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The Da Vinci Robot is the most advanced micro-control system in endoscopic surgical instruments and has gained a lot of valuable experience today. However, the technical feasibility and oncological safety of the robot over open surgery are still uncertain. This work is to systematically evaluate the efficacy of the unilateral axillary approach for robotic surgery compared to open surgery for differentiated thyroid carcinoma. PubMed, Embase, Cochrane Library, and Web of Science databases were utilized to search for relevant literatures of robotic thyroid surgery using unilateral axillary approach compared to open thyroid surgery, and a meta-analysis was performed using RevMan software version 5.3. Statistical analysis was performed through Mantle-Haenszel and inverse variance methods. Twelve studies with a total of 2660 patients were included in the meta-analysis. The results showed that compared with the open group, the robotic group had a longer total thyroidectomy time, shorter hospital stay, less intraoperative bleeding, more postoperative drainage, fewer retrieved central lymph nodes, and higher cosmetic satisfaction (all P < 0.05). In contrast, temporary and permanent laryngeal recurrent nerve injury, temporary and permanent hypoparathyroidism or hypocalcemia, brachial plexus nerve injury, number of retrieved central lymph nodes, number of retrieved lymph nodes in the lateral cervical region, number of lymph node metastases in the lateral cervical region, hematoma, seroma, lymphatic leak, stimulated thyroglobulin (sTg) and unstimulated thyroglobulin (uTg), and the number and recurrence rate of patients with sTg <1ng/ml were not statistically different between the two groups (P > 0.05). The unilateral axillary approach for robotic thyroid surgery may achieve outcomes similar to those of open surgery. Further validation is required in a prospective randomized controlled trial.

Objective: Recurrent laryngeal nerve (RLN) injury is a serious complication during thyroid reoperation. Intraoperative neuromonitoring (IONM) is one of the means to reduce RLN paralysis. However, the role of IONM during thyroidectomy is still controversial. The aim of this study was to assess whether the IONM could reduce the incidence of RLN injury during thyroid reoperation. Methods: We performed a systematic review to identify studies in English language which were published between January 1, 2004, and March 25, 2023 from PubMed, EMBASE, and Cochrane Library, comparing the use of IONM and Visualization Alone (VA) during thyroid reoperation. The RLN injury rate was calculated in relation to the number of nerves at risk. All data were analyzed using Review Manger (version 5.3) software. The Cochran Q test (I2 test) was used to test for heterogeneity. Odds ratios were estimated by fixed effects model or random effects model, according to the heterogeneity level. Results: Eleven studies (3655 at-risk nerves) met criteria for inclusion. Data presented as odds ratio(OR) and their 95% confidence intervals(CI). Incidence of overall, temporary, and permanent RLN injury in IONM group were, respectively, 4.67%, 4.17%, and 2.39%, whereas for the VA group, they were 8.30%, 6.27%, and 2.88%. The summary OR of overall, temporary, and permanent RLN injury compared using IONM and VA were, respectively, 0.68 (95%CI 0.4-1.14, p=0.14), 0.82 (95%CI 0.39-1.72, p=0.60), and 0.62 (95%CI 0.4-0.96, p=0.03). Conclusions: The presented data showed benefits of reducing permanent RLN injury by using IONM, but without statistical significance for temporary RLN injury. doi: https://doi.org/10.12669/pjms.40.8.8241 How to cite this: Ji S, Hu M, Zhang C, Pei M. Systematic review with meta-analysis of intraoperative neuromonitoring during thyroid reoperation. Pak J Med Sci. 2024;40(8):1860-1866. doi: https://doi.org/10.12669/pjms.40.8.8241 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This paper presents a study on the inter-regional supply chain which helps company to manage the flow of components among regions of affiliate’s and Joint Ventures. Using a type of mode named as IRF (Inter-Regional Flow), the company will be able to create simplified supply chain network and reduce complexity for operation. Other resulting advantages include centralization of capacity management, utilization of sharing of parts from common and modified supplier tooling, and reduction of logistic and manpower cost for the receiving region in purchasing, manufacturing and supply chain management.

