Background and Aims:Biliary tract cancers(BTCs)are highly aggressive malignancies with dismal prognosis,for which radical resection remains the only potentially curative treatment.Laparoscopic surgery has demonstrated superiority over open surgery in perioperative safety and recovery,yet it is technically limited in complex operations.Robot-assisted laparoscopy,with its high-definition three-dimensional vision and enhanced instrument dexterity,may overcome these limitations.However,comparative evidence balancing baseline differences between laparoscopic and robot-assisted laparoscopic radical resections for BTCs is still lacking.This study aimed to evaluate and compare their short-term safety using propensity score matching(PSM).Methods:A total of 151 patients with biliary tract cancers who underwent radical resection were retrospectively enrolled from the Chinese Biliary Tract Tumor Collaborative Group database,including 128 in the laparoscopic group and 23 in the robotic-assisted laparoscopic group.To balance baseline differences,an initial 1∶1 PSM was performed,yielding 19 laparoscopic and 19 robotic cases.Subsequently,using the robotic group as the reference,a 1∶2 PSM was conducted,resulting in 36 laparoscopic and 18 robotic cases.Primary outcomes(conversion to open surgery,ICU admission,and postoperative complications)and secondary outcomes(operative time,intraoperative blood loss,transfusion,postoperative hospital stay,reoperation,readmission,and hospitalization costs)were compared between the two groups.Multivariate regression analyses were performed to explore factors associated with conversion to open surgery and postoperative hospital stay.Results:After matching,baseline characteristics were well balanced between groups.For primary outcomes,the conversion rate to open surgery was significantly higher in the laparoscopic group than in the robotic group(41.7％vs.0,P=0.001),while ICU admission,overall postoperative complications,and Clavien-Dindo graded complications showed no significant differences(all P＞0.05).For secondary outcomes,the postoperative hospital stay was significantly more extended in the laparoscopic group compared with the robotic group(18.5 d vs.8.0 d,P=0.005),whereas operative time,intraoperative blood loss,transfusion,reoperation,readmission,and hospitalization costs were comparable(all P＞0.05).Logistic regression for conversion did not identify statistically significant predictors,but moderately differentiated tumors,elevated preoperative CA19-9,and higher harvested lymph node counts showed trends toward increased risk.Multivariate linear regression revealed that robotic-assisted surgery was an independent factor for reduced postoperative hospital stay(P=0.024),while preoperative total bilirubin(P=0.020),longer operative time(P=0.000),postoperative complications(P=0.006),and reoperation(P=0.005)were found to be associated with a prolonged hospital stay.Conclusion:Robot-assisted laparoscopic radical resection for BTCs is not inferior to conventional laparoscopy in short-term safety and may further reduce conversion rates and hospital stay.Its technical advantages may be particularly valuable in anatomically complex or challenging cases.Nonetheless,cost-effectiveness and resource allocation should be considered for wider adoption.

Objective To investigate the effect and mechanism of melatonin in alleviating hypoxia-induced apoptosis in ovarian gra-nulosa cells.Methods Rat ovarian granulosa cells were isolated and divided into normoxic,hypoxic,and melatonin groups.Hypoxia-induced injury models were established in the hypoxic and melatonin groups,and granulosa cells in the melatonin group were treated with melatonin.A total of 24 rats were randomized into the control,model,and intervention groups(n=8 per group).Rat models of declining ovarian function induced by long-term hypoxia were established in the model and intervention groups.The rats in the intervention group were intraperitoneally injected with melatonin.Cell proliferation was measured using a CCK-8 assay,and lactate secretion and HIF-1αprotein with a specific kit,respectively.The levels of estradiol and progesterone in the cell supernatant and rat serum were detected using ELISA.Granulosa cell apoptosis was detected by flow cytometry,ovarian morphology by HE staining,and Bax and caspase-3 expression by Western blotting.Results Compared with the normoxic group,the hypoxic group exhibited decreased granulosa cell proliferation,increased apoptosis,elevated lactate and HIF-1α levels,and reduced estradiol and progesterone levels(P＜0.05).Compared with hypoxic group,these changes were significantly reversed in the molatonin group(P＜0.05).Compared with the control group,the model group showed increased lactate,HIF-1α,Bax,and caspase-3 levels,decreased estradiol and progesterone levels,and reduced follicles.Compared with the model group,all the indicators were ameliorated in the intervention group(P＜0.05).Conclusion Melatonin alleviated hypoxia-induced granulosa cell apoptosis and promoted the recovery of ovarian function.

