Volume 105 · Issue 17 · 2025

Robotic-assisted joint reconstruction has gradually become a routine procedure in clinical practice. Robots enhance surgical precision, minimize soft tissue damage, and improve clinical outcomes in joint reconstruction. This article will discuss the impact of surgical robots on joint reconstruction surgery, transitioning from empirical knowledge to analytical understanding, and from experiential practice to refined precision. The application of robotic technology facilitates the parameterization and multivariable modeling of surgical parameters in joint replacement procedures, enabling the analytical elucidation of inter-parameter relationships. This variability and analytical capability endow the surgeons with an unprecedented level of multi-faceted information perception and information processing and analysis abilities. These innovations not only deepen but also revolutionize traditional understandings of joint replacement surgery, reshaping its objectives, procedural approaches, and prosthesis selection strategies. The optimization and individualization of multiple surgical parameters in joint reconstruction are now becoming achievable.

China is a high-burden country for tuberculosis (TB), and patients with rheumatic diseases (RD) are at significantly increased risk of TB infection and progression. Currently, there are no comprehensive clinical practice guidelines providing recommendations for the screening, diagnosis, treatment, and prevention of TB in RD patients. To address this issue, the Collaborative Group for TB Prevention and Control in Patients with RD in China, in collaboration with the Chinese Society of Clinical Epidemiology and Evidence-Based Medicine, Chinese Society of Rheumatology, Chinese Society of Tuberculosis and Chinese Society of Infectious Diseases, developed evidence-based recommendations. These were formulated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology and the Reporting Items for Practice Guidelines in Healthcare (RIGHT) standards. Based on the 14 clinical questions formed from the preliminary research, including: (1) which RD patients need to be screened for TB; (2) how to select the screening methods for TB; (3) whether to conduct re-screening for latent tuberculosis infection (LTBI) after the initial screening is negative; (4) how to diagnose and differentiate RD patients with active tuberculosis (ATB); (5) the indications and courses of empirical anti-TB treatment for RD patients suspected of ATB; (6) how to diagnose drug-resistant TB in RD patients with ATB; (7) the characteristics and management of subclinical TB in RD patients with ATB; (8) the recommended treatment regimens and courses for TB in RD patients; (9) the interaction between anti-TB drugs and RD treatment drugs and how to choose alternative regimens; (10) how to handle adverse drug reactions during anti-TB treatment in RD patients; (11) how to evaluate the effectiveness of anti-TB treatment in RD patients; (12) the indications for initiating tuberculosis preventive treatment (TPT) in RD patients; (13) the recommended regimens and courses for TPT in RD patients; (14) the protection period of TPT and whether to repeat it, detailed evidence-based recommendations were provided, aiming to offer decision support for clinical practice.

Chronic active Epstein-Barr virus disease (CAEBVD) is a group of lymphoproliferative diseases caused by Epstein-Barr virus (EBV) infection of T cells and/or natural killer (NK) cells. It has both inflammatory and clonal proliferative characteristics, and the disease is systemic and progressive. The clinical manifestations are diverse, which can involve multiple systems and it′s easy to miss diagnosis and misdiagnosis. In order to improve the understanding of CAEBVD among clinicians in China, based on the current evidence of evidence-based medicine, the Lymphocyte Group of Hematology Branch of the Chinese Medical Association, the Hematology Group of Pediatrics Branch of the Chinese Medical Association and the Infectious Disease Branch of the Chinese Medical Association organized medical experts in hematology, infection, pediatrics, pathology and other fields to discuss and formulate this expert consensus. A total of 13 recommendations were put forward from 8 aspects, including clinical manifestations, laboratory examination, pathological diagnosis and treatment. On this basis, the diagnostic criteria and treatment procedures of CAEBVD in China were formulated, aiming at improving the diagnostic level of CAEBVD in China and guiding standardized treatment.

