Objective:To compare and analyze the short-term efficacy of the Da Vinci Xi (fourth generation) robotic surgical system and laparoscopic-assisted radical gastrectomy for gastric cancer.Method:In this retrospective cohort study, clinical pathological data of 190 patients with gastric cancer were collected from the clinical database of the First Affiliated Hospital of Dalian Medical University from 2020 Dec to 2023 May. The cohort comprised 136 men and 54 women aged 65 (30–85) years. Ninety of these patients had undergone robot assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the robot-assisted group. The remaining 100 patients had undergone laparoscopic- assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the laparoscopic control group. Variables investigated included surgical and postoperative factors and postoperative complications.Result:The procedure was successfully completed without the need to transition to open surgery in every patient in both groups. The median duration of surgery was 315 (270, 360) minutes and 240 (202, 280) minutes, median intraoperative blood loss 20 (10, 30) mL and 30 (10, 50) mL, median incision length 12.0 (10.8,13.0) cm and 10.0 (8.0, 10.8) cm, median time to first postoperative passage of flatus 4 (3, 5) days and 4 (4, 5) days, median time to first postoperative fluid intake 6 (4, 7) days and 8 (6, 9) days, time to gastric tube removal 4 (3, 7) days and 6 (5, 8) days, median time to drainage tube removal 8 (7, 10) days and 10 (9, 12) days, median duration of postoperative hospitalization 8 (7, 11) days and 12 (10, 14) days, and cost of surgery (7.6±1.2)×10 4 yuan and (4.0±0.6)×10 4 yuan in the robot-assisted and laparoscopic control groups, respectively. All the differences in the above indicators between the two groups of patients were statistically significant (all P<0.05). There were also significantly fewer complications in the robot-assisted than the laparoscopic control group (28.9% [26/90] vs. 44.0% [44/100], χ 2=0.31, P=0.031). Further subgroup analysis showed that the following factors were associated with greater improvement in the robot-assisted than laparoscopic control group: male sex (OR=0.41, 95%CI: 0.20–0.83, P=0.015), body mass index Conclusion:The Da Vinci robotic surgical system is safe and feasible for gastrectomy achieving a shorter recover period and fewer preoperative comorbidities.

Objective To explore the establishment of a risk prediction model for concurrent bronchiolitis obliterans(BO)in children with refractory Mycoplasma pneumoniae pneumonia(RMPP).Methods A retrospective study included 116 RMPP children treated in the Department of Pediatrics of Xiangya Changde Hospital from June 2021 to December 2023.Eighty-one cases were allocated to the training set and thirty-five cases to the validation set based on a 7:3 ratio.Among them,26 cases in the training set developed BO,while 55 did not.The multivariate logistic regression was used to select variable factors for constructing the BO risk prediction model.Nomograms were drawn,and the receiver operating characteristic(ROC)curve was used to assess the discriminative ability of the model,while calibration curves and Hosmer-Lemeshow tests evaluated the model's calibration.Results Multivariate logistic regression analysis indicated that several factors were significantly associated with concurrent BO in RMPP children,including length of hospital stay,duration of fever,atelectasis,neutrophil percentage(NEUT%),peak lactate dehydrogenase(LDH),ferritin,peak C reactive protein(CRP),oxygenation index(PaO2/FiO2),≥2/3 lung lobe consolidation,pleural effusion,bronchial mucous plugs,bronchial mucosal necrosis,and arterial oxygen partial pressure(PaO2)(P<0.05).ROC curve analysis for the training set indicated an area under the curve of 0.904 with 88%sensitivity and 83%specificity;the validation set showed an area under the curve of 0.823 with 76%sensitivity and 93%specificity.The Hosmer-Lemeshow test's Chi-square values for the training and validation sets were 2.17 and 1.92,respectively,with P values of 0.221 and 0.196,respectively.Conclusions The risk prediction model for BO in RMPP children based on logistic regression has good performance.Variables such as length of hospital stay,duration of fever,atelectasis,peak LDH,peak CRP,NEUT%,ferritin,≥2/3 lung lobe consolidation,pleural effusion,bronchial mucous plugs,bronchial mucosal necrosis,PaO2/FiO2,and PaO2 can be used as predictors.

