BACKGROUND: Telesurgery has the potential to overcome spatial limitations for surgeons, which depends on surgical robot and the quality of network communication. However, the influence of network latency and bandwidth on telesurgery is not well understood. METHODS: A telesurgery system capable of dynamically adjusting image compression ratios in response to bandwidth changes was established between Beijing and Sanya (Hainan province), covering a distance of 3000 km. In total, 108 animal operations, including 12 surgical procedures, were performed. Total latency ranging from 170 ms to 320 ms and bandwidth from 15-20 Mbps to less than 1 Mbps were explored using designed surgical tasks and hemostasis models for renal vein and internal iliac artery rupture bleeding. Network latency, jitter, frame loss, and bit rate code were systemically measured during these operations. National Aeronautics and Space Administration Task Load Index (NASA-TLX) and a self-designed scale measured the workload and subjective perception of surgeons. RESULTS: All 108 animal telesurgeries, conducted from January 2023 to June 2023, were performed effectively over a total duration of 3866 min. The operations were completed with latency up to 320 ms and bandwidths as low as 1-5 Mbps. Hemostasis for vein and artery rupture bleeding models was effectively achieved under these low bandwidth conditions. The NASA-TLX results indicated that latency significantly impacted surgical performance more than bandwidth and image clarity reductions. CONCLUSIONS This telesurgery system demonstrated safety and reliability. A total of 320 ms latency is acceptable for telesurgery operations. Reducing image clarity can effectively mitigate the potential latency increase caused by decreased bandwidth, offering a new method to reduce the impact of latency on telesurgery.
Animals ; Robotic Surgical Procedures/methods* ; Laparoscopy/methods*

Acute kidney injury (AKI) has high morbidity and mortality, but effective clinical drugs and management are lacking. Previous studies have suggested that macrophages play a crucial role in the inflammatory response to AKI and may serve as potential therapeutic targets. Emerging evidence has highlighted the importance of forkhead box protein O1 (FoxO1) in mediating macrophage activation and polarization in various diseases, but the specific mechanisms by which FoxO1 regulates macrophages during AKI remain unclear. The present study aimed to investigate the role of FoxO1 in macrophages in the pathogenesis of AKI. We observed a significant upregulation of FoxO1 in kidney macrophages following ischemia-reperfusion (I/R) injury. Additionally, our findings demonstrated that the administration of FoxO1 inhibitor AS1842856-encapsulated liposome (AS-Lipo), mainly acting on macrophages, effectively mitigated renal injury induced by I/R injury in mice. By generating myeloid-specific FoxO1-knockout mice, we further observed that the deficiency of FoxO1 in myeloid cells protected against I/R injury-induced AKI. Furthermore, our study provided evidence of FoxO1's pivotal role in macrophage chemotaxis, inflammation, and migration. Moreover, the impact of FoxO1 on the regulation of macrophage migration was mediated through RhoA guanine nucleotide exchange factor 1 (ARHGEF1), indicating that ARHGEF1 may serve as a potential intermediary between FoxO1 and the activity of the RhoA pathway. Consequently, our findings propose that FoxO1 plays a crucial role as a mediator and biomarker in the context of AKI. Targeting macrophage FoxO1 pharmacologically could potentially offer a promising therapeutic approach for AKI.

The prevalence of Class III malocclusion varies among different countries and regions. The populations from Southeast Asian countries (Chinese and Malaysian) showed the highest prevalence rate of 15.8%, which can seriously affect oral function, facial appearance, and mental health. As anterior crossbite tends to worsen with growth, early orthodontic treatment can harness growth potential to normalize maxillofacial development or reduce skeletal malformation severity, thereby reducing the difficulty and shortening the treatment cycle of later-stage treatment. This is beneficial for the physical and mental growth of children. Therefore, early orthodontic treatment for Class III malocclusion is particularly important. Determining the optimal timing for early orthodontic treatment requires a comprehensive assessment of clinical manifestations, dental age, and skeletal age, and can lead to better results with less effort. Currently, standardized treatment guidelines for early orthodontic treatment of Class III malocclusion are lacking. This review provides a comprehensive summary of the etiology, clinical manifestations, classification, and early orthodontic techniques for Class III malocclusion, along with systematic discussions on selecting early treatment plans. The purpose of this expert consensus is to standardize clinical practices and improve the treatment outcomes of Class III malocclusion through early orthodontic treatment.
Humans ; Malocclusion, Angle Class III/classification* ; Orthodontics, Corrective/methods* ; Consensus ; Child