Extracorporeal membrane oxygenation (ECMO) serves as a pivotal life-support modality. However, the associated increased brain injury and its prognosis and outcome have raised significant concern. To address these challenges, an interdisciplinary task force comprising neurologists, neurosurgeons, intensivists, emergency physicians, pediatricians, anesthesiologists, pharmacists, and medical ethics physicians collaboratively developed the "Expert consensus on the assessment of brain injury and determination of brain death during extracorporeal membrane oxygenation support". Utilizing a modified Delphi methodology and the Oxford Centre for Evidence-Based Medicine 2009 criteria, and guided by 29 clinical issues, the consensus analyzed and discussed 4 themes, including an overview of ECMO, brain injury during ECMO, brain function assessment during ECMO, and brain death determination during ECMO. A total of 9 recommendations were put forward, aiming to provide help and guidance for clinicians and improve the prognosis and outcome of patients.

To evaluate the clinical efficacy of drug-coated balloon (DCB) vs percutaneous transluminal angioplasty (PTA) for the treatment of in-stenting restenosis (ISR) in patients with complex long-segment combined with severely calcified femoropopliteal artery disease.

This study was a single-center retrospective cohort study that included 124 patients with femoropopliteal artery disease in the Department of Vascular Surgery, Gulou Hospital, Nanjing University School of Medicine, from January 2018 to June 2022. The patients were divided into 2 groups according to the surgical procedure used to treat restenosis: the PTA group (n=59) and the DCB group (n=65). All patients had primary restenosis after stenting, and CTA of both lower extremity arteries was performed after admission to determine the length of the lesion and the degree of calcification. The primary safety endpoints were the rate of adverse cardiovascular events at 30 days (MACEs) and all-cause mortality, the primary clinical endpoints were the 2-year phase Ⅰ patency rate and freedom from clinically-driven target lesion revascularization (FCD-TLR), and the secondary clinical endpoints were amputation-free survival (AFS), major amputation, minor amputation, and secondary open surgery rates. The Kaplan-Meyer (K-M) curves was used to analyze the differences between clinical and safety endpoints between the two groups, and univariate and multivariate Cox regression models were used to analyze the risk factors associated with 2-year phase Ⅰ patency rates in patients with femoropopliteal artery disease.

A total of 124 patients were included in this study. There were 41 males and 18 females in the PTA group, aged (73.6±9.7) years, with a mean lesion length of (20.2±10.7) cm, and 76.3% (45/59) of the patients with severe calcification; there were 42 males and 23 females in the drug-coated balloon group, aged (74.7±9.5) years, with a mean lesion length of (17.3±9.2) cm, and 77.0% (50/65) of patients with severe calcification. The PTA group had a significantly higher rate of minor amputations at 24 months than the DCB group [37.3% (22/59) vs 18.5% (12/65), P=0.035]. However, there were no significant differences between the PTA and DCB group in the two-year primary patency [15.3% (9/59) vs 16.9% (11/65)], FCD-TLR [22.0% (13/59) vs 24.6% (16/65)], AFS [33.9% (20/59) vs 41.5% (25/65)], major amputation rate [10.2% (6/59) vs 9.2% (6/65)], second open surgery rate [13.6% (8/59) vs 10.8% (7/65)], 30-day MACEs [1.7% (1/59) vs 1.5% (1/65)] and all-cause mortality [6.7% (4/59) vs 7.6% (5/65)](all P>0.05). Multifactorial Cox regression analysis showed that smoking (HR=1.95, 95%CI: 1.22-3.14, P=0.006) and severe calcification (HR=1.46, 95%CI: 1.30-1.72, P=0.001) were risk factors for reduced primary patency.

In patients with ISR of femoropopliteal artery disease associated with complex long segments with severe calcification, DCB can significantly reduce the rate of minor amputation in patients at 2 years compared with plain balloons, but there is no significant differences in other clinical and safety end points between the two treatment modalities.

To compare the differences in perioperative blood loss and the coagulation-fibrinolysis system between patients undergoing robot-assisted or traditional total knee arthroplasty (TKA).