The profound integration of novel qualitative productive forces throughout the entire process of diagnosing and treating gastrointestinal cancer has catalyzed innovative advance-ments in surgical techniques and postoperative rehabilitation. In the field of minimally invasive resection, technological innovations, from laparoscopic surgery to robot-assisted surgical systems that transcend traditional visual and operational limitations, and further to the integration of artificial intelligence and 5G technologies that overcome spatiotemporal barriers for real-time decision-making and telemedicine, have significantly enhanced the precision and safety of gastrointestinal tumor surgery. Concurrently, the development of innovative medical devices plays a pivotal role in improving perioperative and postoperative rehabilitation efficiency. Functional device design focuses on addressing the holistic needs of patients throughout their clinical journey, systematically resolving efficiency and safety bottlenecks inherent in conventional diagnostic and therapeutic approaches. Technological progress has further enabled non-invasive, convenient remote health management for patients. Novel qualitative productive forces not only redefine surgical paradigms but also deliver efficient, safe, and patient-centered diagnostic and therapeutic experiences through comprehensive innovation across all treatment phases. This evolution marks a critical breakthrough in modern medicine's transition toward intelligence and systematization, heralding a new era of intelligent healthcare delivery.

Background and Aims:Biliary tract cancers(BTCs)are highly aggressive malignancies with dismal prognosis,for which radical resection remains the only potentially curative treatment.Laparoscopic surgery has demonstrated superiority over open surgery in perioperative safety and recovery,yet it is technically limited in complex operations.Robot-assisted laparoscopy,with its high-definition three-dimensional vision and enhanced instrument dexterity,may overcome these limitations.However,comparative evidence balancing baseline differences between laparoscopic and robot-assisted laparoscopic radical resections for BTCs is still lacking.This study aimed to evaluate and compare their short-term safety using propensity score matching(PSM).Methods:A total of 151 patients with biliary tract cancers who underwent radical resection were retrospectively enrolled from the Chinese Biliary Tract Tumor Collaborative Group database,including 128 in the laparoscopic group and 23 in the robotic-assisted laparoscopic group.To balance baseline differences,an initial 1∶1 PSM was performed,yielding 19 laparoscopic and 19 robotic cases.Subsequently,using the robotic group as the reference,a 1∶2 PSM was conducted,resulting in 36 laparoscopic and 18 robotic cases.Primary outcomes(conversion to open surgery,ICU admission,and postoperative complications)and secondary outcomes(operative time,intraoperative blood loss,transfusion,postoperative hospital stay,reoperation,readmission,and hospitalization costs)were compared between the two groups.Multivariate regression analyses were performed to explore factors associated with conversion to open surgery and postoperative hospital stay.Results:After matching,baseline characteristics were well balanced between groups.For primary outcomes,the conversion rate to open surgery was significantly higher in the laparoscopic group than in the robotic group(41.7％vs.0,P=0.001),while ICU admission,overall postoperative complications,and Clavien-Dindo graded complications showed no significant differences(all P＞0.05).For secondary outcomes,the postoperative hospital stay was significantly more extended in the laparoscopic group compared with the robotic group(18.5 d vs.8.0 d,P=0.005),whereas operative time,intraoperative blood loss,transfusion,reoperation,readmission,and hospitalization costs were comparable(all P＞0.05).Logistic regression for conversion did not identify statistically significant predictors,but moderately differentiated tumors,elevated preoperative CA19-9,and higher harvested lymph node counts showed trends toward increased risk.Multivariate linear regression revealed that robotic-assisted surgery was an independent factor for reduced postoperative hospital stay(P=0.024),while preoperative total bilirubin(P=0.020),longer operative time(P=0.000),postoperative complications(P=0.006),and reoperation(P=0.005)were found to be associated with a prolonged hospital stay.Conclusion:Robot-assisted laparoscopic radical resection for BTCs is not inferior to conventional laparoscopy in short-term safety and may further reduce conversion rates and hospital stay.Its technical advantages may be particularly valuable in anatomically complex or challenging cases.Nonetheless,cost-effectiveness and resource allocation should be considered for wider adoption.