The potential hazards of triazole fungicides to non-target organisms necessitate environmental risk assessment. This study, therefore, focused on characterizing the differential toxicity of the enantiomers of Ipfentrifluconazole (IFZ), a new triazole fungicide, in zebrafish larvae using a multi-endpoint approach. Acute toxicity tests determined the LC50 values of 1.709 mg/L for rac-IFZ, 1.531 mg/L for (+)-IFZ, and 1.809 mg/L for (−)-IFZ, indicating a higher toxicity of the (+)-enantiomer. To avoid overt mortality while revealing organ-level effects, we chose a concentration of approximately 20% of the LC50 of (+)-IFZ, which is 340 μg/L, as the exposure concentration. Exposure to IFZ induced developmental defects, including swim bladder malformation, cardiac blood pooling, and metabolic disturbances during the early developmental stage of zebrafish. Additionally, cardiac and hepatic development and function were disrupted in zebrafish larvae following IFZ exposure. Biochemical and transcriptomic analyses revealed distinct toxic mechanisms: (+)-IFZ primarily disrupted lipid metabolism through alterations in PPAR signaling pathway and fatty acid degradation, while (−)-IFZ significantly impaired cardiac function by affecting adrenergic signaling in cardiomyocytes and cardiac muscle contraction. Rac-IFZ mainly influenced drug metabolism, particularly cytochrome P450-related pathways. These findings demonstrated the toxic effects of IFZ, emphasizing the need for evaluating environmental and health risks of chiral pesticides. The study provides valuable insights into the molecular mechanisms underlying IFZ toxicity.

Background Imatinib is the standard first‐line treatment for advanced gastrointestinal stromal tumors (GISTs); however, most patients eventually develop imatinib resistance, leading to considerable clinical challenges. Few direct comparisons have been made between different post‐first‐line therapies on clinical efficacy in advanced GIST following imatinib failure. Methods Databases including PubMed, Embase, Scopus, Google Scholars, and Cochrane Library from inception to February 2023 were retrieved for randomized controlled trials evaluating the clinical efficacy of different post‐first‐line agents for advanced GIST following imatinib failure. Network and conventional meta‐analysis were carried out using Stata/MP 16.0. Results Ripretinib showed significant improvement in progression‐free survival (PFS) rates from the 2nd to the 12th month compared to placebo, while there was virtually no evidence that the rest active agents had a significant benefit at the 12th month. Masitinib, ripretinib, sunitinib, regorafenib, and pimitespib exhibited significantly longer median PFS than placebo, and pairwise comparisons indicated there were no significant differences among masitinib, ripretinib, and sunitinib. These post‐first‐line agents decreased the risk of disease progression or death by 65% (HR = 0.35, 95% CI: 0.26–0.47) compared to placebo. Ripretinib and sunitinib came into effect earlier and exhibited more consistent overall survival (OS) rate improvements than masitinib and pimitespib, while pairwise comparisons revealed no significant differences in these four active agents concerning the improvement in OS rate. These post‐first‐line agents decreased the risk of death by 39% (HR = 0.61, 95% CI: 0.44–0.83) over placebo for advanced GIST following imatinib failure. Conclusion The active agents in our analysis as post‐first‐line therapies are able to provide superior clinical efficacy, with improved PFS rate and OS rate at certain time points, as well as absolute values of PFS and OS for advanced GIST. Ripretinib might be the optimal recommendation as a post‐first‐line treatment for advanced GIST following imatinib failure.