Osteoporosis is a prevalent skeletal condition characterized by reduced bone mass and strength, leading to increased fragility. Buqi-Tongluo (BQTL) decoction, a traditional Chinese medicine (TCM) prescription, has yet to be fully evaluated for its potential in treating bone diseases such as osteoporosis. To investigate the mechanism by which BQTL decoction inhibits osteoclast differentiation in vitro and validate these findings through in vivo experiments. We employed MTS assays to assess the potential proliferative or toxic effects of BQTL on bone marrow macrophages (BMMs) at various concentrations. TRAcP experiments were conducted to examine BQTL's impact on osteoclast differentiation. RT-PCR and Western blot analyses were utilized to evaluate the relative expression levels of osteoclast-specific genes and proteins under BQTL stimulation. Finally, in vivo experiments were performed using an osteoporosis model to further validate the in vitro findings. This study revealed that BQTL suppressed receptor activator of NF-κB ligand (RANKL)-induced osteoclastogenesis and osteoclast resorption activity in vitro in a dose-dependent manner without observable cytotoxicity. The inhibitory effects of BQTL on osteoclast formation and function were attributed to the downregulation of NFATc1 and c-fos activity, primarily through attenuation of the MAPK, NF-κB, and Calcineurin signaling pathways. BQTL's inhibitory capacity was further examined in vivo using an ovariectomized (OVX) rat model, demonstrating a strong protective effect against bone loss. BQTL may serve as an effective therapeutic TCM for the treatment of postmenopausal osteoporosis and the alleviation of bone loss induced by estrogen deficiency and related conditions.
Animals ; NFATC Transcription Factors/genetics* ; Drugs, Chinese Herbal/pharmacology* ; Ovariectomy ; Osteoclasts/metabolism* ; Female ; Osteogenesis/drug effects* ; Rats, Sprague-Dawley ; Rats ; NF-kappa B/genetics* ; Osteoporosis/genetics* ; Signal Transduction/drug effects* ; Bone Resorption/genetics* ; Cell Differentiation/drug effects* ; Humans ; RANK Ligand/metabolism* ; Mitogen-Activated Protein Kinases/genetics* ; Transcription Factors

Objective To establish and validate a method for simultaneous determination of 9 sedative-hypnotics in human plasma,and to explore the preliminary clinical application.Methods Plasma samples were precipitated with acetonitrile and determined by high performance liquid chromatography tandem mass spectrometry.The column was Agilent Poroshell 120 EC-C18(2.1 mm × 50.0 mm,2.7μm)and eluted with acetonitrile water containing 0.1％formic acid in an equal degree program at a flow rate of 0.3 mL·min-1.The column temperature was 20 ℃ and injection volume was 5 μL.The deprotonated ions of analytes were ionized by positive ion,electron spray ionization and multiple reaction monitoring mode.The specificity,standard curve and lower limit of quantification,precision and recovery,matrix effect,stability and dilution effect of the method were investigated.Results Excellent linear relationship with correlation coefficient of r2 ≥ 0.997 7 was obtained.The linear of esazolam,alprazolam,oxazepam,clonazepam,lorazepam,triazolam,midazolam,diazepam and zolpidem were 18-1 800,4.5-450,25-2 500,3.5-350,25-2 500,1.5-150,5.5-550,35-3 500,4-400 ng·mL-1,respectively.The lower limit of quantification were 18,4.5,25,3.5,25,1.5,5.5,35,4 ng·mL-1.The method was accurate and precise with acceptable intra-day and inter-day precisions(relative standard deviations were less than 20％for a lower limit of quantification and less than 15％for other quality control samples)and an accuracy of 86.21％-112.38％.The extraction recovery rate were 93.07％-110.50％.The matrix factors normalized by internal standard were 86.61％-108.41％,relative standard deviations were less than 15％.Plasma samples remained stable under various storage conditions.The precision and accuracy of plasma samples were acceptable after dilution.Conclusion The method is simple,rapid,sensitive and specific,and it can be used for simultaneous detection of the 9 sedative-hypnotics in human plasma.

