Objective:To explore the application status and research hotspots of robotic surgery system in surgical nursing based on literature analysis.Methods:Relevant literature on the application with robotic surgical nursing as the subject word was retrieved from CNKI,Wanfang Data,and VIP Chinese website from 2013 to 2022.CiteSpace software was used to extract information on authors,research institutions,and keywords,the cooperative relationships and research hotspots in this field were discussed and analyzed.Results:A total of 875 Chinese articles published between 2013 and 2022 were retrieved,and 454 articles were finally included in the analysis after deduplication screening.From 2013 to 2022,the annual number of papers published in robotic surgical nursing increased year by year,decreased slightly in 2019,and increased rapidly from 2021 to 2022,with 70 and 90 papers,respectively.The top 10 keywords with highest to lowest frequency were nursing,robotics,nursing cooperation,surgical cooperation,laparoscopy,perioperative,complications,prostate cancer,surgical nursing care and surgery.The degree of collaboration among different research institutions and authors was weak.Research hotspots included nursing cooperation and perioperative complication care.The research mainly focused on nursing experience sharing and nursing model discussion,while there were fewer studies on nursing quality standards,training models and relevant nursing interventions.Conclusion:Analysis of the application status and research hotspots of surgical nursing of robotic surgical system based on CiteSpace visualization software,can understand the research hotspots and trends of robotic surgery in the field of nursing by various research institutions and literature authors in China,and provide reference for the research direction of robotic surgery nursing.

Objectives:To explore the clinical use and observe the clinical efficacy of the Pivox system in oblique lateral interbody fusion(OLIF)in treating single-segment lumbar spinal diseases.Methods:The clini-cal data of patients with single-segment lumbar spinal diseases(Discogenic low back pain,lumbar spondylolis-thesis,lumbar spinal stenosis)who underwent OLIF without posterior instrumentation from May 2020 to Jan-uary 2021 in our hospital were collected,including 36 males and 33 females,aged 32-79 years old(59.1±5.9 years).And the patients were divided into OLIF stand-alone group(39 patients)and Pivox+OLIF group(30 pa-tients).The perioperative parameters of the two groups of patients were compared,including incision length,operative time,intraoperative blood loss,and length of hospital stay.The visual analogue scale(VAS)and Os-westry disability index(ODI)were assessed before operation,at 1 week,1,3,6 and 12 months after operation for clinical efficacy.The intervertebral disc height,foraminal height and foraminal area before and after oper-ation,and the fusion rate were evaluated and compared between the two groups.Complications were recorded and compared as well.Results:The patients were followed up for 14.0±0.3 months(12-18 months).No signif-icant differences were found between the two groups in gender,age,disease type,operative level,bone min-eral density(BMD),or body mass index(BMI)(P＞0.05).The operative time in OLIF group was shorter than that in Pivox+OLIF group(P＜0.05),while there were no significant differences in blood loss,incision length and hospital stay(P＞0.05).The VAS score and ODI index in both groups before surgery were higher than those at 1 week,1 month,3 months,6 months,and 12 months after surgery(P＜0.05).No significant differences in VAS and ODI were found at 1 week,1 month,3 months,6 months,and 12 months after surgery between the two groups,respectively(P＞0.05).The intervertebral disc height,foraminal height and foraminal area at postoperative 1 week,6 and 12 months were all greater than those before operation in both groups,while the increase values of intervertebral disc height,foraminal height and foraminal area in Pivox+OLIF group were greater than those in OLIF group at 1 week,and 6 and 12 months after surgery,but without statistical differ-ences(P＞0.05).Cage subsidence occurred in both groups,and cage displacement was noticed in two cases in the OLIF group,while none was there in the Pivox+OLIF group.There were no significant differences in fu-sion rate and incidence of complications between two groups(P＞0.05).Conclusions:The short-term effect of Pivox+OLIF procedure in the treatment of single-segment lumbar degenerative diseases is satisfactory,but comparing with stand-alone OLIF,Pivox+OLIF has no obvious advantage in spinal canal decompression and preventing cage subsidence.

