Objective To introduce the current status of clinical research on endoscopic cholecystolithotomy with reservation of gallbladder.Methods Literatures related to the basis,advantage,indication,contraindication,operative method and current controversy were reviewed and summarized.Results The objective evidences were afforded by postoperative complications of cholecystectomy for endoscopic cholecystolithotomy with reservation of gallbladder.The progress of endoscopic technique made it possible for reservation of gallbladder.The controversy in endoscopic cholecystolithotomy with reservation of gallbladder was focused on the choice of indications and operative procedure.Incorrect patient selection and undue pursuit of cholecystolithotomy with reservation of gallbladder would be completely opposite to the treatment of gallstone.Conclusion It is feasible for endoscopic cholecystolithotomy with reservation of gallbladder to remove completely stone and reserve gallbladder function,but further investigation and long-term follow up are required to delineate gallstone recurrence after operation.

Objective To explore the relationship between the overlap volume of organ at risk (OAR) and target (Voverlap) and the mean dose to OAR (DmOAR) in intensity-modulated radiotherapy (IMRT).Methods Fifty randomly selected patients undergoing IMRT for nasopharyngeal carcinoma (NPC) and an equal number of patients undergoing radical IMRT for cervical cancer in our hospital were enrolled as subjects.The relationship between Voverlap and DmoAR in IMRT was analyzed.The Matlab software was used to generate function to fit the relationship between Voverlap and DmOAR for different OARs.Results The Voverlap varied among patients with NPC or cervical cancer.The ratio of Voverlap to the volume of OAR (VOAR) was positively correlated with the ratio of DmOAR to the prescribed dose (Dp) (all P=0.01).A function was generated to fit the correlation between Voverlap/VOAR ratio and DmOAR/Dp ratio.Conclusions In IMRT,patients have different Voverlap/VoAR ratios due to varicd target volume,disease stages,OAR filling status,and OAR volume.As criteria for plan verification,a specific DmOAR value for each OAR should be calculated before radiotherapy planning based on the corresponding correlation function and the Voverlap/VoAR ratio with a fixed dose prescription.It can be used to reduce the subjective influence on the optimization of radiotherapy planning.

Background and purpose:High expression of excision repair cross-complementing 1 (ERCC1) is related to resistance in patients treated with platinum-containing regimens. The ERCC1 antibody 8F1 was usually used in past studies, but it was found to have no-speciifcity recently. This study aimed to investigate the predictive role of a new ERCC1 antibody 4F9 to platinum chemotherapy in non-small cell lung cancer (NSCLC) patients. Methods:Expression of ERCC1 was detected using antibody 4F9 by immunohistochemistry (IHC) in 72 NSCLC tissues. The relationship between the expression of ERCCl and the clinical pathological parameters, the efficacy of platinum chemotherapy and overall survival of patients were explored by statistical analysis. Results: The high expression of ERCCl protein was 55.5%in 72 cases. There was no signiifcant correlation between the ERCC1 expression with gender, age, pathological type, clinical stage and lymphatic metastasis (P>0.05). Patients with low expression of ERCC1 had signiifcantly higher response rates to platinum chemotherapy, longer median survival time and 2-years survival rate comparing with those with high expression of ERCC1 (62.5%vs 37.5%;22.9 vs 18.4 month;46.9%vs 37.5%), respectively (P<0.05). Conclusion:The expression analysis of ERCC1 using new ERCC1 antibody 4F9 by IHC method is helpful to assign chemotherapeutic regimen, and guide individual platinum chemotherapy for post-operation patients.

OBJECTIVETo study the protective effects of astragaloside (AST) on memory impairment and the expression levels of amyloid precursor protein (APP) and its mRNA, alpha secretase and beta secretase mRNA in the brain of mice induced by dexamethasone (DEX).