Post‐translational modifications (PTMs) play a pivotal role in epigenetic regulation and are key pathways for modulating protein functionality. PTMs involve the covalent attachment of distinct chemical groups, such as succinyl, crotonyl, and lactyl, at specific protein sites, which alter protein structure, function, stability, and activity, ultimately influencing biological processes. Recently, metabolically derived short‐chain acylation modifications (with acyl groups containing fewer than six carbon atoms) have been progressively identified, such as butyrylation, succinylation, crotonylation, and lactylation, differing from traditional acetylation in structure, physicochemical properties, function, and regulation. Aberrant short‐chain acyl‐PTMs are often associated with tumorigenesis. Research highlights that PTMs like succinylation and lactylation are essential in regulating tumor metabolism, drug resistance, and immune responses. This review elucidates the regulatory mechanisms of eight short‐chain acyl‐PTMs—butyrylation, succinylation, crotonylation, malonylation, glutarylation, 2‐hydroxyisobutyrylation, β‐hydroxybutyrylation, and lactylation—that are involved in tumor initiation and progression. Their roles in controlling tumor genomic stability, gene transcription, protein stability, enzyme activity, and nuclear localization are summarized, demonstrating their impact on related biological processes such as tumor metabolism, multi‐drug resistance, and immune evasion. Additionally, the review provides an overview of current drug research targeting enzymes that regulate PTMs, offering critical insights to advance therapeutic strategies for cancer treatment.

Thunberg, a multifunctional medicinal plant native to East and Southeast Asia, has been introduced worldwide. However, the environmental factors that determine its habitat and its precise distribution in China remain incompletely characterized. Therefore, the Maximum Entropy (MaxEnt) model integrated with, ArcGIS was employed to predict the potential distribution of in China, using 479 initial occurrence records (which were spatially filtered to 191 points) and 33 environmental variables (of which 15 were selected for the final analysis). Model performance was assessed via AUC-ROC, with key variables identified through permutation importance and response curves. Future projections were made under SSP126 and SSP585 scenarios for the 2050s and 2090s. The model demonstrated high accuracy (AUC = 0.934). The distribution of was primarily governed by annual precipitation (Bio12), the minimum temperature of the coldest month (Bio06), elevation, and the mean diurnal temperature range (Bio02). The optimal ranges for these variables were as follows: annual precipitation of 708.5-2,956.8 mm, a minimum temperature of the coldest month between -4.9 and 8.9 °C, elevation of 273.9-1,019.4 m, and a mean diurnal temperature range of 6.81-10.18 °C. At present, suitable habitats are concentrated in central and southwestern China. Future projections indicate a northward shift and altitudinal increase in suitable areas, with expansions in Beijing, Hebei, and Liaoning, but contractions in Guangxi and Shandong. Hunan, Jiangxi, Sichuan, and Guizhou remain core suitable regions. This northward shift is consistent with preference of for the warm temperatures and adequate humidity, highlighting both its vulnerability and its adaptive potential under global warming. is highly sensitive to climatic variables, particularly temperature and precipitation. Our findings provide a scientific basis for developing well-targeted conservation strategies, promoting sustainable utilization, and optimizing cultivation practices for under climate change.

is a well-known medicinal plant that belongs to woody liana, possessing high therapeutic and economic value. The market demand of is huge, but its wild resources are scarce and artificial cultivation methods have not been established, which leads to a situation with strong contradiction and imbalance between supply and demand. In this study, 303 sample of distribution data for in China were collected, 33 environmental variables related to terrain, climate and soil were analyzed and the suitable habitats of during various periods were predicted by MaxEnt model and ArcGIS software, aiming to provide a basis for scientific cultivation and effective utilization of resources. The results indicated that precipitation and temperature were significant factors in the distribution of . The primary environmental variables influencing the potential distribution of were precipitation during the driest quarter (Bio17), annual precipitation (Bio12), mean diurnal range (Bio2), and annual temperature range (Bio7). Among them, precipitation of driest quarter (Bio17) was the most influential environmental variable for the distribution of with the range between 100.68 and 274.48 mm. The current distribution of is mainly located in the coastal areas of eastern and southern China, especially Guangxi, Guangdong, Zhejiang and Fujian, with a total area of 51.74 × 104 km2. Future climate change of global warming will lead to a reduction in the total suitable areas and high suitable areas under various climate scenarios. Especially in the SSP585 scenario, the total suitable area and the highly suitable area will be significantly reduced by 89.26% and 87.95% compared with the present during the 2090s. Overall, these findings can provide useful references for the suitable areas' determination of wild resources, optimization of artificial cultivation and scientific selection of high quality medicinal materials on .

