < 0.05). CONCLUSION Polymorphisms of CYP19A1 gene at the rs700519 and rs4646 loci are associated with susceptibility of breast cancer. The AA and CC genotypes at the two loci may increase the risk for breast cancer.
Humans ; Female ; Breast Neoplasms/genetics* ; Aromatase/genetics* ; Polymorphism, Single Nucleotide/genetics* ; Middle Aged ; Genetic Predisposition to Disease ; Adult ; Genotype ; Case-Control Studies ; Alleles ; Gene Frequency ; Risk Factors ; Aged

Obesity is a worldwide health problem. An imbalance in energy metabolism is an important cause of obesity and related metabolic diseases. Our previous studies showed that inhibition of miR-429 increased the protein level of uncoupling protein 1 (UCP1) in beige adipocytes; however, whether local inhibition of miR-429 in subcutaneous adipose tissue affects diet-induced obesity and related metabolic disorders remains unclear. The aim of this study was to investigate the effect of local overexpression of miR-429 sponge in subcutaneous adipose tissue on obesity and related metabolic disorders. The control adeno-associated virus (AAV) or AAV expressing the miR-429 sponge was injected into mouse inguinal white adipose tissue. Seven days later, the mice were fed a high-fat diet for 10 weeks to induce obesity. The effects of the miR-429 sponge on body weight, adipose tissue weight, plasma glucose and lipid levels, and hepatic lipid content were explored. The results showed that the overexpression of miR-429 sponge in subcutaneous white adipose tissue reduced body weight and fat mass, decreased fasting blood glucose and plasma cholesterol levels, improved glucose tolerance, and alleviated hepatic lipid deposition in mice. Mechanistic investigation showed that the inhibition of miR-429 significantly upregulated the expression of UCP1 in adipocytes and adipose tissue. These results suggest that local inhibition of miR-429 in subcutaneous white adipose tissue ameliorates obesity and related metabolic disorders potentially by upregulating UCP1, and miR-429 is a potential therapeutic target for the treatment of obesity and related metabolic disorders.
Animals ; MicroRNAs/physiology* ; Obesity/metabolism* ; Mice ; Adipose Tissue, White/metabolism* ; Metabolic Diseases ; Subcutaneous Fat/metabolism* ; Male ; Uncoupling Protein 1/metabolism* ; Diet, High-Fat ; Mice, Inbred C57BL

Objective:To analyze the impact of lung-protective ventilation strategy on postoperative pulmonary function and prognosis in abdominal surgery patients with a history of coronavirus disease 2019 (COVID-19) infection.Methods:A total of 80 patients with a history of COVID-19 who underwent emergency or elective abdominal surgery at the Central Hospital of Yongzhou from December 2023 to April 2025 were selected. They were divided into the lung-protective group ( n=40) and the traditional ventilation group ( n=40) using a random number table method. The lung-protective group was set with a tidal volume (VT) of 6 ml/kg, positive end-expiratory pressure (PEEP) of 5 cmH 2O, and lung recruitment was performed every 30 minutes; the traditional ventilation group was only set with a VT of 8-10 ml/kg. Blood gas analysis indicators [partial pressure of arterial carbon dioxide (PaCO 2) and partial pressure of arterial oxygen (PaO 2)] and pulmonary function indicators [forced expiratory volume in one second (FEV 1), forced vital capacity (FVC), and FEV 1/FVC] were compared between the two groups before surgery and 3 days after surgery. The modified clinical pulmonary infection score (MCPIS) was calculated, and the incidence of postoperative complications was statistically analyzed in both groups. Results:There were no statistically significant differences in blood gas analysis and pulmonary function indicators between the two groups before surgery (all P>0.05). Compared with preoperatively, PaCO 2 decreased and PaO 2 increased in both groups 3 days after surgery (all P<0.05); 3 days after surgery, PaCO 2 in the lung-protective group was lower than that in the traditional ventilation group, and PaO 2 was higher than that in the traditional ventilation group (all P<0.05). Compared with preoperatively, FEV 1 and FVC decreased, and FEV 1/FVC increased in both groups 3 days after surgery (all P<0.05); 3 days after surgery, FEV 1, FVC, and FEV 1/FVC in the lung-protective group were all higher than those in the traditional ventilation group (all P<0.05). The MCPIS of the lung-protective group 3 days after surgery was lower than that of the traditional ventilation group, with a statistically significant difference [(2.75±0.45) vs (4.23±0.68), t=11.479, P<0.05]. There was no statistically significant difference in the total incidence of complications between the lung-protective group and the traditional ventilation group ( P>0.05). Conclusions:Lung-protective ventilation strategy can improve postoperative blood gas analysis indicators and pulmonary function in abdominal surgery patients with a history of COVID-19, thereby improving prognosis, with good safety.