METHODMice were randomly divided into six groups: control group, model group, AST ( 10, 20, 40 mg x kg(-1)) groups and ginsenoside Rg1 (6.5 mg x kg(-1)) group. The animal models of dysmnesy mice were established by intragastrical administration of DEX (5 mg x kg(-1)) for 21 days. Subsequently, the dysmnesy mice were treated by intragastrical administration of ginsenoside Rg1 and different doses of AST (10, 20, 40 mg x kg(-1)), respectively. Morris water maze was applied to evaluate the learning and memory function in mice. The expression of APP, alpha secretase and beta secretase mRNA were analysed by RT-PCR, and immunohistochemistry was used to evaluate the expression levels of APP in cerebral cortex, hippocampus CA1 and CA3.

RESULTAST (20, 40 mg x kg(-1)) could improve the learning and memory function in mice (P<0.05, P<0.01), decrease the expression levels of APP and beta secretase mRNA (P<0.05), increase the expression level of alpha secretase mRNA (P<0.05), and decrease the expression level of APP in cerebral cortex and hippocampus CA1 (P<0.05).

CONCLUSIONAST could improve the learning and memory function in mice, which mechanism may contribtuted to the expression inhibition of APP and APP mRNA, beta secretase mRNA, and promotion of the expression of alpha secretase mRNA.

Amyloid Precursor Protein Secretases ; genetics ; Amyloid beta-Protein Precursor ; genetics ; Animals ; Dexamethasone ; pharmacology ; Male ; Memory Disorders ; drug therapy ; prevention & control ; Mice ; RNA, Messenger ; analysis ; Saponins ; pharmacology ; Triterpenes ; pharmacology

Organ shortage is a common problem in the field of transplantation worldwide. It is urgent to expand the donor pool via different effective and safe approaches. Recently, "the statement from international collaborative on expanding controlled donation after the circulatory determination of death (cDCDD)" has attracted widespread attention from scholars. The statement aims to promote cDCDD in order to increase organ donation rates, with the ultimate goal of achieving self-sufficiency in transplantation. In this article, the key contents mentioned in the statement were summarized, the terminology update and relevant discussion of donation after the circulatory determination of death (DCDD), the development trend of DCDD, the basic part of the clinical pathway of cDCDD and the key factors affecting the implementation of cDCDD were illustrated, and the inspiration drew from this statement to the sustainable development of organ donation program in China was reflected.

The morbidity of scoliosis in adolescents in China is about 3%-5%, 80%-85% of the patients are adolescent idiopathic scoliosis (AIS), whose etiology is unknown. Scoliosis is a structural spine disease occurring during puberty or before skeletal maturation. Scoliosis has a greatly negative impacton not only the growth and development of adolescent spine, but also the mental health of adolescents. Ocular disease is a common clinical disease in which the eye ball and its accessory structures have structural abnormalitiesordys function. Ocular disease snotonly bring in convenience to patients's life, but also may induce diseases in other organs. Recent studies have shown that various ocular diseases may have a potential impact on scoliosis, and quite a fewof patients with certain ocular diseases have higher incidence rate of scoliosis. Therefore, in this article, the etiological relationship between eye diseases and scoliosis will be summarized, which provides guidance and direction for the etiological research of scoliosis and eye diseases. After sorting out, we found that the relationship between ophthalmic diseases and scoliosis mainly concentrated in the following four aspects: choroidal thickness and scoliosis, Goldenhar syndrome, gene level and strabismus. Among them, the genetic relationship is the most complex, about 40 kinds of gene or chromosome abnormalities have been found to cause ocular diseases and scoliosis; Goldenhar syndrome, also known as oculo-auriculo-vertebral spectrum, first revealed the relationship between ocular diseases and scoliosis, but the current statistical relationship is still very vague. There are few studies on choroidal thickness and strabismus at home and abroad, which are statistical studies, only revealing the relationship between choroidal thickness and scoliosis, and there are many defects in the study of choroidal thickness, which need further research.

