To summarize the clinical efficacy of robotic-assisted left thoracic small-incision minimally invasive direct coronary artery bypass grafting （MIDCAB）.

A retrospective analysis was conducted on the procedures and treatment outcomes of robotic-assisted MIDCAB in the Army Medical Center of PLA from October 2016 to June 2023. Baseline clinical information，MIDCAB-related data，perioperative conditions and data during follow-up were collected and analyzed.

There were 23 patients subjected，including 21 males and 2 females，with a mean age of 58.17±7.49 years，and a body mass index （BMI） of 23.99±3.25 kg/m². All of them experienced angina pectoris，and 1 had a history of myocardial infarction，1 had dilated cardiomyopathy，2 patients had chronic obstructive pulmonary disease （COPD），and 10 had a history of percutaneous coronary intervention （PCI）. Robotic-assisted MIDCAB procedure was successfully completed. No internal mammary artery injury or transformation of the procedure occurred in these cases，and excellent bridging vessel flow was achieved after anastomosis of the internal mammary artery to left anterior descending branch. The incision length in the left chest was 8 （8，8） cm，the operation time was 380 （300，465） min，the intraoperative bleeding volume was 300 （100，400） mL，the length of ICU stay was 3 （2，3） d，the amount of thoracic drainage was 780 （525，1 040） mL，and the postoperative length from surgery to discharge was 11.17±2.38 d. No mortality was observed during or within 30 d of hospitalization，and 1 patient was readmitted due to pericardial effusion within 30 d，and was discharged after symptomatic treatment including pericardiocentesis and drainage. No deaths，major adverse cardiovascular and cerebrovascular events （MACCE），or re-revascularization occurred in all patients during outpatient and telephone follow-up.

Robotic-assisted internal mammary artery dissection is a delicate and safe technique，and coronary artery bypass grafting in minimally invasive small-incision off-pump is effective，safe and feasible，with satisfactory short- and mid-term outcomes. The technique is suitable for minimally invasive coronary artery disease surgery and is worthy of popularization and application.

To analyze the diversity and composition changes of gut fungal communities between patients with chronic kidney disease （CKD） and healthy controls.

A total of 8 CKD patients admitted in Department of Nephrology of our hospital，and another 5 age- and gender-matched healthy individuals were recruited in this study. Fresh fecal samples were collected from the CKD patients and healthy controls. ITS DNA sequencing was employed to determine the composition of intestinal fungi，and then bioinformatics analysis was applied to compare the differences in fungal community diversity，structure，and function between the 2 groups.

There were no statistical differences between the 2 groups in terms of age，gender composition，BMI，and so forth. The results of Alpha diversity assessment showed statistical differences were observed in Simpson index and Shannon index in the intestinal fungi between the 2 groups （P<0.01）. So was in the Beta diversity between them （P<0.01）. The relative abundance of Candida was increased significantly （P<0.01），while those of Cladosporium and Penicillium were decreased in the CKD group （P<0.05）. LEfSe analysis revealed that Candida was significantly enriched in CKD patients，whereas Cladosporium and Penicillium were significantly lower in abundance when compared to the healthy control group.

The composition of intestinal fungi in CKD patients is different from that in healthy individuals，exhibiting characteristic changes. Dysfunction of gut fungal flora may promote the progression of CKD. Regulating gut fungi and restoring gut microbiota homeostasis may become a new strategy for CKD treatment.

To investigate the diagnostic value of our regression model based on quantitative parameters of dual-energy CT and clinical features for stages T2 and T3 colorectal cancer.

A cross-section study was performed on 91 patients with colorectal cancer confirmed by postoperative pathology in our hospital from January 2022 to November 2023. All of them underwent dual-energy CT examination. According to the pathological T staging criteria of Chinese Colorectal Cancer Diagnosis and Treatment Standard （2020 Edition），they were divided into T2 group （n=43） and T3 group （n=48）. Univariate analysis was used to compare the differences in quantitative CT parameters and clinical features between the 2 groups，and the obtained significant variables were employed to construct diagnosis models by univariate or multivariate logistic regression analysis. The area under receiver operating characteristic curve （AUC） of the CT parametric model and the model combined with clinical features was compared to evaluate the efficacy of diagnosing T2 and T3 stages.

Univariate analysis showed that carcinoembryonic antigen （CEA），N stage，tumor location，tumor longest diameter （LD），CT value of virtual noncontrast （CT-VNC），fat fraction，electron density （Rho） and dual energy index （DEI） were significantly different between the T2 and T3 groups （P<0.05）. Multivariate logistic regression analysis found that N stage，tumor location，LD，fat fraction and DEI were independent risk factors for the diagnosis of stage T3. The AUC value of the model of above CT parameters in diagnosing stage T3 colorectal cancer was 0.671 （95%CI：0.558~0.783），and the AUC value of the combined model of above CT parameters and clinical features was 0.886 （95%CI：0.815~0.957），and statistical difference was observed in the AUC value between the combined model and the CT parametric model （P<0.01）.