A retrospective cohort study was conducted to analyze the clinical data of 232 patients who underwent TKA at the Department of Orthopedics, the First Affiliated Hospital of Chongqing Medical University, from March 2021 to September 2023. The cohort included 25 men and 207 women with a mean age of (69.1±7.5) years. The patients were further divided into two groups based on whether robot-assisted surgery was performed: the conventional group (168 patients, including 15 men and 153 women) and the robot-assisted group (64 patients, including 10 men and 54 women). Data on perioperative laboratory tests and postoperative complications were collected. The differences in perioperative blood loss, coagulation index (CI), fibrinolysis index, fibrinogen degradation products (FDP), D-dimer (D-D), and postoperative complications such as ecchymosis and venous thromboembolism (VTE) were compared between the two groups.

There was no statistically significant differences in the baseline characteristics between the two groups (all P>0.05). The incidence of bleeding-related complications, specifically ecchymosis, was significantly lower in the robot-assisted group compared to the conventional group [20.3% (13/64) vs 33.9% (57/168), P=0.043]. In terms of blood loss, the robot-assisted group exhibited significantly lower total blood loss and occult blood loss on the first postoperative day compared to the conventional group [total blood loss: (263±167) ml vs (382±173) ml, P<0.001; occult blood loss: (222±163) ml vs (342±173) ml, P<0.001]. Similarly, on the third postoperative day, the robot-assisted group had lower total blood loss and occult blood loss [total blood loss: (504±240) ml vs (680±222) ml, P<0.001; occult blood loss: (468±238) ml vs (640±222) ml, P<0.001]. Regarding coagulation function, the robot-assisted group had a lower CI on thromboelastography postoperatively (0.33±1.34 vs 0.93±1.59, P=0.008) and fewer patients with a hypercoagulable state (CI>3) [0 vs 7.1%(12/168), P=0.028]. In terms of fibrinolysis function, the robot-assisted group had lower levels of FDP and D-D on the first postoperative day [FDP: (6.24±4.49) mg/L vs (9.24±6.47) mg/L, P<0.001; D-D: (3.23±2.96) mg/L vs (4.23±2.97) mg/L, P=0.023].

Compared with manual TKA, robot-assisted TKA not only effectively reduces perioperative blood loss but also offers advantages in controlling postoperative hypercoagulability and hyperfibrinolysis.

To explore the correlation between fat and iron accumulation in the liver and pancreas of obese patients with glycemic metabolic indicators, and to analyze the risk factors for glycemic abnormalities in obese patients.

A prospective study enrolled 160 obese patients who visited Xiangya Third Hospital of Central South University from October 2022 to October 2023. The age [M (Q₁, Q₃)] was 40.8 (29.5, 43.9) years, with 74 males and 86 females. According to the results of the oral glucose tolerance test (OGTT), they were divided into the normal glucose metabolism (NGT) group(n=68), the impaired glucose tolerance (IGR) group(n=37), and the type 2 diabetes mellitus (T2DM) group(n=55). The proton density fat fraction (PDFF) measured by the MRI-based Dixon technique was used to quantitatively assess the fat content in the liver and pancreas, and the R2^* value was used to quantify the iron content in the liver and pancreas. Correlation analysis was used to analyze the correlation between fat and iron deposition in the liver and pancreas of obese patients and glucose metabolism indicators. The multivariate logistic regression model was used to analyze the influencing factors of abnormal glucose metabolism in obese patients.

