The combination of mobile communication technology and the medical field has given rise to telemedicine, whose clinical practice can greatly alleviate the problem of uneven distri-bution of regional medical resources and provide patients with instant and high-quality diagnostic and treatment services. The concept of telemedicine has also been applied in the field of surgery. With the rapid development of high-speed communication technology and robotic surgery systems, remote robotic surgery is gradually entering people′s vision. However, remote robotic surgery requires extremely high speed and stability in long-distance information exchange, and traditional communi-cation technologies are gradually unable to meet the development needs of remote robotic surgery. The fifth generation mobile communication technology, namely 5G network, is bringing significant changes to the development of remote healthcare, especially remote robotic surgery, due to its advantages such as high speed, high bandwidth, and low latency. The author has consulted relevant literature and combined with the team′s experience in conducting 5G remote robotic surgery, provi-ding a detailed introduction to the current application status and future prospects of 5G network based remote medical robotic surgery, aiming to promote the deep development and further promo-tion of this new technology.

Objective: To investigate the impact of temperature changes between neighboring days (TCN) on the mortality risk of respiratory diseases, so as to provide the evidence for the study of deaths from respiratory diseases caused by climate change. Methods: The monitoring data of deaths from respiratory diseases in Zibo City from 2015 to 2019 were collected from Shandong Provincial Management Information System for Chronic Diseases and Cause of Death Surveillance. The meteorological and air pollutant data of the same period were collected from China Meteorological Data Website and ChinaHighAirPollutants dataset. The effect of TCN on the risk of deaths from respiratory diseases was examined using a generalized additive model combined with a distributed lag non-linear model, and subgroup analyses for gender and age were conducted. The disease burden attributed to TCN at different intervals was assessed by calculating attributable fraction. Results: Totally 11 767 deaths from respiratory diseases were reported in Zibo City from 2015 to 2019, including 6 648 males (56.50%) and 5 119 females (43.50%). There were 1 307 deaths aged <65 years (11.11%), and 10 460 deaths aged 65 years and older (88.89%). A monotonically increasing exposure-response relationship was observed between TCN and deaths from respiratory diseases in the general population, females, and the population aged 65 years and older. The 95th percentile of TCN (P95, 3.84 ℃) reached the peak at a cumulative lagged of day 11 (RR=2.063, 95%CI: 1.261-3.376). The results of subgroup analyses showed greater impacts on females and the population aged 65 years and older, with cumulative lagged effects peaking at day 12 (RR=3.119, 95%CI: 1.476-6.589) and day 11 (RR=2.107, 95%CI: 1.260-3.523). The results of attributional risk analysis showed that next-day warming might increase the attributable risk of deaths from respiratory diseases, and next-day cooling might decrease the attributable risk. Conclusion Next-day warming may increase the mortality risk of respiratory diseases, and has greater impacts on females and the population aged 65 years and older.

Objective　To investigate the morphological changes of Cys C intervention on cerebral cortex AQP4,MMP-2 and BBB ultrastructure after cerebral ischemia reperfusion injury (CIRI) in rats and to explore its underlying mechanisms.Methods　One hundred male SD rats were randomly divided into sham group,IR group，Cys C low,medium and high concentration group.The rat middle cerebral artery embolism model was established by the modified Longa occlusion method.The water content of brain tissue was measured by dry and wet weight method,the content of EB in brain tissue was detected,and the degree of permeability change of the BBB was evaluated by focal ischemia for 2 h with middle cerebral artery occlusion and 24 h reperfusion.TEM was used to observe the ultrastructure changes of BBB.The opening of microvessels was observed under SEM;Western blot was used to detect AQP4 expression in cerebral cortex tissue.MMP-2 was detected expression by immune histochemistry.Results　Compared with IR group,the degree of BBB injury in Cys C low、medium groups was significantly reduced,and the number of capillaries opening increased.The expression of AQP4 protein was decreased,and the OD value of MMP-2 expression was also significantly decreased.In Cys C high group,the BBB was severely damaged.AQP4 protein expression was significantly increased,and the OD value of MMP-2 expression was also significantly increased.Conclusions　The application of Cys C intervention can reduce the damage of the BBB.It is mechanism may be relation to the decrease of AQP4 protein expression and the decrease of OD value of MMP-2 expression.

Objective:To retrospectively analyze the impact of adjuvant iodine-125( 125I)brachytherapy on postoperative recurrence and survival for patients with hepatocellular carcinoma (HCC) treated with partial hepatectomy with narrow resection margins. Methods:The data of 72 HCC patients who underwent partial hepatectomy with narrow resection margins from January 2011 to June 2015 at Weihai Municipal Hospital were analyzed retrospectively. The patients were divided into the adjuvant 125I brachytherapy group ( 125I group) ( n=36) and the control group ( n=36). The data of the two groups of patients were compared to study the factors influencing long-term survival outcomes and recurrence. Results:The follow-up time was (45.0±18.4) months. There were no deaths relating to 125I brachytherapy. The median recurrent free survival (RFS) was significantly longer in the 125I group than the control group (41.0 months vs 21.5 months, P<0.05). The 1-, 3- and 5-year RFS rates of the 125I group and the control group were 94.4%, 58.3%, 41.6% versus 86.1%, 33.3%, 25.0%, respectively ( P<0.05). The 1-, 3- and 5-year overall survival (OS) rates of the 125I group versus the control group were 97.2%, 69.4%, 52.8% versus 94.4%, 52.8%, 27.8%, respectively ( P<0.05). On multivariate analysis, 125I implantation was an independent factor affecting RFS and OS ( HR=2.112, 95% CI: 1.155-3.860, P<0.05; HR=2.492, 95% CI: 1.272-4.693, P<0.05). Conclusion:Adjuvant 125I brachytherapy was safe and effective for HCC patients with narrow resection margins after hepatectomy. It obviously reduced the tumor recurrence rate and prolonged the long-term RFS and OS.