Atrazine (ATZ) is a herbicide used in agricultural production and has been detected in surface water due to its widespread use worldwide. This may pose a threat to the health of aquatic animals. To explore the ATZ−induced hepatic metabolism disorder, male zebrafish were exposed to 300 and 1000 μg/L ATZ for 21 days, respectively. The results revealed that ATZ exposure significantly reduced hepatic triglyceride (TG) levels, while significantly (p < 0.05) increased pyruvate (PYR) and total cholesterol (TC) levels. In addition, the liver sample from the 1000 μg/L ATZ−treated group was used for GC/MS metabolomic analysis. The principal component analysis (PCA) model showed significant separation of the 1000 μg/L ATZ group from the control group, indicating that ATZ exposure altered hepatic metabolism in male adult zebrafish. A total of 29 significantly (p < 0.05) different metabolites were observed and identified in the ATZ−treated group. Moreover, the most disturbed pathways by ATZ were the arginine and proline metabolic pathways, followed by the glutathione metabolic pathway. Three and two metabolites were significantly altered in the arginine and proline metabolic pathways and glutathione metabolic pathway, respectively. Based on these results, we suggested that ATZ was capable of altering liver metabolism in zebrafish and that its ecological risk to aquatic organisms cannot be ignored.

Lung adenocarcinoma (LUAD) is a leading cause of cancer-related mortality worldwide. The tumor microenvironment (TME) plays a pivotal role in LUAD progression, but the specific molecular mechanisms driving malignancy and immune evasion remain incompletely understood. Bone marrow stromal cell antigen 2 (BST2) has been implicated in other cancers, yet its functional role and therapeutic potential in LUAD require further elucidation. We integrated single-cell RNA sequencing (scRNA-seq) data from primary LUAD tissues and normal lung tissues with bulk RNA-seq data from The Cancer Genome Atlas (TCGA)-LUAD and GEO cohorts. Malignant epithelial cells were identified using inferCNV analysis. Cellular trajectory and cell-cell communication analyses were systematically performed to delineate the malignant transformation process and its interactions with the TME. High-dimensional weighted gene coexpression network analysis further identified key functional modules within malignant subpopulations. The oncogenic role of BST2 was comprehensively validated through differential expression analysis, survival analysis, gene set enrichment analysis (GSEA), and in vitro cellular assays, including RT‑qPCR, MTT, colony formation, Transwell invasion, and wound healing experiments. In addition, we employed the tumor immune dysfunction and exclusion (TIDE) algorithm to evaluate its association with immunotherapy response and performed drug screening via the Clue.io platform to explore its therapeutic potential. scRNA-seq analysis revealed significant heterogeneity in the TME and identified two distinct subpopulations of malignant epithelial cells. Trajectory analysis uncovered a specific lineage (Lineage 4) driving the normal-to-malignant transition, while cell communication analysis highlighted interactions between malignant cells and tumor-associated macrophages (TAMs) mediated by MIF and APP signaling pathways. High-dimensional weighted gene coexpression network analysis (hdWGCNA) identified a coexpression gene module (Module 1) specifically enriched in malignant subpopulations. By intersecting with a set of immunoregulatory genes, BST2 was ultimately determined as a key candidate oncogene. BST2 was significantly upregulated in malignant epithelial cells and TAMs, and its high expression was closely associated with poor patient prognosis. GSEA demonstrated that high BST2 expression was linked to the activation of crucial oncogenic pathways, including oxidative phosphorylation, Kras signaling, and epithelial-mesenchymal transition (EMT). In vitro validation further confirmed that BST2 knockdown suppressed LUAD cell proliferation, migration, and invasion. Furthermore, elevated BST2 expression was associated with reduced efficacy of immune checkpoint blockade (ICB) therapy. Our study unveils BST2 as a critical oncogene in LUAD, promoting tumor progression and influencing the TME, particularly via TAM recruitment. BST2 expression predicts patient prognosis and immunotherapy response, positioning it as a promising biomarker and therapeutic target.