Objective:To compare and analyze the short-term efficacy of the Da Vinci Xi (fourth generation) robotic surgical system and laparoscopic-assisted radical gastrectomy for gastric cancer.Method:In this retrospective cohort study, clinical pathological data of 190 patients with gastric cancer were collected from the clinical database of the First Affiliated Hospital of Dalian Medical University from 2020 Dec to 2023 May. The cohort comprised 136 men and 54 women aged 65 (30–85) years. Ninety of these patients had undergone robot assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the robot-assisted group. The remaining 100 patients had undergone laparoscopic- assisted radical resection of gastric cancer and reconstruction of the digestive tract and were assigned to the laparoscopic control group. Variables investigated included surgical and postoperative factors and postoperative complications.Result:The procedure was successfully completed without the need to transition to open surgery in every patient in both groups. The median duration of surgery was 315 (270, 360) minutes and 240 (202, 280) minutes, median intraoperative blood loss 20 (10, 30) mL and 30 (10, 50) mL, median incision length 12.0 (10.8,13.0) cm and 10.0 (8.0, 10.8) cm, median time to first postoperative passage of flatus 4 (3, 5) days and 4 (4, 5) days, median time to first postoperative fluid intake 6 (4, 7) days and 8 (6, 9) days, time to gastric tube removal 4 (3, 7) days and 6 (5, 8) days, median time to drainage tube removal 8 (7, 10) days and 10 (9, 12) days, median duration of postoperative hospitalization 8 (7, 11) days and 12 (10, 14) days, and cost of surgery (7.6±1.2)×10 4 yuan and (4.0±0.6)×10 4 yuan in the robot-assisted and laparoscopic control groups, respectively. All the differences in the above indicators between the two groups of patients were statistically significant (all P<0.05). There were also significantly fewer complications in the robot-assisted than the laparoscopic control group (28.9% [26/90] vs. 44.0% [44/100], χ 2=0.31, P=0.031). Further subgroup analysis showed that the following factors were associated with greater improvement in the robot-assisted than laparoscopic control group: male sex (OR=0.41, 95%CI: 0.20–0.83, P=0.015), body mass index Conclusion:The Da Vinci robotic surgical system is safe and feasible for gastrectomy achieving a shorter recover period and fewer preoperative comorbidities.

Background/Aims: Despite the high efficacy of direct-acting antivirals (DAAs), approximately 1–3% of hepatitis C virus (HCV) patients fail to achieve a sustained virological response. We conducted a nationwide study to investigate risk factors associated with DAA treatment failure. Machine-learning algorithms have been applied to discriminate subjects who may fail to respond to DAA therapy. Methods: We analyzed the Taiwan HCV Registry Program database to explore predictors of DAA failure in HCV patients. Fifty-five host and virological features were assessed using multivariate logistic regression, decision tree, random forest, eXtreme Gradient Boosting (XGBoost), and artificial neural network. The primary outcome was undetectable HCV RNA at 12 weeks after the end of treatment. Results: The training (n=23,955) and validation (n=10,346) datasets had similar baseline demographics, with an overall DAA failure rate of 1.6% (n=538). Multivariate logistic regression analysis revealed that liver cirrhosis, hepatocellular carcinoma, poor DAA adherence, and higher hemoglobin A1c were significantly associated with virological failure. XGBoost outperformed the other algorithms and logistic regression models, with an area under the receiver operating characteristic curve of 1.000 in the training dataset and 0.803 in the validation dataset. The top five predictors of treatment failure were HCV RNA, body mass index, α-fetoprotein, platelets, and FIB-4 index. The accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the XGBoost model (cutoff value=0.5) were 99.5%, 69.7%, 99.9%, 97.4%, and 99.5%, respectively, for the entire dataset. Conclusions Machine learning algorithms effectively provide risk stratification for DAA failure and additional information on the factors associated with DAA failure.