The regression model constructed with dual-energy CT quantitative parameters combined with clinical features has high value in the preoperative diagnosis of stages T2 and T3 colorectal cancer before surgery.

To investigate the influencing factors of pain during ultrasound-guided puncture sclerotherapy in the treatment of ovarian chocolate cyst (OEC).

A retrospective cohort study was conducted on 209 OEC patients undergoing ultrasound-guided puncture sclerotherapy in our department from September 2021 to September 2023. Demographic data, medical history and surgical information were collected. According to surgical approach, they were divided into transabdominal surgery group (n=57) and transvaginal surgery group (n=152). Pain scores were assessed at 5 surgical time points: needle insertion, irrigation, displacement, sclerosis, and needle withdrawal. Pain scores were compared between the 2 groups at each surgical moment. According to the pain scores at the moments of needle insertion and replacement, the patients were divided into the no/mild pain group (pain score ≤3) and the moderate/severe pain group (pain score ≥4), and the related factors of the incidence of moderate/severe pain were analyzed.

There was no statistical difference in intraoperative pain between different surgical approaches (transabdominal/transvaginal) in treating OEC under the guidance of ultrasound. At the moment of needle insertion, significantly higher incidence of moderate/severe pain was observed in the patients with a body mass index (BMI) >23.9 kg/m² than those with BMI ≤23.9 kg/m², and those with a history of dysmenorrhea than those without (P<0.05). At the time point of displacement, BMI and history of dysmenorrhea had no correlation with the incidence of moderate/severe pain. Age, obstetric history, mode of delivery, time of menarche, menstrual volume, history of pelvic surgery, history of combined adenomyosis, size of cysts, duration of surgery, and surgical approach had no notable impacts on intraoperative pain.

Different surgical approaches for ultrasound-guided puncture sclerotherapy of OEC have no effect on pain levels at various surgical moments. From the aspect of humanistic care, transabdominal puncture should be preferred. During needle insertion and displacement, particular attention should be given to the overweight patients and those with a history of dysmenorrhea, and appropriate pain intervention measures should be formulated.

To analyze the risk factors for chronic mountain sickness （CMS） in young male migrants living in high-altitude areas and to construct a diagnostic model and evaluate its diagnostic efficacy.

From June 10 to December 29，2023，a cross-sectional study was conducted on young male migrants subjected with convenience sampling who had been living in high-altitude areas （4 500~5 000 m） for 6 months or longer. Their demographic data were collected and blood samples were collected for laboratory test. According to the Qinghai Score for Chronic Mountain Sickness，they were divided into CMS group and non-CMS group. Then the participants were randomly divided into a training set and a test set in a ratio of 8∶2. Independent risk factors for CMS occurrence were screened out，through random forest variable importance ranking，univariate and multivariable logistic regression analysis，and a diagnostic model was constructed based on these factors. Receiver operating characteristic （ROC） curve analysis，calibration curve analysis，clinical decision curve analysis，and influence curve analysis were used to comprehensively evaluate the diagnostic performance of the model.

According to the inclusion and exclusion criteria，308 out of 376 participants were finally subjected，and 17.53% of them were diagnosed with CMS. The major clinical symptoms of the CMS patients were dyspnea or palpitations （79.63%） and sleep disorders （85.19%）. Further analysis revealed that creatine kinase-MB/creatine kinase （CK-MB/CK， OR=2.17，95%CI：1.43~3.28），high-altitude residence time （OR=2.44，95%CI：1.08~5.54），and body mass index （BMI，OR=1.62，95%CI：1.05~2.50） were 3 major independent risk factors for CMS. The area under the curve （AUC） value of the CMS diagnostic model in the training set and test set was 0.821 （95%CI：0.756~0.886） and 0.821 （95%CI：0.700~0.944），the specificity was 66.30% and 73.90%，the sensitivity was 89.50% and 81.20%，respectively，indicating good discrimination ability. Hosmer-Lemeshow goodness-of-fit test showed consistency between predicted results and actual observations （χ²=10.029，P=0.263； χ²=4.477，P=0.812）. Clinical decision curve analysis demonstrated that within the threshold probability range from 0.1 to 0.7，the net benefit of the model exceeded both full intervention and no intervention strategies. The influence curve analysis showed high consistency between the model predictions and actual incidence when the threshold probability exceeded 0.4. These two analyses together confirmed the clinical application value of the model.

CK-MB/CK，high-altitude residence time and BMI are independent risk factors for CMS，and their diagnostic model helps identify potential individuals at risk for CMS. Early intervention can prevent the harm of CMS to the health of young men migrating to high-altitude areas.