Objective To investigate the effect and mechanism of melatonin in alleviating hypoxia-induced apoptosis in ovarian gra-nulosa cells.Methods Rat ovarian granulosa cells were isolated and divided into normoxic,hypoxic,and melatonin groups.Hypoxia-induced injury models were established in the hypoxic and melatonin groups,and granulosa cells in the melatonin group were treated with melatonin.A total of 24 rats were randomized into the control,model,and intervention groups(n=8 per group).Rat models of declining ovarian function induced by long-term hypoxia were established in the model and intervention groups.The rats in the intervention group were intraperitoneally injected with melatonin.Cell proliferation was measured using a CCK-8 assay,and lactate secretion and HIF-1αprotein with a specific kit,respectively.The levels of estradiol and progesterone in the cell supernatant and rat serum were detected using ELISA.Granulosa cell apoptosis was detected by flow cytometry,ovarian morphology by HE staining,and Bax and caspase-3 expression by Western blotting.Results Compared with the normoxic group,the hypoxic group exhibited decreased granulosa cell proliferation,increased apoptosis,elevated lactate and HIF-1α levels,and reduced estradiol and progesterone levels(P＜0.05).Compared with hypoxic group,these changes were significantly reversed in the molatonin group(P＜0.05).Compared with the control group,the model group showed increased lactate,HIF-1α,Bax,and caspase-3 levels,decreased estradiol and progesterone levels,and reduced follicles.Compared with the model group,all the indicators were ameliorated in the intervention group(P＜0.05).Conclusion Melatonin alleviated hypoxia-induced granulosa cell apoptosis and promoted the recovery of ovarian function.

The profound integration of novel qualitative productive forces throughout the entire process of diagnosing and treating gastrointestinal cancer has catalyzed innovative advance-ments in surgical techniques and postoperative rehabilitation. In the field of minimally invasive resection, technological innovations, from laparoscopic surgery to robot-assisted surgical systems that transcend traditional visual and operational limitations, and further to the integration of artificial intelligence and 5G technologies that overcome spatiotemporal barriers for real-time decision-making and telemedicine, have significantly enhanced the precision and safety of gastrointestinal tumor surgery. Concurrently, the development of innovative medical devices plays a pivotal role in improving perioperative and postoperative rehabilitation efficiency. Functional device design focuses on addressing the holistic needs of patients throughout their clinical journey, systematically resolving efficiency and safety bottlenecks inherent in conventional diagnostic and therapeutic approaches. Technological progress has further enabled non-invasive, convenient remote health management for patients. Novel qualitative productive forces not only redefine surgical paradigms but also deliver efficient, safe, and patient-centered diagnostic and therapeutic experiences through comprehensive innovation across all treatment phases. This evolution marks a critical breakthrough in modern medicine's transition toward intelligence and systematization, heralding a new era of intelligent healthcare delivery.

Jiangsu Provincial People's Hospital takes the reform of DRG payment method as an opportunity,based on the theory of incentive behavior,uses literature research,expert consultation,and key performance indicator methods to develop evaluation indicators,and applies PDCA management tools to establish a continuously improving medical insurance service quality evaluation system.It introduces the process of medical insurance service quality evaluation system construction and its application in medical insurance performance management,and analyzes the implementation effect:DRG operation is improving,disease group structure is optimized,medical quality and efficiency continue to improve,and medical service evaluation scores are improving.

Objective:To investigate the application effect of case-based collaborative learning (CBCL) based on data-information-knowledge-wisdom (DKIW) model in the training of the informatization teaching ability of clinical teachers.Methods:From March to August in 2022, 71 clinical teachers from four grade A tertiary hospitals in Tianjin, China, were selected as subjects and were randomly divided into control group with 35 patients and experimental group with 36 patients using a random number table. The teachers in the control group received blended teaching online and offline, and those in the experimental group received CBCL teaching based on DIKW model. The two groups were compared in terms of theoretical assessment score, informatization teaching demonstration score, and informatization teaching ability score before and after intervention. SPSS 27.0 was used for the t-test and the Mann-Whitney U rank sum test. Results:Compared with the control group after intervention, the experimental group had significantly higher scores of theoretical assessment (83.50±3.11) and informatization teaching demonstration (84.19±1.89) ( P<0.05). After intervention, the control group had significant increases in the total score of informatization teaching ability (74.34±4.08) and the scores of each dimension (15.40±1.19, 19.29±1.62, 28.54±1.67, and 11.11±1.79), and the experimental group also had significant increases in the total score of informatization teaching ability (83.64±5.25) and the scores of each dimension (16.53±1.21, 20.94±1.98, 33.03±2.10, and 13.14±1.48); the experimental group had significantly higher scores than the control group ( P<0.05). Conclusions:The CBCL teaching model based on DIKW model can help to improve the comprehensive informatization teaching ability of clinical teachers.