Objectives:To investigate the effectiveness and safety of unilateral approach contralateral under-cutting decompression assisted with ultrasonic osteotome in treating severe degenerative lumbar spinal stenosis.Methods:174 patients with severe degenerative lumbar spinal stenosis who were treated with ultrasonic os-teotome assisted unilateral approach contralateral undercutting decompression between June 2018 and June 2021 were collected[unilateral approach bilateral decompression transforaminal lumbar interbody fusion(TLID group,group A],and 129 patients undergone bilateral transforaminal decompression during the same period were randomly selected as control(bilateral small incision TLIF group,group B).The perioperative parameters such as incision length,operative time,intraoperative blood loss,postoperative drainage,and length of hospital stay were recorded and compared between the two groups.Creatine phosphokinase(CPK)test was performed to evaluate muscle damage conditions,and visual analogue scale(VAS)and Oswestry disability index(ODI)were used to evaluate the postoperative therapeutic effects.The complications and fusion conditions were compared between the two groups.Results:There wasn't significant difference in average length of bilateral incisions and length of hospital stays between the two groups(P＞0.05).Group A was less significantly than group B in terms of operative time,intraoperative blood loss,and postoperative drainage,with statistical significance(P＜0.05).The preoperative CPK value was comparable between the two groups(P＞0.05),and on postoperative 1d and 3d it was statistically greater in group B than in group A(P＜0.05),but on postoperative 5d it wasn't sig-nificantly different between the two groups(P＞0.05).The postoperative VAS scores and ODI improved com-pared with the preoperative values in both groups on postoperative 3d,at 1 month,3 months,and 12 months(P＜0.05),and there was no statistical difference between the two groups respectively at the same follow-up period(P＞0.05),even though group A was better in ODI and VAS than group B at 12 months after operation.There was no significant difference between the two groups in postoperative complications such as dural tear,incision fat liquefaction,cerebrospinal fluid leakage and postoperative infection.Group A was less in the pro-portion of postoperative worsening lower limb numbness and rebound of hip/lower limb symptoms than in group B(P＜0.05).1 year after operation,12 cases in group A were not fused,and 8 cases in group B were not fused.There was no statistically significant difference in the bone graft fusion between the two groups(P＞0.05).Conclusions:Comparing with bilateral small incision TLIF,ultrasonic osteotome assisted unilateral ap-proach contralateral undercutting decompression also can achieve good treatment results,which features in less trauma,less effects on spinal stability,shorter operative time,and less intraoperative blood loss,and therefore worth in clinical promotion.

Objective:To screen the endoplasmic reticulum stress (ERS) signature-related differentially expressed genes (DEG) in gastric cancer and to construct a prognostic risk model based on a bioinformatics.Methods:Transcriptome sequencing data (RNA-seq) of 375 gastric cancer and 32 paracancerous tissue samples downloaded from The Cancer Genome Atlas (TCGA) database and the corresponding clinical information were obtained as training set samples; data of 387 gastric cancer patients (GSE84437) from Gene Expression Omnibus (GEO) database were downloaded as validation set samples. All data were obtained on December 25, 2021. A total of 785 ERS signature-related genes (ERS-RG) were obtained from the GeneCards database. DEG between gastric cancer tissues and paracancerous tissues in the TCGA database was analyzed. The identified gastric cancer DEG were intersected with ERS-RG from the GeneCards database to obtain gastric cancer ERS signature-related DEG, which were analyzed for gene ontology (GO) function and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment. Univariate Cox proportional risk model was used to screen ERS signature-related DEG with prognostic value in gastric cancer, and LASSO regression analysis was performed to construct a polygenic prognostic risk model, and to calculate the prognostic risk score. The patients in training set and validation set were divided into high-risk group and low-risk group according to the median of the prognostic risk score (2.369); Kaplan-Meier survival analysis was used to compare the overall survival (OS) and to draw time-dependent receiver operating characteristic (ROC) curves of patients in the two groups; nomogram was drawn based on the prognostic independent influencing factors of gastric cancer. The characteristic immune cell infiltration abundance between the two groups was analyzed by using the inverse convolution-based CIBERSORT algorithm. Cytolytic activity scores were calculated by using the geometric mean of granzyme A and perforin 1 expression. According to the median prognostic risk score (2.369) and median tumor mutation burden (TMB) (3.000), all patients with gastric cancer were divided into high risk score-high TMB group, high risk score-low TMB group, low risk score-high TMB group and low risk score-low TMB group to compare the OS of patients in each group.Results:A total of 444 ERS signature-related DEG in gastric cancer including 168 down-regulated genes and 276 up-regulated genes were obtained, which were mainly enriched in biological processes such as protein processing in the endoplasmic reticulum, extracellular matrix (ECM) receptor interactions and unfolded protein responses (all P < 0.05). Univariate Cox regression analysis showed that 12 prognostic-related ERS signature-related DEG in gastric cancer were screened out. LASSO regression analysis was performed to obtain a prognostic risk score = 0.052×NOS3+0.137×PON1+0.067×CXCR4+0.131×MATN3+0.116×ANXA5+0.090×SERPINE1. The results of Kaplan-Meier analysis showed that the OS of the low-risk group in both the training and validation sets was better than that of the high-risk group (all P < 0.01). The results of the time-dependent ROC curve analysis showed that the AUC for the 3-year, 5-year, 8-year OS rates was 0.695, 0.786, 0.698, respectively in the training set, while the AUC for the 3-year 5-year, 8-year OS rates was 0.580, 0.625, 0.627, respectively in the validation set. Multivariate Cox regression analysis showed that prognostic risk score ( HR = 3.598, 95% CI 2.290-5.655, P < 0.001) and tumor stage ( HR = 1.344, 95% CI 1.057-1.709, P < 0.05) were independent factors influencing the prognosis of gastric cancer. Among 375 gastric cancer patients in the TCGA database, the expression levels of ATF6, HSPA5, XBP1 and ATF4 in the high-risk group were higher than those in the low-risk group (all P < 0.05); CIBERSORT results showed that the abundance of activated CD4 memory T cells in the high-risk group was lower than that in the low-risk group, and the abundance of both M0 and M2 macrophages in the high-risk group was higher than that in the low-risk group (all P < 0.05). The expression levels of common immune checkpoints (CD274, CTLA4, TNFRSF9, TIGIT, PDCD1, LAG3) in the high-risk group were all higher than those in the low-risk group (all P < 0.05). Cytolytic activity score in the high-risk group was higher than that in the low-risk group ( P < 0.05). The prognostic risk score was negatively correlated with TMB ( r = -0.20, P < 0.001). Patients in the low-risk score-high TMB group had the best OS and those in the high-risk score-low TMB group had the worst OS (both P < 0.001). Conclusions:The prognostic risk score model is established based on 6 ERS signature-related DEG in gastric cancer and its prognostic risk score may be effective as an independent prognostic factor to predict the prognosis of gastric cancer patients.