Objective:To investigate the clinical efficacy of da Vinci Xi robotic surgical system assisted pylorus and vagus preserving partial gastrectomy (RaPPG) for early gastric cancer.Methods:The retrospective cohort study was conducted. The clinicopathological data of 40 patients with early gastric cancer who were admitted to the First Affiliated Hospital of Dalian Medical University from December 2020 to November 2022 were collected. There were 26 males and 14 females, aged (64±8)years. Of the 40 patients, 19 patients undergoing da Vinci Xi RaPPG were divided into the robotic assisted group, and 21 patients undergoing laparoscopic assisted pylorus and vagus preserving partial gastrectomy (PPG) were divided into the laparoscopic control group. Observation indicators: (1) surgical situations; (2) postoperative complications; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the independent t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and comparison between groups was conducted using the Mann-Whitney U test. Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data was conducted using the rank sum test. Results:(1) Surgical situations. All patients in the two groups underwent surgery successfully, without conversion to laparotomy. The operation time, volume of intraoperative blood loss, time to postoperative first flatus, time to postoperative first liquid food intake, time to post-operative drainage tube removal, duration of postoperative hospital stay, tumor diameter, distance from distal resection margin to tumor were (298±52)minutes, 10(10, 10)mL, 3.0(3.0, 3.0)days, 3.0(3.0,4.0)days, 6.0(6.0,8.0)days, 7.0(6.0,8.0)days, (2.3±0.7)cm, 3.0(2.0,3.0)cm in patients of the robotic assisted group, versus (236±37)minutes, 25(15,50)mL, 5.0(4.0,5.0)days, 6.0(5.5,7.0)days, 8.0(8.0,9.5)days, 8.0(7.5,9.5)days, (2.9±1.1)cm ,2.0(1.5,2.0)cm in patients of the laparoscopic control group, showing significant differences in the above indicators between the two groups ( t=4.41, Z=-3.38, -4.75, -4.38, -2.98, -2.58, t=-2.10, Z=-3.03, P<0.05). (2) Postoperative complications. Cases with postoperative complications, cases with delayed gastric emptying, cases with acid regurgita-tion, cases with atelectasis, cases with infection of incision, cases with hyperamylasemia, cases with uroschesis were 6, 1, 1, 0, 1, 3, 0 in patients of the robotic assisted group. The above indicators were 20, 4, 3, 2, 1, 9, 1 in patients of the laparoscopic control group. There was a significant difference in the postoperative complications between the two groups ( χ2=17.77, P<0.05). (3) Follow-up. Of the 40 patients, 34 patients were followed up. There were 16 patients in the robotic assisted group who were followed up for 9(range, 6-18)months, and there were 18 patients in the laparoscopic control group who were followed up for 16(range, 9-23)months. During the follow-up period, all patients had good anastomosis healing, pyloric contraction function, and gastric emptying function. Conclusions:da Vinci Xi RaPPG is safe and feasible for the treatment of early gastric cancer. Compared with laparoscopic assisted PPG, treatment of gastric cancer with da Vinci Xi RaPPG can significantly reduce the volume of intraoperative blood loss, shorten the time to postoperative first flatus, time to postoperative first liquid food intake, time to postoperative drainage tube removal, duration of postoperative hospital stay, benefit the distance from distal resection margin to tumor, and reduce the incidence of postoperative complications.

METRNL is a recently identified secreted protein with emerging functions. This study is to find major cellular source of circulating METRNL and to determine METRNL novel function. Here, we show METRNL is abundant in human and mouse vascular endothelium and released by endothelial cells using endoplasmic reticulum-Golgi apparatus pathway. By creating endothelial cell-specific Metrnl knockout mice, combined with bone marrow transplantation to produce bone marrow-specific deletion of Metrnl, we demonstrate that most of circulating METRNL (approximately 75%) originates from the endothelial cells. Both endothelial and circulating METRNL decrease in atherosclerosis mice and patients. By generating endothelial cell-specific Metrnl knockout in apolipoprotein E-deficient mice, combined with bone marrow-specific deletion of Metrnl in apolipoprotein E-deficient mice, we further demonstrate that endothelial METRNL deficiency accelerates atherosclerosis. Mechanically, endothelial METRNL deficiency causes vascular endothelial dysfunction including vasodilation impairment via reducing eNOS phosphorylation at Ser1177 and inflammation activation via enhancing NFκB pathway, which promotes the susceptibility of atherosclerosis. Exogenous METRNL rescues METRNL deficiency induced endothelial dysfunction. These findings reveal that METRNL is a new endothelial substance not only determining the circulating METRNL level but also regulating endothelial function for vascular health and disease. METRNL is a therapeutic target against endothelial dysfunction and atherosclerosis.

Occupational exposure to diacetyl can lead to bronchiolitis obliterans. In this paper, two patients with severe obstructive ventilation disorder who were exposed to diacetyl at a fragrance and flavours factory were analyzed. The clinical manifestations were cough and shortness of breath. One of them showed Mosaic shadows and uneven perfusion in both lungs on CT, while the other was normal. Field investigation found that 4 of the 8 workers in the factory were found to have obstructive ventilation disorder, and 2 had small airway dysfunction. This paper summarizes the diagnostic process of patients in order to improve the understanding of airway dysfunction caused by occupational exposure to diacetyl and promote the development of relevant standards.
Humans ; Diacetyl/adverse effects* ; Occupational Diseases/diagnosis* ; Occupational Exposure/adverse effects* ; Lung ; Bronchiolitis Obliterans/diagnosis*