To construct risk models for predicting the occurrence of high altitude de-acclimatization syndrome （HADAS） in the population returning from the plateau to the plain based on different machine learning algorithms and validate the predicting efficiency of these models.

Field or online surveys were conducted on the individuals who had ended their high-altitude living and returned to the plain areas from November 2020 to February 2024. Basic information，chronic mountain sickness （CMS），HADAS symptoms and other data were collected. With the inclusion and exclusion criteria，totally 1 095 individuals were subjected and assigned into the modeling group. Positive events were defined as HADAS score >5. Then the modelling group was divided into a training set （n=766） and an internal test set （n=329） in a 7∶3 ratio. Least absolute shrinkage and selection operator （LASSO） regression was used to select independent variables. Risk prediction models for high-altitude adaptation symptoms were built based on 8 machine learning methods，including multiple factor logistic regression （LR），decision tree （DT），random forest （RF），eXtreme gradient boosting （XGB），support vector machine （SVM），K-nearest neighbor （KNN），light gradient boosting （LGB） and naïve bayes （NB）. The models were compared and evaluated using receiver operating characteristic （ROC） curves，calibration curves and confusion matrices in the internal test set. The final model was presented using a nomogram or Shapley additive explanations （SHAP） algorithm. In August 2024，another 132 individuals who returned to the plains and met the same criteria were recruited and served as the external validation group.

There were 549 individuals （50.14%） out of the 1 095 subjects having HADAS symptoms. LASSO regression identified CMS score，age and duration of high-altitude residence as significant predictors. Among the 8 machine learning algorithms，the LR model was identified as the best，with an area under the curve （AUC） value of 0.819 （95%CI：0.789~0.850） and 0.841 （95%CI：0.799~0.884），and an F1 score of 0.801 in the internal test set，respectively，and the AUC value and F1 score of the LR model were the largest among the 8 models in the internal test set. Spiegelhalter Z test of the calibration curve of the LR model indicated that its P=0.703 in the training set while P=0.281 in the internal test set. The AUC value of the LR model was 0.867（95%CI：0.765~0.969） in the external validation set.

The LR model constructed based on indicators including CMS score，age and duration of high-altitude residence has a good overall performance in the internal test set，and good discriminating effect in the external validation set. The constructed nomogram is convenient for application.

To explore the characteristics of military training injuries in high-altitude troops and determine the possible impact of daily diet on these training injuries in order to provide theoretical reference for scientific training and medical service support for high-altitude troops.

A cross-sectional scheme was adopted in this study. A self-designed Military Training Injury Questionnaire for Plateau Troops was used to survey the officers and soldiers from resident high-altitude troops in July 2024 for their training injuries，daily diet，and other situations. The obtained data were statistically analyzed.

Among the 3 655 participants，the incidence of military training injuries was 17.87%. The subject with highest incidence was physical training （45.94%），the most common season was winter （31.39%）. The most common sites of injury were waist （28.48%），knees （22.21%），and ankles （18.07%），and the most common types were sprains （28.48%），chronic fatigue injuries （18.38%） and strains （12.25%）. The intake amounts of coarse grains and potatoes，bean products，aquatic products and nuts were relatively low in the daily diet of high-altitude troops. Multivariate logistic regression analysis found intake of fruit （OR=0.625，95%CI：0.508~0.768，P<0.001） and of nut （OR=0.759，95%CI：0.654~0.879，P<0.001） were correlated with the occurrence of training injury.

The occurrence pattern of military training injuries in high-altitude troops in this survey is basically consistent with that of previous reports，but the incidence rate is slightly decreased. Regular consumption of fruit and nut may be protective factors for the occurrence of training injuries.

To investigate the effects of plateau hypoxia on the growth and tumor microenvironment of colorectal carcinoma in vivo.

A total of 16 male BALB/C mice （6 weeks old，weight 18-20 g） were randomly divided into plateau hypoxic group and plain normoxic group，with 8 mice in each group，while 14 male C57BL/6 mice were grouped in same way，with 7 mice in each group. The mice in the plateau hypoxic group were housed in a low-pressure oxygen （10%） chamber to simulate an altitude of approximately 5 600 m，while the mice of the other group was maintained in SPF-grade normal atmospheric conditions （21% oxygen，at an altitude of about 300 m）. Colorectal tumor MC38 cells and colon adenocarcinoma CT26 cells were subcutaneously implanted into C57BL/6 mice and BALB/C mice，respectively to construct subcutaneous tumor-bearing mouse models. Then the tumor size and weight were measured in 4 groups of mice. After the tumor tissues，spleen and blood samples were collected in the C57BL/6 mice. Flow cytometry was used to determine the percentages of macrophages，T lymphocytes，IFN-γ⁺ T lymphocytes，and myeloid-derived suppressor cells （MDSC）. The differences in these immune cells were compared between the cells from the plateau hypoxic group and those from the plain normoxic group.