Objective To analyze the influencing factors of clinical pregnancy and live birth rates in patients undergoing frozen-thawed embryo transfer(FET)for the first time.Methods The clinical data of 1 458 patients who underwent FET cycle-assisted pregnancy for the first time were retrospectively analyzed and divided into four groups according to clinical pregnancy and live bith outcomes.The clini-cal data were compared to analyze the factors affecting clinical pregnancy and live birth rates in FET cycles that were included in multiple logistic regression analysis.Results Of the 1458 cycles,the clinical pregnancy and live birth rates were 44.0% and 34.0%,respectively.The mean age of the clinical pregnancy and live birth groups was lower than that in non-clinical pregnancy and stillbirth groups(P<0.05).The clinical pregnancy and live birth rates of patients aged<35 years were higher than those aged≥35 years(P<0.05).The clinical preg-nancy and live birth rates of patients with≥8 mm endometrial thickness were higher than those with<8 mm endometrial thickness(P<0.05).The clinical pregnancy rate of natural cycles of endometrial preparation regimen was higher than that of HRT cycles(P<0.05).The clinical pregnancy and live birth rates of double-embryo transfers were higher than that of single-embryo transfers(P<0.05).The clinical pregnancy and live birth rates of blastocyst transfers were higher than those of cleavage stage(P<0.05).Conclusion Age,endometrial thickness,number of transplanted embryos,and embryo morphology were the independent factors influencing clinical pregnancy and live birth outcomes during FET cycle transplantation.

Objective:To investigate the risk factors for severe distal curve progression after posterior hemivertebra (HV) resection and short-segment fixation in patients with congenital cervicothoracic scoliosis (CTS), and to analyze the surgical revision strategy.Methods:Imaging and clinical data of patients who underwent posterior HV resection and short-segment fixation for CTS between August 2012 and August 2021 at Nanjing Drum Tower Hospital were retrospectively analyzed. A total of 55 patients were recruited, including 27 females and 28 males with an average age of 8.5±3.6 years (range 3-15 years) at surgery and an average Risser grade of 0.7±1.4 (range 0-4). The number of fused segments averaged 6.9±1.6 (range 4-10), and the mean follow-up was 38.7±18.9 months (range 9-94 months). According to the severity of distal curve progression, the recruited patients were divided into three groups: non-progression group (NPG), mild progression group (MPG), and severe progression group (SPG). The latter two groups were collectively called the progression group (PG). The cervicothoracic Cobb angle, T1 tilt angle, coronal balance distance (CBD), neck tilt angle, clavicular angle, head tilt angle, head shift, and upper (UIV) and lower instrument vertebra (LIV) tilt angle on the standing whole spine X-ray were measured before and after surgery and at the last follow-up. The correction rate of the Cobb angle in the osteotomy area was measured and calculated on CT three-dimensional reconstruction, and the proportion of patients with Klippel-Feil syndrome (KFS) was recorded. Statistical analysis was conducted on the various parameters between the two groups. For factors with statistical significance in the single-factor analysis, binary logistic regression analysis was performed to identify the high-risk factors for distal curve progression.Results:There were 38 cases in the NPG, 11 in the MPG, and 6 in the SPG. Compared to the NPG, the PG showed more severe coronal imbalance preoperatively, with CBD of 35.6±22.3 mm and 11.6±7.1 mm respectively; more severe neck tilt and head shift, with neck tilt angle of 17.4°±8.3° and 12.4°±6.9° respectively, and head shift of 22.8±17.7 mm and 13.9±9.8 mm respectively; and a higher proportion of KFS, 65% (11/17) and 34% (13/38) respectively, all with statistical significance ( P<0.05). Postoperatively, the PG showed more severe coronal imbalance compared with the NPG, with 17.3±12.7 mm and 9.6±8.1 mm respectively; more evident residual deformity, with cervical tilt angles of 9.4°±4.6° and 6.4°±5.3° respectively, and head shift of 14.7±7.4 mm and 9.1±5.9 mm respectively; lower correction of Cobb angle in the apical osteotomy region, with rates of 40.1%±15.2% and 50.3%±19.9% respectively; more significant UIV and LIV tilt, with UIV tilt angles of 14.3°±7.4° and 9.8°±5.3° respectively, and LIV tilt angles of 8.1°±5.5° and 4.5°±3.6° respectively, all with statistical significance ( P<0.05). SPG showed only more severe coronal imbalance preoperatively compared with the MPG, with 50.7±31.3 mm and 27.3±9.6 mm respectively; and head shift, with 33.5±25.0 mm and 16.9±11.0 mm respectively, all with statistical significance ( P<0.05). Logistic regression analysis demonstrated a significant correlation between significant preoperative coronal imbalance and postoperative distal scoliosis progression [ OR=1.299, 95% CI (1.101, 1.531), P=0.002]. Five cases (83.3%) in SPG underwent revision surgery with an average follow-up of 25 months, and selecting the LIV down to the stable region was the major revision strategy. Conclusion:Combined KFS, residual cervicothoracic deformities, and tilting of UIV and LIV are key causes, whereas significant preoperative coronal imbalance is an independent risk factor predisposing to the distal curve progression.