Currently, the rapid development of minimally invasive surgical techniques poses significant challenges to the traditional surgical education and training system. The teaching model relying on laboratory animals is facing the need for transformation due to ethical controversies, high costs, and limitations of the model. Through a combined approach of systematic literature analysis and summarization of practical experience at the Da Vinci Surgical Robot Training Center at the First Affiliated Hospital of Naval Medical University, this study systematically evaluated the multidimensional efficacy of laboratory animals in training for the Da Vinci robot operating system and laparoscopic techniques. The results indicate that, under current technological conditions, laboratory animals—leveraging their advantages of authentic tissue tactile feedback, dynamic physiological responses, and the ability to be trained under complex surgical field exposure—remain the core modality for cultivating advanced surgical skills (such as vascular dissection and mobilization, organ suturing, etc.). Their irreplaceability lies primarily in key training aspects such as simulating intraoperative dynamic physiological responses and handling intraoperative emergencies. Based on interdisciplinary technical assessment and practical observation, the authors propose and construct an "Ethics-Technology Synergy" development framework. They further explore the innovative value of the virtual-real interaction mechanism in extended reality technology, the construction of pathological simulation platforms using organoid models, and the resource coordination mechanism of digital sharing platforms. Using application cases from the training center, the study verifies the potential of these technologies to form a "stepwise replacement" pathway for laboratory animals. It also highlights their key breakthroughs in standardized scenario replication, improved tactile simulation accuracy, and reduced laboratory animal usage. This study emphasizes that the transformation of the minimally invasive surgical education and training system is not only a technological innovation but also an advancement of ethical concepts. The "Ethics-Technology Synergy" pathway requires focusing on three key implementation areas: constructing a multi-modal hybrid training system from the perspective of technological integration; establishing a collaborative biological specimen sharing network from the perspective of resource management; and refining standards for assessing the necessity of animal use from the perspective of ethical practice. This provides an actionable pathway for building a new training paradigm that balances technical efficacy with ethical compliance, thereby promoting the transformation of surgical education towards precision and minimal harm.

ObjectiveTo verify the technical feasibility and safety of partial nephrectomy in experimental pigs using a single-port endoscopic surgical robot in a transcontinental ultra-remote environment spanning 13 000 km with an average network delay of 204 ms, and to explore a dynamic combined anesthesia strategy that can effectively prevent intraoperative body movement in animals. MethodsThe research team used one experimental pig in Shanghai, China, and one in Orlando, the United States, and performed bidirectional remote surgery using the same model of single-port endoscopic surgical robot system. The anesthesia regimen included preoperative administration of 0.02 mg/kg dexmedetomidine hydrochloride and 0.05 mg/kg fentanyl citrate for combined sedation and analgesia. During remote surgery, according to the animal's reflex activity, pain response, and train-of-four stimulation (TOF) count results, vecuronium bromide was continuously infused at an initial rate of 0.04 mg·kg^-1·h^-1, and the dose was dynamically adjusted. Together with isoflurane inhalation anesthesia, the animal was maintained in a deep neuromuscular block state (TOF=0) to prevent intraoperative body movement. In addition, heart rate, blood pressure, muscle relaxation, and other indicators were monitored throughout the operation. ResultsSurgical operations were successfully performed at both sites, and the network delay remained stable at 202-208 ms. There was no data packet loss and no robot equipment failure. The vital signs of the experimental animal in Shanghai, China, remained stable, with zero body movement throughout the operation. Intraoperative blood loss was controllable, and no abnormal bleeding occurred. ConclusionIn transcontinental ultra-remote robotic surgery with inherent network delay, a dynamically adjusted anesthesia strategy can effectively avoid accidental bleeding caused by animal body movement and reduce the risks associated with network latency, thereby verifying the feasibility of this technical approach. In the future, it will be necessary to build a real-time cross-regional physiological data synchronization platform, standardize anesthesia protocols for animals undergoing remote surgery, and provide a technical basis for clinical translation to human trials.