Objective:To investigate the status of lymph node metastasis in transverse colon cancer and its association with clinicopathological characteristics and prognosis.Methods:A retrospective cohort study was performed. Clinical data from patients with transverse colon cancer at stages T1-4, N0-2, M0 who were consecutively admitted in the Department of Colorectal Surgery, Fudan University Shanghai Cancer Center from 2010 to 2022 were retrospectively analyzed. Patients were excluded if they had a history of prior tumors, developed a second or subsequent primary malignancy during the follow-up after the current primary transverse colon cancer, or underwent emergency surgery due to complications such as gastrointestinal bleeding or obstruction. The observation indicators included: (1) lymph node metastasis status and its impact on prognosis; (2) lymph node dissection status and the impact of dissection of <12 lymph nodes on prognosis; (3) factors influencing the dissection of <12 lymph nodes. Postoperative follow-up was performed to evaluate tumor recurrence, metastasis, and survival, with a follow-up cutoff date of March, 2025. Chi-squared tests, one-way ANOVA, multivariate logistic regression, the Kaplan-Meier method, and log-rank tests were used to analyze the relevant factors of lymph node dissection and its impact on patient prognosis. Postoperative follow-up was conducted via outpatient visits and telephone interviews to assess tumor recurrence, metastasis, and survival.Results:A total of 336 transverse colon cancer patients were included, including 219 males and 117 females, with a median age of 60 years (range: 24-84 years). There were 212, 83, and 41 patients with stage N0, N1, and N2, respectively. The median number of metastatic lymph nodes in the entire cohort was 0 (range: 0-18), with an overall lymph node metastasis rate of 36.9% (124/336). The metastasis rates of the 1st, 2nd, and 3rd station lymph nodes were 30.4% (102 cases), 19.6% (66 cases), and 2.4% (8 cases), respectively. Within the T1, T2, T3, and T4 stage groups, the 1st, 2nd, and 3rd station lymph node metastasis rates were 3.1% (1/32), 0, and 0 in T1; 14.6% (6/41), 2.4% (1/41), and 0 in T2; 31.6% (54/171), 23.4% (40/171), and 2.3% (4/171) in T3; and 44.6% (41/92), 27.2% (25/92), and 4.3% (4/92) in T4, respectively. There was a statistically significant difference in the total lymph node metastasis rates among different T stages (χ2=36.816, P<0.001). Additionally, statistically significant differences were also observed in the metastasis rates of lymph nodes at Station 1 and Station 2 among different stages (χ2=24.924, P<0.001; χ2=20.338, P<0.001). However, no statistically significant difference was found in the metastasis rate of lymph nodes at station 3 (χ2=3.313, P=0.346). Skip metastasis was observed in 23 patients (6.8%), including 14 cases in T3 stage and 9 cases in T4 stage, with no skip metastasis found in T1 or T2 stages. The median follow-up time was 39 months (95%CI: 36-42). 1-, 3-, and 5-year overall survival (OS) rates were 96.6%, 87.8%, and 85.8%, respectively, and disease-free survival (DFS) rates were 94.7%, 82.6%, and 74.7%, respectively. The 5-year DFS rates in N0, N1, and N2 stages were 85.4%, 66.1%, and 41.3%, respectively (χ2=67.408, P<0.001). Patients with station 1 lymph node metastasis had a significantly lower 5-year DFS than those without metastasis (56.8% vs. 83.0%, χ2=32.348, P<0.001). Similarly, patients with station 2 lymph node metastasis had a significantly lower 5-year DFS than those without (50.2% vs. 81.0%, χ2=28.313, P<0.001). However, no significant difference in 5-year DFS was found between patients with station 3 lymph node metastasis and those without (51.4% vs. 75.1%, χ2=2.759, P=0.097). There was also no significant difference in 5-year DFS between patients with and without skip metastasis (65.0% vs. 75.5%,χ2=0.879, P=0.349). The median number of dissected lymph nodes in the entire cohort was 16 (range: 3-52). Using 12 lymph nodes as the cutoff, 286 patients (85.1%) had ≥12 lymph nodes dissected, and 50 patients (14.9%) had <12. The 5-year DFS in the <12 lymph nodes group was lower than that in the ≥12 group (62.1% vs. 76.6%), but the difference was not statistically significant (χ2=2.863, P=0.091). Univariate analysis showed that age, tumor length, high-moderate differentiation, and T stage were influencing factors for dissecting <12 lymph nodes (all P<0.1). Going further, multivariate logistic regression analysis revealed that age ≥50 years (OR=2.564, 95%CI: 1.085-6.054, P=0.032), high-moderate tumor differentiation (OR=2.582, 95% CI: 1.265-5.271, P=0.009), and T1-2 stage (OR=2.520, 95%CI: 1.177-5.396, P=0.017) were independent risk factors for dissecting <12 lymph nodes (all P<0.05). Conclusions:Lymph node metastasis in transverse colon cancer mainly occurs at the 1st and 2nd stations. Skip metastasis may occur in T3-T4 stages. For T1-2 stage transverse colon cancer, D2 radical resection can be performed, but for cancers in T3 to T4, D3 radical operation should be carried out.