Second Affiliated Hospital of Nanjing Medical University

Robotic single-port transvaginal natural orifice transluminal endoscopic surgery (RSP-vNOTES) is an emerging minimally invasive approach that combines the advantages of robotic surgery with scarless transvaginal access. Its application in gynecologic oncology remains limited, particularly for omentectomy during ovarian cancer staging.

We present the case of a 45-year-old woman with an ovarian granulosa cell tumor (GCT) who underwent supplemental staging surgery following unilateral oophorectomy. Using a single-port robotic system via the transvaginal route, hysterectomy, right salpingo-oophorectomy, and omentectomy were performed. Key technical steps included enhanced visualization with gauze placement and use of an additional robotic arm for omental traction.

The procedure lasted 2 hours and 10 minutes with an estimated blood loss of 50 mL. No intraoperative or postoperative complications occurred. The patient did not require postoperative analgesics and was discharged on postoperative day 3. Final pathology confirmed absence of omental metastasis.

This case demonstrates the feasibility and safety of RSP-vNOTES for omentectomy in gynecologic oncology. The technique offers potential benefits including reduced abdominal trauma, faster recovery, and superior visualization for complex dissections. While further studies are necessary to validate long-term oncologic outcomes, RSP-vNOTES may represent a promising minimally invasive option for selected patients requiring ovarian cancer staging surgery.

Sympathetic overactivity is closely associated with vascular remodeling. Sympathetic fibers dominantly innervate the adventitia of arteries rather than tunica media. Vascular adventitial fibroblasts (VAFs) play crucial roles in vascular remodeling. However, the link between sympathetic overactivity and VAF proliferation and migration is unknown.

Primary VAFs were isolated from the thoracic aorta of spontaneously hypertensive rats and Wistar-Kyoto rats. Norepinephrine (NE) bitartrate monohydrate was applied to VAFs to simulate the sympathetic overactivity.

NE increased NADPH oxidase (NOX) 2 expression and superoxide level, which were almost abolished by NOX2 inhibitor GSK2795039 or α-adrenoceptor antagonist prazosin, but not significantly affected by NOX1 inhibitor ML171, NOX4 inhibitor GLX351322 or β-adrenoceptor antagonist propranolol. Superoxide scavenger tempol or NOX2 inhibitor GSK2795039 attenuated NE-induced VAF proliferation and migration. NE promoted protein kinase C (PKC) phosphorylation and NFκB-p65 nuclear translocation. Either PKC inhibitor Go6983 or NFκB inhibitor BAY11-7082 attenuated NE-induced NOX activation, NOX2 upregulation, superoxide production, proliferation and migration.

NE promotes oxidative stress by α-receptor/PKC/NFκB-mediated NOX2 upregulation, which contributes to proliferation and migration of VAFs.

The influenza vaccination rate among the elderly in China remains suboptimal. As key figures in effective intervention strategies, the perspectives of primary healthcare workers (PHCWs) on this issue have not been explored yet. This study aims to use the capability, opportunity, motivation-behavior (COM-B) model to identify the factors that influence influenza vaccination among the elderly from the perspective of PHCWs in China, analyze the mechanisms, and formulate targeted intervention strategies. A qualitative study used semi-structured, face-to-face interviews with PHCWs in Yangzhou, Jiangsu Province, China, conducted in September 2023, based on the COM-B model. A purposive sampling method was used, resulting in the participation of 16 PHCWs. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. The study included 16 PHCWs (7 Public health professionals [43.75%], 7 general practitioners [43.75%], and 2 nurses [12.50%]). The main barriers to influenza vaccination identified were the lack of recommendations from PHCWs (Reflective Motivation), limited knowledge of influenza or the influenza vaccine among the elderly (Psychological Capability), and the self-payment policy for the influenza vaccine (Physical Opportunity). Additionally, a clear division of professional boundaries between clinicians and public health professionals was found to discourage the elderly from receiving the influenza vaccine (Reflective Motivation). The components - capability, opportunity, and motivation - of the COM-B model interact with each other to change behavior. Improving elderly influenza vaccination rates in China requires stronger recommendations from PHCWs, better awareness of the elderly, and optimized self-payment policies.