Objective:To explore the correlation between occupational stress and the current working environment of clinical nurses.Methods:The cluster sampling method was used to select clinical nurses from First Affiliated Hospital of Xi'an Jiaotong University from March to September 2019 as the research objects. The research tools included nurses' general condition questionnaire, Occupational Stress Inventory Revised edition (OSI-R) and Profession Practice Environment (PPE) Scale. A total of 560 questionnaires were distributed and 540 valid questionnaires were recovered.Results:The Occupational Role Questionnaire (ORQ) score of 540 clinical nurses was (152.09±20.65) , the score of Personal Strain Questionnaire (PSQ) was (104.04±17.04) , the score of Personal Resources PPE Scale Questionnaire (PQR) was (125.84±19.75) and the total average score of PPE Scale was (3.00±0.28) . Pearson correlation analysis showed that the ORQ and PSQ scores of nurses were negatively correlated with the scores of the PPE Scale, and the PQR scores of nurses were positively correlated with the scores of PPE Scale ( P<0.05) . Conclusions:The overall performance of nurses is moderate occupational stress, the sense of occupational stress of nurses is negatively correlated with the working environment, and the coping resources of occupational stress are positively correlated with their professional working environment. Managers should take targeted measures to intervene to improve the professional working environment of nurses, reduce the level of occupational stress and guide nurses to improve their professional coping skills.

This article introduces the current status and controversy of laparoscopic technique in the treatment of gallbladder carcinoma. Combined with the characteristics of incidental gallbladder carcinoma, the feasibility of laparoscopic techniques for the treatment of early gallbladder carcinoma is analyzed.In the era of minimally invasive medical, laparoscopic techniques should play a more important role in the management of gallbladder cancer, but the long-term prognosis of laparoscopic radical surgery for gallbladder cancer needs strict prospective and high-volume clinical research to validate.

Objective To study the optimal timing of preoperative injection of indocyanine green in laparoscopic liver tumor resection under indocyanine green fluorescent navigation to obtain the most satisfactory fluorescence imaging effects.Methods 60 patients with liver tumors who underwent laparoscopic hepatectomy from April 2017 to October 2018 were retrospectively studied on the intraoperative fluorescence imaging effects.A simple grading of the fluorescence imaging effects was developed.The ICG R15 and preoperative injection times of ICG were correlated with the intraoperative fluorescence imaging effects.Results Of 60 patients with liver tumors,59 patients underwent laparoscopic liver resection and one patient was converted to open surgery.The overall satisfaction rate of intraoperative fluorescence imaging was 73.4％ (44/60).In the patients with an ICG R15 rate ≤ 7％,it was easier to obtain good fluorescence imagings when the preoperative administration time was longer than 48 hours.Even when the preoperative administration time was longer than 5 days,satisfactory fluorescence imaging effect could still be obtained in these patients.In the patients with an ICG R15 rate ＞ 7％,intraoperative fluorescence imagings were unsatisfactory when the administration time was less than 6 days.Relative better imagings were obtained in these patients when the preoperative administration time was more than 6 days.Conclusions When the pre-operative ICG injection dose was not changed,the preoperative administration time should be adjusted according to the value of the ICG R15 to obtain better intraoperative fluorescence imaging effects of the liver tumors.The optimal timing needs to be further studied by a large case study.

This article introduces the current status and controversy of laparoscopic technique in the treatment of gallbladder carcinoma. Combined with the characteristics of incidental gallbladder carcinoma, the feasibility of laparoscopic techniques for the treatment of early gallbladder carcinoma is analyzed.In the era of minimally invasive medical,laparoscopic techniques should play a more important role in the management of gallbladder cancer, but the long?term prognosis of laparoscopic radical surgery for gallbladder cancer needs strict prospective and high?volume clinical research to validate.

This article introduces the current status and controversy of laparoscopic technique in the treatment of gallbladder carcinoma. Combined with the characteristics of incidental gallbladder carcinoma, the feasibility of laparoscopic techniques for the treatment of early gallbladder carcinoma is analyzed.In the era of minimally invasive medical,laparoscopic techniques should play a more important role in the management of gallbladder cancer, but the long?term prognosis of laparoscopic radical surgery for gallbladder cancer needs strict prospective and high?volume clinical research to validate.

Objective: To explore the clinical application and effect of sideburns aesthetic reconstruction with local flaps. Methods: Between June 2012 and June 2017, there were 12 cases of patients with Benign tumor which is in the sideburn , including 7 Male patients, 5 female patients, thier ages are from 37 to 68 years old.The tumor size ranged from 0.5 cm×1.0 cm to 1.5 cm×2.5 cm, and the defects, size ranged from 1.0 cm× 1.2 cm to 1.5 cm× 3.0 cm. Single leaf flaps, double leaves flaps or local flaps which are on the ipsilateral sideburn or in the hairy area behind the ear are designed for sideburns reconstruction according to the size and shape of the defect, The flaps size ranged from 1.5 cm× 2.5 cm to 1.8 cm× 3.5 cm. Results: All flaps with 12 cases of patients survived completely with no flap blood supply obstacles, and the incision healed well, all patients were followed up for 6-24 months with no recurrence of the tumor , and the incision scars are hidden in the sideburns, And the sideburn showed satisfactory effect of aesthetic reconstruction with good symmetric cosmetic effect. Conclusions The local flaps have less injury in the surgery area , simple surgical approach, hidden incision scars, reliable blood supply and high survival rate, which do not affect the sideburns symmetry.Aesthetic result can be achieved by local flaps in the reconstruction of defect after resection of benign tumor at sideburn.