The weight of subcutaneous tumor mass was significantly inhibited in both C57BL/6 and BALB/C mice from the plateau hypoxic group than those from the 2 plain normoxic groups （0.17 vs 0.09 g，1.38 vs 0.51 g， P<0.01）. When compared with the immune cells from the tumor mass of the plain normoxic C57BL/6 mice，the percentage of M2-type macrophages was reduced in the tumor tissue from the plateau hypoxic mice（22.13% vs 15.90%， P<0.05），so was that of MDSC （2.06% vs 1.05%， P<0.01），particularly in the monocytic （M）-MDSC subgroup （60.97% vs 41.13%，P<0.01）. While，no significant change was observed in the proportion of the polymorphonuclear （PMN）-MDSC subgroup （10.97% vs 9.70%，P>0.05）. Additionally，the percentage of CD4⁺ T cells was significantly reduced （48.70% vs 41.93%，P<0.05），whereas that of CD8⁺ T cells was obviously increased （41.25% vs 51.18%，P<0.05），along with a notable rise in the proportions of IFN-γ⁺ T，IFN-γ⁺ CD4⁺ T and IFN-γ⁺ CD8⁺ T cells （28.58% vs 59.65%，23.33% vs 53.65%，36.9% vs 66.48%，P<0.01）. However，between the peripheral blood samples of the 2 groups of C57BL/6 mice，the proportions of M1-type macrophages and CD4⁺ T cells were reduced （84.98% vs 78.43%，5.86% vs 4.01%， P<0.01），and those of MDSC and PMN-MDC were increased （4.47% vs 16.43%，36.56% vs 62.97%，P<0.01）. In the spleen tissues，notable decreases were observed in the proportions of CD8⁺ T cells and IFN-γ⁺ CD8⁺ T cells between the 2 groups （33.05% vs 27.68%，5.13% vs 1.58%，P<0.01）.

Plateau hypoxia improves the immune response within the tumor microenvironment，and inhibits subcutaneous tumor growth of colorectal cancer，but suppresses systemic immune response.

To investigate the expression profile of cell adhesion molecular 3 （CADM3） on pulmonary endothelial cells，analyze its role in mediating specific adhesion to monocyte，and explore a new mechanism of hypoxia inducing peripheral monocyte infiltration in pulmonary vessels.

Human umbilical vein endothelial cells （HUVEC），rat pulmonary vascular endothelial cells （rPEC），and rat aortic endothelial cells （rAEC） were subjected，and divided into normoxic （21%O₂） control group and hypoxic （1%O₂ or 5%O₂） treatment group. Analyzing the transcriptome data of HUVEC exposure to hypoxia for 8 h screened a differentially expressed molecule，CADM3. Cell adhesion experiments，siRNA interference，immunohistochemical assay，Western blotting，and flow cytometry were used to study the role of CADM3 in hypoxia specific high adhesion of HUVEC monocytes. Iron chelator deferoxamine （DFX） and shRNA interference were employed to enhance the expression of HIF-1α，and the effect of HIF-1 transcriptional activity on CADM3 expression was analyzed.

Hypoxic treatment resulted in enhanced expression of CADM3 in HUVEC，and the expression level reached the peak at 6-8 h after hypoxia，and then decreased. Transfection with siRNA targeting CADM3 decreased the expression of CADM3，and significantly reduced the adhesion rate of hypoxic HUVEC-U937 cells when compared with the negative control group （P<0.05）. Compared with the solvent control group，the protein levels of HIF-1α and its target protein STC2 in HUVEC treated with DFX （100 μmol/L） were increased. Transfection with shRNA targeting HIF-1α led the protein levels of HIF-1α and its target protein STC2 decreased，but had no effect on the protein expression of CADM3 in comparison to the negative control group. The protein level and distribution of CADM3 on the cell membrane were increased in hypoxic rPEC. No expression of CADM3 protein was found in the rAEC when compared with rPEC. After treatment with 5 μg/mL LPS，there were no significant changes in HIF-1α，STC2 and CADM3 in rPEC cultured under normoxia or hypoxia. The adhesion rate between hypoxia rPEC with CD11b⁺ cells was the highest，with statistical significance （P<0.01）. After incubation with anti-CADM3 antibody，the adhesion of hypoxic rPEC-U937 was significantly decreased compared with the solvent control group （P<0.05）.

Hypoxia specifically induces the expression of CADM3 in pulmonary vascular endothelial cells in a HIF-1-independent manner，and promotes the specific adhesion of pulmonary vascular endothelial cells and monocytes induced by hypoxia.