ObjectiveTo investigate the effect of repetitive transcranial magnetic stimulation (rTMS) on prolonged disorders of consciousness (pDoC) after stroke. MethodsSixty patients with pDoC admitted to Zhejiang Provincial People's Hospital from January to July, 2024 were randomly assigned into control group (n = 30) and observation group (n = 30). Both groups received conventional rehabilitation therapy combined with hyperbaric oxygen therapy, while the observation group received rTMS in addition, for four weeks. Before and after treatment, they were assessed with Coma Recovery Scale-Revised (CRS-R), National Institutes of Health Stroke Scale (NIHSS), and bilateral N20 amplitude and latency of somatosensory-evoked potential (SEP), while consciousness status classification and Judson classification were recorded. ResultsOne case in the control group and two in the observation group dropped out. Significant time main effects and interaction effects were observed in CRS-R score (F = 118.420, P < 0.001; F = 23.980, P < 0.001, respectively) and NIHSS score (F = 103.376, P < 0.001; F = 14.241, P < 0.001, respectively). Significant group main effects, time main effects and interaction effects were observed in N20 amplitude (F > 4.303, P < 0.05) and N20 latency (F > 7.569, P < 0.05). Simple effects analysis showed CRS-R score, N20 amplitude, NIHSS score and N20 latency were better in the observation group than in the control group (P < 0.05) after the intervention, while the consciousness status classification and Judson classification were also better (|Z| > 2.160, P < 0.05). ConclusionrTMS can further promote recovery of consciousness, improve neurological function, and enhance the integrity of central conduction pathways in patients with pDoC after stroke.

Implementation Science is an interdisciplinary field dedicated to systematically studying how to effectively translate evidence-based research findings into practical application and implementation. In the health-related context, it focuses on enhancing the efficiency and quality of healthcare services, thereby facilitating the transition from scientific evidence to real-world practice. This article elaborates on Theories, Models, and Frameworks (TMF) within health-related Implementation Science, clarifying their basic concepts and classifications, and discussing their roles in guiding implementation processes. Furthermore, it reviews and prospects current research from three aspects: the constituent elements of TMF, their practical applications, and future directions. Five representative frameworks are emphasized, including the Consolidated Framework for Implementation Research (CFIR), the Practical Robust Implementation and Sustainability Model (PRISM), the Exploration, Preparation, Implementation, Sustainment (EPIS)framework, the Behavior Change Wheel (BCW), and the Normalization Process Theory (NPT). Additionally, resources such as the Dissemination & Implementation Models Webtool and the T-CaST tool are introduced to assist researchers in selecting appropriate TMFs based on project-specific needs.

The incidence of falls is high among the elderly population,particularly in patients with dementia.It was associated with their quality of life,accelerated disease progression,and reducing life expectancy.However,there is still a lack of relevant guidelines and recommendations for the occurrence,prediction,and intervention of falls in people with dementia.By reviewing the epidemiology,pathogenesis,risk factors,prediction models,and intervention measures related to falls in patients with dementia to provide a reference for clinicians to manage the whole process management of senile dementia patients.It was shown a higher risk of falling in elderly with dementia,which may be associated with visuospatial impairment,executive dysfunction,motor dysfunction,poor nutritional status,and a decline in daily living ability.Falling directly affects the prognosis of patients and increases the social and medical burden,which needs to be paid attention to.

The incidence of falls is high among the elderly population,particularly in patients with dementia.It was associated with their quality of life,accelerated disease progression,and reducing life expectancy.However,there is still a lack of relevant guidelines and recommendations for the occurrence,prediction,and intervention of falls in people with dementia.By reviewing the epidemiology,pathogenesis,risk factors,prediction models,and intervention measures related to falls in patients with dementia to provide a reference for clinicians to manage the whole process management of senile dementia patients.It was shown a higher risk of falling in elderly with dementia,which may be associated with visuospatial impairment,executive dysfunction,motor dysfunction,poor nutritional status,and a decline in daily living ability.Falling directly affects the prognosis of patients and increases the social and medical burden,which needs to be paid attention to.