ObjectiveTo evaluate the dynamic disinfection effect of the upper-room 222 nm ultraviolet radiation on the air in different areas of the emergency department, and to provide references for a new solution of air disinfection that man-machine coexisted in the medical and healthcare institutions. MethodsThe upper-room 222 nm ultraviolet radiation air sterilizers were installed at a height of 2.3‒2.6 m from the ground in the observation room, computed tomography (CT) scanning room, rescue room and consulting room of the emergency department in Beijing Tiantan Hospital, Capital Medical University . The test area was divided into a 222 nm ultraviolet group and a control group according to whether the 222 nm ultraviolet germicidal air disinfection was conducted or not. The experimental group started air disinfection at8:00 a.m., and the air sampling was conducted from 9:00 a.m. to 16:00 p.m., with a 10 min sampling interval of every 1 hour. While the control group only collected air sample with the same air sampling method used in the experimental group, without air disinfection. The air microbial sampler with six-level sieve impingement was used for the air sampling, and the differences in the total number of airborne bacterial colonies were compared between the two groups. ResultsA total of 128 air samples were collected in the trial, of which 64 were from the experimental group and 64 from the control group. The total number of airborne bacterial colonies in the experimental group was lower than that in the control group (all P<0.001), and was maintained at a lower level throughout the entire period. The killing rate of 222 nm ultraviolet radiation to airborne microorganisms was approximately 55.76% to 76.33% in different sampling areas. The qualified rates of the total number of dynamic airborne bacterial colonies in the observation room, rescue room and consulting room were improved from 12.50%, 37.50% and 25.00% to 81.25%, 100.00% and 100.00%, respectively (all P<0.001). Over 62.50% of the time, the air quality in the consulting room and CT room in the 222 nm ultraviolet group met the environment standards for airborne bacterial colony criteria of class Ⅰ or class Ⅱ. ConclusionThe upper-room222 nm ultraviolet radiation germicidal disinfection can effectively reduce the total number of airborne bacterial colonies and improve the environment for emergency department, and the continuous using of it is helpful for keeping the air safe and clean.

Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3 561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4％,31.0％and 21.6％.The incremental cost of interventional screening was 160 245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1 060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.

Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3 561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4％,31.0％and 21.6％.The incremental cost of interventional screening was 160 245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1 060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.

Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3 561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4％,31.0％and 21.6％.The incremental cost of interventional screening was 160 245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1 060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.

Objective:To explore the impact and cost-effectiveness of community stroke screening intervention mode on stroke risk.Methods:A total of 3 561 community people over 40 years old who participated in screening intervention in 2017,2019 and 2021 were selected as research objects,and stroke risk was divided into low risk,medium risk and high risk.A Markov model was established to explore the impact of screening intervention mode on stroke risk in community population.The cost increment during the phase I trial was calculated,and the life year increment was adjusted according to the quality estimate of previous studies.The cost-effectiveness increment ratio was calculated,and the screening intervention mode was evaluated,and univariate sensitivity analysis was performed.Results:Within a certain range,intervention screening could effectively shift the status of residents to the low-risk direction,and finally stabilize the distribution of low-risk,medium-risk and high-risk were 47.4％,31.0％and 21.6％.The incremental cost of interventional screening was 160 245 yuan,the incremental quality-adjusted life year was 151.129 yuan,and the incremental cost-effectiveness ratio(ICER)was 1 060.319 yuan/QALY,which was less than 1 times the per capita GDP.The intervention program was fully cost-effective.Conclusion:Screening intervention can promote the transformation of the commu-nity population to a low-risk state of stroke in the prevention stage,and this approach has good cost-effectiveness performance.It is recommended that the primary medical and health institutions that are not enough to fully implement the integrated process ser-vice of community prevention and treatment of stroke should first implement low-cost screening intervention.