Background As a cornerstone of minimally invasive surgery, laparoscopy poses considerable operational challenges for surgeons. This study assessed the current laparoscopic skill level among young physicians in Southern Zhejiang (China) and identified influencing factors. Methods A multicenter cross-sectional survey was conducted, recruiting young physicians from 24 hospitals to participate in a three-module laparoscopic skills competition. Pre-competition questionnaires were collected for correlation analysis. Results Among the 102 participants included in the skills assessment, 75 completed valid questionnaires. The mean total scores were as follows: circular cutting, 89.2 ± 17.5 (Completion: 64.1 ± 10.1; Technical: 18.1 ± 7.3; Bonus: 5.6 ± 6.8; 43.1% received no bonus); soybean transfer, 54.6 ± 22.0 (Completion: 53.1 ± 20.1; Bonus: 0.1 ± 1.5; 99% received no bonus); and fixed-point suturing, 83.2 ± 20.0 (Completion: 60.0 ± 14.7; Technical: 18.4 ± 3.6; Bonus: 3.3 ± 5.3; 63.7% received no bonus). Regression analysis indicated that prior laparoscopic training was associated with better performance in fixed-point suturing (P = 0.04). Cumulative training exceeding 30 hours correlated with higher scores in soybean transfer (P = 0.05) and fixed-point suturing (P = 0.04). Frequent simulation training significantly improved outcomes across all modules (P = 0.03, 0.05, 0.04). Participants who self-rated as “able to proficiently complete tasks within the allotted time” achieved notably higher scores, particularly in soybean transfer and suturing (P < 0.01). No significant associations were observed between performance and demographic characteristics such as motivation, gender, education, professional title, or years of experience (P > 0.05). Conclusion Young physicians in Southern Zhejiang demonstrate general competency in laparoscopic skills but perform less effectively in time-sensitive, high-precision tasks. Future training should emphasize systematic simulation and competitive practice to comprehensively enhance proficiency.
This study aimed to test the hypothesis that the NCOR2/DLL-4/Jagged-1 axis is dysregulated in cord blood of offspring from mothers with preeclampsia (PE) and gestational hypertension (GH), favoring an anti-angiogenic profile. We compared expression levels of these Notch pathway components among PE, GH, and healthy control groups to explore their potential role in fetal vascular programming. This is a prospective cohort study, including 17 mother-offspring pairs with gestational hypertension, 17 mother-offspring pairs with preeclampsia, and 34 healthy mother-offspring pairs as controls. Standardized questionnaires were used to collect family and birth information, medical records were used to collect clinical data, and Western blot was employed to measure the expression levels of NCOR2, DLL-4, and Jagged-1 in cord blood. We analyzed the differences in offspring cord blood proteins among the three groups. Cord blood protein expression revealed significant dysregulation of the NCOR2/DLL-4/Jagged-1 axis. Compared to the control group (1.36 ± 0.44), the GH (1.00 ± 0.12) and PE (0.94 ± 0.15) groups were characterized by a significant downregulation of NCOR2 (p = 0.001). Furthermore, a progressive and significant increase in DLL-4 (p = 0.001) was observed across the control (0.82 ± 0.28), GH (0.98 ± 0.17), and PE (1.27 ± 0.40) groups, which was accompanied by a significant stepwise decrease in Jagged-1 expression (control: 1.36 ± 0.28, GH: 1.02 ± 0.12, PE: 0.87 ± 0.18, p < 0.001). The cord blood levels of NCOR2 and Jagged-1 proteins were significantly decreased in offspring of PE and GH, while DLL-4 protein expression was significantly increased in offspring of PE. These findings suggest that dysregulated Notch signaling, characterized by an anti-angiogenic profile in the fetal circulation, may contribute to the vascular programming observed in offspring of preeclamptic pregnancies.