Objective: To explore the correlation between the attachment type of lateral pterygoid muscle (LPM) and the position of temporomandibular joint (TMJ) disc in patients with temporomandibular disorders (TMD) by using wireless amplified magnetic resonance imaging detector (WAND) coupled with conventional head and neck joint coil for high resolution imaging of TMJ. Methods: Eighty-five patients with TMD diagnosed by oral and maxillofacial surgeons of Guizhou Provincial People's Hospital from October 2019 to January 2022 were collected. A total of 160 TMJ were included. There were 16 males and 69 females, aged (32.7±14.2) years. All patients were scanned with open, closed oblique sagittal and coronal WAND coupled head and neck coils with bilateral TMJ. Based on TMJ and LPM high resolution imaging, to explore the correlation between LPM attachment types and the position of TMJ disc in TMD patients, and to evaluate the potential clinical value of LPM attachment types in TMD patients. χ² test and Pearson correlation analysis were used to evaluate the correlation between LPM attachment type and TMJ disc location. Results: There were three types of LPM attachment: type Ⅰ in 51 cases [31.9% (51/160)], type Ⅱ in 77 cases [48.1% (77/160)] and type Ⅲ in 32 cases [20.0% (32/160)]. There was a significant correlation between the type of LPM attachment and the position of articular disc (χ²=28.20, P=0.002, r=0.776). There was no statistical significance between the type of LPM attachment and the reversible displacement of articular disc (χ²=0.24, P=0.887, r=0.825). Conclusions: There is a correlation between the attachment type of LPM and the position of the disc in TMD patients. WNAD coupled with conventional head and neck joint coil TMJ high resolution scan can provide reliable imaging evidence for TMD patients in evaluating the type of LPM attachment and the location of disc.
Male ; Female ; Humans ; Temporomandibular Joint Disc/pathology* ; Pterygoid Muscles/pathology* ; Joint Dislocations ; Temporomandibular Joint Disorders/diagnostic imaging* ; Magnetic Resonance Imaging/methods* ; Temporomandibular Joint/pathology*

Objective:To summarize and analyze the results of the individual dose intercomparison in which province-level health institutions participating, and explore the role of ability intercomparison in improving the detection capabilities of province-level health institutions.Methods:From 2009 to 2022, the results obtained by the province-level CDCs and occupational prevention and control institutions in the individual dose intercomparison countrywide for time periods of 2009—2020 and 2021—2022 were summarized. The intercomparison results were analyzed and compared for three regions of east, central and west China divided according to the method from China Health Statistics Yearbook 2022.Results:A total of 24 province-level CDCs and 14 occupational prevention and control institutions countrywide participated in the ability intercomparison from 2009—2022 for 13 times. Number of participating institutions increased from 26 in 2009 to 37 in 2022. The qualified rates of the intercomparison results among the province-level health institutions in the three regions were maintained at higher than 85% for 37 times and 100% for 28 times. The pass rate and excellent rate of the three regions were higher than the overall level at whole country level (2009-2020) and national level (2021-2022) in the same period for 9 and 5 times, respectively. The excellent rate of province-level health institutions in central region were higher than that of the other two regions in 9 intercomparisons.Conclusions:With the improvement of the intercomparison standard, the province-level health institutions in various regions have maintained a relatively stable and high detection capability. The ability intercomparison effectively improve the detection ability and the quality control of the province-level health organizations. Many province-level agencies have listed the ability intercomparison as the regular work.

Objective:To evaluate the feasibility of artificial intelligence (AI) diagnosis of pulmonary nodules on virtual non-contrast(VNC) images derived from dual-layer detector spectral CT.Methods:Totally 52 patients who underwent non-contrast and dual-phase enhanced chest CT scan from May 2022 to November 2022 were enrolled in this study. The VNC images of lung were reconstructed based on venous phase data. CT values and image noise of lung parenchyma, signal-to-noise ratio (SNR) were measured. The dose-length product (DLP) of each scan was recorded and the effective dose ( E) was calculated. All of the objective indicators of image quality and radiation dose were compared by Paired t test. Image quality was evaluated subjectively by two radiologists and compared with Wilcoxon non-parametric test. Wilcoxon symbolic rank test was used to compare the sensitivity and false positive detection rate (FPDR) of AI diagnosis between two groups. Results:Compared with TNC, the noise of venous VNC image was decreased by 13.8%, SNR increased by 14.9%, and both of DLP and E decreased by 33.3% ( t=5.82, -5.35, 22.93, 22.92, P <0.05). There were no significant differences in CT values and subjective scores between 2 groups ( P >0.05). For different types of pulmonary nodules, there was no statistical difference in the sensitivity of AI diagnosis between two groups ( P >0.05). For solid nodules with diameter ≤4 mm and all pulmonary nodules in general, FPDR in VNC group was slightly increased with statistical significance ( Z=-2.03, -3.09, P<0.05), while for other types of pulmonary nodules, there was no statistical difference ( P >0.05). Conclusions:The VNC images of thoracic venous phase based on spectral CT can significantly reduce the radiation dose of patients while the image quality and the AI diagnostic sensitivity of pulmonary nodules remain unchanged, and the FPDR without significantly increase. And it could replace TNC for daily routine.