Objective:To investigate the efficacy and safety of argon plasma coagulation (APC) in the treatment of patients with hemorrhagic chronic radiation proctitis (HCRP).Methods:The clinical data of 36 HCRP patients who received APC treatment in Shanxi Province Cancer Hospital between January 2017 and June 2021 were retrospectively analyzed. The severity of HCRP was assessed by using the Zinicola endoscopic score and the Vienna proctoscopy score. The elimination of rectal bleeding or occasional bloody stools that did not require further treatment within 6 months of the last APC treatment was considered to be the therapy success.Results:The median follow-up time was 1.63 years (0.85-2.68 years). There were 20 (55.6%) patients with severe HCRP according to the Zinicola endoscopic score. After APC treatment, 32 patients with HCRP obtained adequate rectal hemostasis, whereas 4 patients with severe HCRP still experienced rectal bleeding symptoms after APC treatment for several times. All patients received APC treatment for (2.7±1.0) times in total. The endoscopic scores of HCRP patients before and after APC treatment were (3.6±0.8) scores, (1.4± 1.1) scores, respectively; Vienna proctoscopy scores were (3.8±0.8) scores, (1.2±1.1) scores, respectively; and the differences were statistically significant ( t values were 22.37, 18.96; all P < 0.001). The hemoglobin levels of HCRP patients before and after APC treatment were (85±15) g/L, (100±17) g/L, respectively, and the difference was statistically significant ( t = 17.86, P < 0.001). Serious side effects including strictures, perforations, or fistulas and other severe complications related to APC therapy were not found. Conclusions:APC may be an effective and safe treatment option for patients with HCRP.

Objective:To explore the effect of the wearable low-level light therapy (LLLT) device on joint pain and knee function in community patients with knee osteoarthritis.Methods:From September 2021 to February 2022, the convenience sampling was used to select 57 middle-aged and elderly patients with knee osteoarthritis who met the inclusion criteria from 8 communities in Shijiazhuang as the study subject. The patients were randomly divided into intervention group ( n=27) and placebo group ( n=30) based on the community. The intervention group used wearable LLLT device to treat bilateral knee joints, while the placebo group wore the same phototherapy device, with the same frequency and duration as the intervention group, but did not turn on the light source. The patients were investigated with the Graphical Knee Osteoarthritis Patient Self-assessment Questionnaire and knee function test, and the joint pain and knee function of the two groups of patients during the study period were compared. Results:A total of 45 patients with knee osteoarthritis in the community completed the study, including 21 in the intervention group and 24 in the placebo group. The results of the Graphical Knee Osteoarthritis Patient Self-assessment Questionnaire showed that the total pain score of the intervention group were lower than that of the placebo group at the third and eighth weeks, with statistically significant differences ( P<0.01). At the eighth week, the scores of knee rest pain, starting pain and joint chills in the intervention group were significantly lower than those in the placebo group, and the differences were statistically significant ( P<0.01). The score of exercise pain in the third and eighth weeks showed a lower trend than that in the placebo group (0.01< P<0.05). There was no statistical difference in knee function test results between the two groups at the beginning of intervention and at the third week ( P>0.05) . Conclusions:Wearable LLLT devices can relieve the joint pain in patients with knee osteoarthritis in the community, but no significant improvement was found in knee function. The effect of wearable LLLT devices still needs to be further verified by multi-center, large sample and long-term follow-up study.