The differences in liver PDFF, liver R2^*, pancreatic PDFF, and pancreatic R2^* among the three groups were all statistically significant (all P<0.05). The pancreatic PDFF in the T2DM group [12.8% (6.9%, 18.5%)] was higher than that in both the NGT group [7.6% (4.7%, 10.3%)] and the IGR group [7.0% (4.1%, 12.0%)] (all P<0.05). The pancreatic R2^* in the T2DM group [33.7 (28.3, 39.0)/s] was higher than that in the NGT group [28.6 (26.3, 33.3)/s] and the IGR group [28.5 (25.9, 32.9)/s] (all P<0.05). Significant differences were also observed among the three groups in terms of the homeostatic model assessment of insulin resistance (HOMA-IR), the homeostatic model assessment of β-cell function (HOMA-β), the insulin sensitivity index (ISI), and blood glucose levels at 0, 0.5, and 2.0 h during the oral glucose tolerance test (OGTT) (all P<0.05). The T2DM group had the lowest HOMA-β, while the NGT group had the highest (all P<0.05). Liver PDFF was positively correlated with HOMA-IR and blood glucose levels at 0, 0.5, and 2.0 h during OGTT (all r>0.25) and negatively correlated with ISI (r=-0.54) (all P<0.05). Pancreatic PDFF was negatively correlated with HOMA-β (r=-0.27) and positively correlated with blood glucose levels at 0, 0.5, and 2.0 h during OGTT (all r>0.24) (all P<0.05). Liver R2^* was positively correlated with HOMA-IR and blood glucose levels at 0, 0.5, and 2.0 h during OGTT (all r>0.24) and negatively correlated with ISI (r=-0.29) (all P<0.05). Pancreatic R2^* was negatively correlated with HOMA-β (r=-0.26) and positively correlated with blood glucose levels at 0, 0.5, and 2.0 h during OGTT (all r>0.21) (all P<0.05). Multivariate logistic regression analysis revealed that liver PDFF≥9.4% (OR=0.044, 95%CI: 1.03-5.76) was a risk factor for abnormal glucose metabolism in obese patients.

Fat and iron accumulation in the liver and pancreas of obese patients is closely related to the occurrence of abnormal glucose metabolism. Fat deposition in the liver is a risk factor for abnormal glucose metabolism in obese patients.

To investigate the predictive value of serum endocan and retinol-binding protein 4 (RBP4) levels for adverse pregnancy outcomes in patients with gestational diabetes mellitus (GDM).

A total of 151 GDM patients admitted to Yantaishan Hospital from May 2021 to April 2023 were enrolled as the GDM group, with an average age of (32.9±5.3) years. Based on the occurrence of adverse pregnancy outcomes, GDM patients were further divided into the adverse pregnancy outcomes group (n=30) and the normal pregnancy outcomes group (n=121). Clinical indicators were compared between two groups. Multivariate logistic regression was used to analyze risk factors for adverse pregnancy outcomes in GDM patients. The predictive value of serum endocan and RBP4 for adverse pregnancy outcomes in patients with GDM was assessed using the area under the receiver operating characteristic curve (AUC).

The adverse pregnancy outcomes group exhibited higher endocan [(176.63±38.80) vs (151.33±37.14) ng/L] and RBP4 [(44.71±3.89) vs (37.59±3.76) mg/L] levels compared to the normal pregnancy outcomes group (both P<0.05). Multivariate logistic regression model indicated that the elevated levels of endocan (OR=1.609, 95%CI: 1.707-4.660) and RBP4 (OR=1.874, 95%CI: 1.486-5.609) were risk factors for adverse pregnancy outcomes. The AUC for serum endocan in predicting adverse pregnancy outcomes in GDM patients was 0.742 (0.643-0.840). At a cut-off value of 162.20 ng/L, the sensitivity and specificity were 68.6% and 76.7%, respectively. The AUC for RBP4 in predicting adverse pregnancy outcomes in GDM patients was 0.845 (0.756-0.934). At a cut-off value of 41.30 mg/L, the sensitivity and specificity were 88.4% and 73.3%, respectively. When combining both markers, the AUC, sensitivity, and specificity were 0.901 (0.835-0.967), 87.6%, and 90.0%, respectively.

Elevated serum endocan and RBP4 levels are associated with adverse pregnancy outcomes in GDM patients. Monitoring these biomarkers may aid in risk stratification and clinical decision-making for GDM pregnancies.

The patient, a 59-year-old female, was admitted to the Hematology Hospital, Academy of Sciences, Chinese Medical College on January 28, 2023 due to "fatigue for more than 20 days". The patient had asthenia as the first manifestation, with elevated white blood cells, splenomegaly, and lymphocytes in blood smears. He was suspected of malignant lymphocytic proliferative disease. Conventional immunophenotype and immunohistochemistry suggested that mature small B lymphocytes were derived and did not conform to the phenotype of chronic lymphocytic leukemia. Spleen B-cell lymphoma/leukemia with obvious nucleolus was diagnosed after comprehensive examination results. Second-generation sequencing suggested TP53 hotspot mutation. After treatment with rituximab and bendamustine combined with veneclax, fatigue was reduced, white blood cells returned to normal, and spleen retracted. Follow-up until Oct. 26, 2024, the condition was stable.