OBJECTIVES: Bloodstream infections in emergency patients have a high incidence, severe disease progression, and rapid deterioration. Early administration of appropriate antimicrobial agents is crucial for improving patient outcomes. This study aims to investigate the incidence, pathogen distribution, and antimicrobial resistance patterns of bloodstream infections in emergency patients, providing a reference for rational antibiotic use in clinical practice. METHODS: Medical records of patients diagnosed with bloodstream infections in the emergency department of a hospital in Hunan Province between January 2018 and October 2022 were retrospectively collected. Clinical characteristics of bloodstream infection patients were analyzed, and the distribution trends and antimicrobial susceptibility of clinical isolates were examined. RESULTS: During the study period, 2 215 blood culture samples were submitted from the emergency department, with a positivity rate of 13.27%. After excluding eight cases with missing data or suspected contamination, 286 patients with bloodstream infections were included, with community-acquired infections accounting for the majority (85.66%). The most common primary infection site was the urinary tract (24.48%), followed by respiratory tract infections (20.28%) and biliary and intra-abdominal infections (17.13%). The 30-day mortality rate of bloodstream infections was 16.08%. A total of 286 pathogens were isolated, including 181 (63.29%) Gram-negative bacteria, primarily Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa; 101 (35.31%) Gram-positive bacteria, mainly Staphylococcus aureus, Staphylococcus epidermidis, and Streptococcus pneumoniae; and only 4 (1.40%) fungal isolates. Antimicrobial susceptibility testing showed that the key Enterobacteriaceae strains exhibited resistance rates of 2.4% to carbapenems, 16.3% to piperacillin sodium and tazobactam sodium, and 15.3% to ceftazidime, with no detected resistance to tigecycline or polymyxins. The main non-fermentative bacteria showed resistance rates of 29.6% to piperacillin sodium and tazobactam sodium, 13.3% to cefoperazone sodium and sulbactam sodium, and 27.1% to quinolones. Among Gram-negative bacteria, multidrug-resistant strains accounted for 40.9% (74/181), with carbapenem-resistant Escherichia coli and Klebsiella pneumoniae detected in 5.4% (5/92) and 13.6% (6/44) of cases, respectively. No carbapenem-resistant Pseudomonas aeruginosa was identified. Among Gram-positive bacteria, resistance rates to penicillin G, rifampicin, and cefoxitin were 74.7%, 4.2%, and 50%, respectively, with only 3 cases of resistant to glycopeptide antibiotics. CONCLUSIONS Bloodstream infections in emergency patients are predominantly community-acquired, with Gram-negative bacteria being the most common pathogens. The isolated pathogens exhibited relatively low resistance rates to commonly used clinical antibiotics.
Retrospective Studies ; Emergency Service, Hospital/statistics & numerical data* ; Drug Resistance, Bacterial ; Anti-Bacterial Agents/therapeutic use* ; Incidence ; Microbial Sensitivity Tests/statistics & numerical data* ; Bacteremia/microbiology* ; Community-Acquired Infections/microbiology* ; Gram-Negative Bacteria/isolation & purification* ; Blood Culture/statistics & numerical data* ; Humans ; Male ; Female ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; China/epidemiology*

Membranous nephropathy (MN) is a type of glomerular disease characterized by diffuse thickening of glomerular basement membrane with subepithelial immune complex deposition, and traditional diagnosis of MN mainly relies on the pathological results of renal biopsy. In recent years, the emergence of biomarkers related to MN such as phospholipase A2 receptor and thrombospondin type-1 domain-containing 7A has changed the diagnosis and treatment mode of MN, providing a new basis for the diagnosis, treatment and prognosis of MN. MN patients with positive specific target antigens exhibit different clinical manifestations and prognoses. Specific target antigens can not only guide diagnosis, but also has predictive value for prognosis. Immunosuppressive therapy is a common treatment for idiopathic MN patients, and the emergence of novel medications such as biologics represents a advance in the treatment of MN, providing a broader array of options for managing the condition. Conversely, the treatment approach for secondary MN primarily targets the management of the primary disease. Based on multiple and new literature, we reviewed the researches progress of target antigens and immunosuppressive therapy related to MN, so as to provide references for clinical diagnosis and treatment of MN.