ABSTRACT In recent years, daratumumab has been increasingly applied in the treatment of systemic light‐chain (AL) amyloidosis, significantly improving the prognosis of patients. Currently, the internationally recognized daratumumab treatment regimen comes from the ANDROMEDA trial. Given the low tumor burden and poor tolerance of patients with amyloidosis, in this study, we modified the ANDROMEDA‐based protocol by administering daratumumab at half the original frequency. We enrolled 48 patients with AL amyloidosis who received low‐frequency daratumumab in multiple hospitals from July 2021 to May 2024 (ChiCTR2100049253). Among these patients, 38 were newly diagnosed and 10 were relapsed and refractory patients. At 3 months, the percentage of newly diagnosed patients with hematologic response≥very good partial response (VGPR) was 75.8%, including 36.4% complete response (CR) and 39.4% VGPR, with an overall response rate (ORR) of 90.9%. The CR, VGPR and ORR rates of relapsed and refractory patients at 3 months were 40.0%, 20.0% and 90.0%, respectively. By 6 months, ≥VGPR was achieved by 86.7% of newly diagnosed patients, while CR, VGPR, and ORR in relapsed and refractory patients were 44.4%, 22.2%, and 77.8%. The 6‐month cardiac and renal response rates were 61.9% and 46.2% in newly diagnosed patients, 20.0% and 50.0% in relapsed and refractory patients, respectively. The median follow‐up time was 26.0 months. The 1‐year and 2‐year OS rates were both 89.5% for newly diagnosed patients, and 90.0% for relapsed and refractory patients. Of the 48 patients, 33 (68.8%) received maintenance therapy and 15 (31.3%) did not. The 1‐year and 2‐year OS rates were both 100.0% for patients receiving maintenance, and 66.7% for patients without maintenance. Considering the safety endpoints, 86.8% of newly diagnosed patients experienced at least one adverse event (AE). In conclusion, the low‐frequency daratumumab regimen can be considered as an effective, safe and feasible treatment strategy for AL amyloidosis.
Introduction Physical activity (PA) reduces the risk of atherosclerotic cardiovascular disease by limiting the overgrowth of fat tissue, particularly visceral adiposity. However, no large-scale studies have investigated the relationship between PA and pericardial adiposity.Methods This study included 16 685 participants from the UK Biobank prospective cohort who underwent cardiac magnetic resonance assessment and had available PA data. PA was objectively measured using a wrist-worn triaxial accelerometer and categorised as light-intensity PA (LPA), moderate-intensity PA (MPA) and vigorous-intensity PA (VPA). Multivariable linear regression models were applied to estimate adjusted mean epicardial and pericardial adipose tissue (EPAT) areas across quartiles of total and intensity-specific PA, with linear trend analyses performed. Restricted cubic spline models were used to examine potential non-linear associations. The association between sedentary behaviour (SB) and EPAT area was also examined as a negative control.Results Accelerometer-derived PA duration across all intensities was negatively correlated with EPAT area. Participants in the highest quartile (Q4) demonstrated smaller EPAT areas relative to those in the lowest quartile (Q1), with relative mean reductions of 21.29% for total PA, 11.24% for LPA, 18.28% for MPA and 19.10% for VPA (all p trend ≤0.001). Conversely, prolonged SB showed a positive correlation with EPAT area. Compared with those in Q1, individuals in Q4 in SB presented 15.90% greater relative mean EPAT area (p for trend <0.001). After adjustment for visceral adipose tissue volume, these associations were attenuated but remained significant. Stratified analyses confirmed that PA-EPAT association persisted among individuals with atherosclerotic cardiovascular disease, diabetes, hypertension or hyperlipidaemia. Mediation analysis showed VAT largely mediated the relationship between PA and EPAT area.Conclusions PA reduces epicardial adiposity by limiting the overgrowth of EPAT area. These findings highlight the importance of PA as a preventive strategy for improving obesity-related health management worldwide.
Serum alkaline phosphatase (ALP) plays a crucial role in bone and muscle health. Previous studies have demonstrated that serum alkaline phosphatase (ALP) is closely associated with muscle mass. Nevertheless, the association between serum alkaline phosphatase (ALP) and grip strength remains unclear. Therefore, the present study focused on exploring the association of serum ALP with grip strength in middle-aged and elderly people. We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey conducted from 2011 to 2014. A total of 3514 participants (1891 males and 1623 females) aged 40–80 years were included in this study. Serum ALP and pelvic grip strength were analyzed as independent and dependent variables, additional variables were the possible impact modifiers. weighted generalized linear models and stratified analysis by gender, age group, and race were applied to assess the relationship between serum ALP and grip strength. Smooth curve fitting and threshold effect analysis/saturation effect analysis were used to analyze the nonlinear relationship between the 2 variables. In the gender-stratified subgroup analysis, we observed an inverse association between serum ALP and grip strength in both male and female. When stratified by age group, the association remained significant among participants 40–59 years of age, but not among those ≥ 60 years old. When stratified by race, the association remained significant among Non-Hispanic White and Non-Hispanic Black. It is noteworthy that serum ALP and grip strength showed a significant negative correlation among female aged 40–59 years, but not among female aged ≥ 60 years. Additionally, Smooth curve fitting showed that serum ALP had a nonlinear relationship with grip strength in male aged 40–59 years and male aged over 60 years, the inflection points are 54 IU and 97 IU respectively. Our study revealed an inverse relationship between serum ALP and grip strength, this finding offers new insights and avenues for understanding how serum alkaline phosphatase affects skeletal muscle health.