This review systematically summarizes the recent advances in digestive endoscopy research in 2024, focusing on endoscopic 3E techniques [endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS), and endoscopic submucosal resection (ESD)], combined application of dual-scope, and endoscopic minimally invasive resection after comprehensive treatment, etc. On this basis, this paper looks forward to the future development direction of ERCP, EUS, ESD and related technologies, in order to provide useful reference for colleagues in the industry.

Hypothalamic obesity (HO) is a stubborn and severe type of obesity caused by congenital inherited diseases or acquired injuries or tumors in the hypothalamic site, mainly manifested as fatigue, decreased physical strength, hyperappetite, and severe obesity. In recent years, glucagon-like peptide-1 receptor agonist (GLP-1RA) has been widely used in diabetic and obese people. GLP-1RA can not only control blood sugar, but also suppress appetite, slow gastric emptying, improve energy metabolism, and play a better role in weight loss. Exenatide can reduce body fat mass, waist circumference and weight in HO patients, liraglutide can reduce total appetite and desire index in adolescent patients with Chubby Willie syndrome, and semaglutide has better weight loss efficacy in patients with severe obesity after craniopharyngioma surgery. GLP-1RA and glucose-dependent insulinotropic polypeptide receptor dual agonists and glucagon receptor triagonists also play a good weight loss role in diabetic and obese people, and are expected to play an important role in the future treatment of HO.

A 70-year-old male went to the Department of Vascular Surgery of the Second Xiangya Hospital of Central South University for "finding a pulsatile abdominal mass combined with high fever (>39 ℃) for 1 week". Deny abdominal pain and diarrhea, no nausea, vomiting, no melena, blood in the stool, jaundice and other symptoms. One month ago, he was discharged from the local hospital due to lumbar spine infection after conservative treatment. He had no history of abdominal surgery and trauma, and no history of special medication. Admission physical examination: blood pressure 120/80 mmHg (1 mmHg =0.133 kPa), body temperature 39.0 ℃, pulse 99 beats/min, clear mind, soft abdomen, a pulsatile mass about 4 cm ×5 cm in size can be palpable in the upper abdomen, without tenderness and rebound pain. Laboratory test at admission: white blood cells 7.78×10⁹/L, neutrophil ratio 72.4%, erythrocyte sedimentation rate 88 mm/1h, C-reactive protein 69.1 mg/L, procalcitonin 0.356 μ g/L; Blood culture showed streptococcal infection, rheumatic immunity and vasculitis tests were negative. Total aortic CTA revealed a 52 mm ×45 mm giant pseudoaneurysm in the middle of the superior mesenteric artery (red arrow in Figure 1, white arrow in Figure 2). Based on medical history, physical examination and imaging, the patient was diagnosed with pseudoaneurysm of the superior mesenteric artery secondary to lumbar spine infection. Considering that the patient is currently complicated with hyperthermia, the pathogenic susceptible antibiotic cefoperazone/sulbactam is given to anti-infection (3 g, once every 8 hours). After the patient's body temperature is normal for 3 consecutive days, digital subtraction angiography (DSA) of superior mesenteric artery is performed under local anesthesia. Superior mesenteric artery pseudoaneurysm is confirmed during the operation, and superior mesenteric artery stent implantation is performed. After stent implantation, re-angiography shows that the pseudoaneurysm is completely isolated and the branches have good blood supply (Figure 3). Cefoperazone/sulbactam anti-infective therapy was continued for 3 months and clopidogrel anti-platelet therapy was given for 6 months. During the 4-year follow-up, the patient recovered well, and no symptoms such as aneurysm recurrence and visceral ischemia were seen.