Closed-loop hospital management can effectivly cope with the COVID-19 pandemic. In order to ensure the continuity of treatments for hemodialysis patients under closed-loop management and minimize possible medical and infection risks, Huashan Hospital affiliated to Fudan University and 9 hospitals in Shanghai established a hemodialysis alliance in January 2021.The alliance optimized hemodialysis resources within the region through overall planning by preparing sites, materials and personnel shifts in advance, and establishing management systems and work processes to ensure that patients could be quickly and orderly diverted to other blood dialysis centers for uninterrupted high-quality hemodialysis services, in case that some hemodialysis centers in the alliance under closed-loop management.From November 2021 to April 2022, 317 of 1 459 hemodialysis patients in the alliance were diverted to other centers for treatment, accumulating 1 215 times/cases of treatments without obvious adverse reactions. The practice could provide a reference for medical institutions to quickly establish mutual support mode under major public health events.

Objective : To investigate the effects of glycated low density lipoprotein (Gly⁃LDL) on the growth of human umbilical vein endothelial cells (HUVECs) and the expression of toll like receptor 4 (TLR4) and hypoxia inducible factor⁃1α (HIF⁃1α), and to explore its possible mechanism . Methods : HUVECs were cultured in vitro and divided into control group, positive control group[50 mg/L normal low density lipoprotein(n⁃LDL)], low concentration, medium concentration and high concentration Gly⁃LDL(50, 75, 100 mg/L) groups . Respectively, the effects of different concentrations of Gly⁃LDL on survival rate of HUVECs were detected by CCK⁃8; The motility of HUVECs under different treatments were detected by wound healing assays; The level of inflammatory cytokine, such as tumor inducing factor⁃α(TNF⁃α), interleukin⁃6(IL⁃6), intercellular adhesion molecule⁃1(ICAM⁃1) and vascular cell adhesion molecule⁃1(VCAM⁃1) were detected by ELISA; The mRNA levels of TLR4, HIF⁃1α, TNF⁃α and IL⁃6 were detected by qRT⁃PCR; Protein expressions of TLR4, HIF⁃1α, TNF⁃α and IL⁃6 were detected by Western blot; Respectively, si⁃RNA of TLR4 and HIF⁃1α was used to intervene the effects of Gly⁃LDL on HUVECs . The experiment was divided into control group, model group (Gly⁃LDL 100 mg/L), si⁃TLR4 group (Gly⁃LDL 100 mg/L + si⁃TLR4), TLR4 unloading group( Gly⁃LDL 100 mg/L + si⁃NC1), si⁃HIF⁃1α group ( Gly⁃LDL 100 mg/L + si⁃HIF⁃1α) and HIF⁃1α unloading group ( Gly⁃LDL 100 mg/L + si⁃NC2) . Protein expressions of TLR4 and HIF⁃1α were detected by Western blot to verify the interaction between TLR4 and HIF⁃1α . Results: The survival rate and migration rate of HUVECs were inhibited in Gly⁃LDL(50 mg/L, 75 mg/L, 100 mg/L) group (P < 0. 01), the inflammatory cytokines, such as TNF⁃α, IL⁃6, ICAM⁃1,VCAM⁃1 increased by Gly⁃LDL function on HUVECs(P < 0. 001), and the mRNA and protein levels of TLR4, HIF⁃1α, TNF⁃α and IL⁃6 increased by Gly⁃LDL in a dose dependent manner. After TLR4 was knocked out, the proteins expression of TLR4 and HIF⁃1α were down⁃regulated compared with model group(P < 0. 05),but after HIF⁃1α was knockout, only the protein expression of HIF⁃1α was down⁃regulated compared with model group( P < 0. 01),while the protein expression of TLR4 was up⁃regulated under the influence of Gly⁃LDL. Conclusion Gly⁃LDL may inhibit the proliferation and migration of HUVECs by up⁃regulating TLR4/HIF⁃1α inflammatory signaling pathway, and promote the expression of inflamma⁃tory cytokines, leading to vascular endothelial injury .

Objective:To explore the genetic basis for a proband with Shprintzen-Goldberg syndrome (SGS).Methods:Whole exome sequencing was carried out to detect potential variants associated with the relevant phenotypes. Candidate variants were verified by Sanger sequencing of the patient and her family.Results:DNA sequencing revealed that that the proband has carried a de novo heterozygous missense c. 94C>G (p.Leu32Val) variant in exon 1 of the SKI gene (NM_003036), which has been reported previously. The same variant was not detected in either parent. Based on the guidelines of the American College of Medical Genetics and Genomics, the variant was predicted to be pathogenic (PS1+ PS2+ PM1+ PM2+ PP2+ PP3). Conclusion:The SKI c. 94C>G (p. Leu32Val) variant probably underlay the autosomal dominant SGS in this patient.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.