It was a single-center cross-sectional study to investigate the association of serum C3 level with blood pressure and estimated glomerular filtration rate (eGFR) in patients with idiopathic membranous nephropathy (IMN). The clinical and pathological data of 98 patients with IMN diagnosed by renal biopsy in the Department of Nephrology of East Hospital Affiliated to Tongji University from August 1, 2018 to October 31, 2023 were retrospectively analyzed. The demographic characteristics, serum complement C3 and other clinical data were compared between the non-hypertension group ( n=37) and hypertension group ( n=61). Pearson or Spearman correlation analysis method was used to analyze the correlation between serum C3 and eGFR in IMN patients and IMN patients with hypertension. Multiple linear regression analysis was used to analyze the related factors of eGFR in IMN patients with chronic kidney disease stage 1-3 in hypertension group. The results showed that compared with the non-hypertension group, the patients in hypertension group were older, and had higher levels of serum creatinine, cystatin C, urinary microalbumin to creatinine ratio, serum C3 and C4, and lower eGFR (all P<0.05). The correlation analysis showed that there was no correlation between serum C3 level and eGFR in IMN patients ( r=0.118, P=0.247). However, serum C3 level was positively correlated with eGFR in IMN patients with hypertension ( r=0.325, P=0.011). Multiple linear regression analysis showed that eGFR was negatively correlated with age ( β=-0.328, P=0.013), and positively correlated with serum C3 level ( β=0.228, P=0.048). The study shows that serum C3 level in hypertension group is higher than that in non-hypertension group in IMN patients. Moreover, serum C3 is positively correlated with eGFR.

Objective:The incidence of infections in patients with malignant hematologic diseases is extremely high and significantly affects their prognosis.Identifying early and precise biomarkers for infection is crucial for guiding the treatment of infections in these patients.Previous studies have shown that procalcitonin(PCT)can serve as an early diagnostic marker for bloodstream infections in patients with malignant hematologic diseases.This study aims to compare serum PCT levels in these patients with different pathogens,disease types,infection sites,and severity levels. Methods:Clinical data and laboratory results of infected patients with malignant hematologic diseases treated at the Department of Hematology,the Third Xiangya Hospital of Central South University from January 2018 to August 2023 were collected.General patient information was retrospectively analyzed.Serum PCT levels were compared among patients with different pathogens,types of malignant hematologic diseases,infection sites,and infection severity;Receiver operator characteristic(ROC)curves were used to determine the cut-off values and diagnostic value of serum PCT levels in diagnosing bloodstream infections versus local infections and severe infections versus non-severe infections.Mortality rates after 4-7 days of anti-infective treatment were compared among groups with rising,falling,and unchanged PCT levels. Results:A total of 526 patients with malignant hematologic diseases were included.The main pathogens were Gram-negative bacteria(272 cases,51.7%),followed by Gram-positive bacteria(120 cases,22.8%),fungi(65 cases,12.4%),viruses(23 cases,4.4%),and mixed pathogens(46 cases,8.7%).The main types of malignant hematologic diseases were acute myeloid leukemia(216 cases,41.1%),acute lymphoblastic leukemia(107 cases,20.3%),and lymphoma(93 cases,17.7%).Granulocyte deficiency was present in 68.3%(359 cases)of the patients during infection,with severe infection in 24.1%(127 cases).Significant differences in serum PCT levels were found among patients with different types of pathogens(P<0.001),with the highest levels in Gram-negative bacterial infections.Significant differences in serum PCT levels were also found among patients with different types of malignant hematologic diseases(P<0.05),with the highest levels in lymphoma patients.Serum PCT levels were significantly higher in systemic infections and severe infections compared to local infections and non-severe infections(both P<0.001).ROC curve analysis showed that the cut-off values for diagnosing bloodstream infections and severe infections were 0.22 and 0.28 ng/mL,with areas under the curve of 0.670 and 0.673,respectively.After 4-7 days of anti-infective treatment,the mortality rates of the PCT declining,PCT unchanged,and PCT rising groups were 11.9%,21.2%,and 35.7%,respectively,and pairwise comparisons were statistically significant(all P<0.05). Conclusion:PCT can be used as an auxiliary indicator for early identification of different pathogens,infection sites,and severity levels in patients with malignant hematologic diseases combined with infections.Dynamic monitoring of PCT levels after empirical antibiotic treatment provides important guidance for assessing patient's prognosis.