Objective: To preliminarily evaluate the safety of the coplanar template-assisted ¹⁹²Ir hypofractionated stereotactic ablative brachytherapy (SABT) in patients with locally advanced non-small cell lung cancer (LA-NSCLC), and assess the effect of template-assisted technology upon the accuracy of SABT by comparing the consistency of dosimetric parameters between preoperative and operative plans. Methods: Fifteen patients histologically confirmed with LA-NSCLC (stage Ⅱ_B-Ⅲ_A) were recruited and received the template-assisted SABT delivered in a risk-adapted fractionation (30 Gy/1F). Preoperative planning, template-assisted needle implantation, operative planning and implementation were performed in all patients. Dosimetric results of preoperative and operative plans were statistically compared by assessing the dosimetric parameters of gross tumor volume (HI, CI, D₉₀, V₁₀₀ and V₁₅₀) and organ at risk(V₅, V₂₀ and mean dose of bilateral lung, D_2cc of spinal cord. The incidence of perioperative complications of SABT was recorded. The safety and feasibility of SABT were evaluated. Results: Slight changes were noted in terms of target dose and irradiated dose to the lung between preoperative and operative plans without statistical significance (both P>0.05). No severe adverse events, such as severe pneumothorax, hemothorax and hemoptysis were observed. Conclusions Application of the template-assisted SABT can enhance the accuracy of implantation, maintain the consistency of the dosimetric parameters between the preoperative and operative plans and guarantee the clinical efficacy.

Objective:To explore the application value of Oxford nanopore technologies (ONT) in the diagnosis and treatment of periprosthetic joint infection (PJI).Methods:A prospective analysis was conducted on 32 patients with PJI admitted to the joint department of Xi'an Honghui Hospital from October 2021 to March 2023, who met the 2018 PJI diagnostic criteria of the American Skeletal Infection Society (MSIS), including 15 males and 17 females with an average age of 63.93±8.93 years. 32 revision patients who did not meet the 2018 MSIS PJI criteria during the same period were collected as controls (non PJI group), including 13 males and 19 females with an average age of 65.53±8.54 years. All patients underwent joint fluid puncture before or during surgery, and the specimens were tested by ONT, metagenomic next generation sequencing (mNGS), and general microbial culture. The receiver operating characteristic (ROC) curves were drawn for both groups, and the sensitivity, specificity, positive predictive value, negative predictive value, and Youden index of the three detection techniques were calculated and compared to evaluate the detection efficiency of different detection methods in PJI.Results:Among the 32 patients with PJI, 30 were positive for ONT, with a total of 30 pathogenic bacteria detected, and the detection time was 22.37±8.36 h. 31 were positive for mNGS, with a total of 33 bacterial species detected, and the detection time was 46.25±9.36 h. 17 were positive for microbial culture, with a total of 8 bacterial species detected, and the detection time was 96.23±15.62 h. Among the 32 patients with non PJI group, 1 was positive for ONT and 5 were positive for mNGS, with a total of 1 and 3 bacterial species detected, respectively. The results of microbial culture were all negative. The detection time and area under the curve (AUC) of ONT and mNGS were 22.37±8.36 h and 0.953[95% CI (0.901, 1.006)], 46.25±9.36 h and 0.906[95% CI (0.835, 0.977)], respectively, which were better than those of microbial culture 96.23±15.62 h and 0.766[95% CI (0.678, 0.853)], and the difference was statistically significant ( P<0.05). The sensitivity of ONT, mNGS, and microbial culture were 0.938, 0.969, and 0.531, respectively, and the specificity was 0.969, 0.844, and 1.000, respectively. The Jordan index was 0.906, 0.813, and 0.531, respectively. Conclusion:ONT testing has higher diagnostic efficacy than mNGS and microbial culture in the diagnosis of PJI, and also has advantages in detection time. It also suggests that some PJI are not caused by a single microbial infection.

Mesh-related visceral complications caused by mesh erosion after tension-free inguinal hernia repair are one kind of rare long-term complications, but they are easily neglected. Interval time from initial hernia repair to mesh-related visceral complications by preperitoneal and laparoscopic repair is short. Rutkow and transabdominal preperitoneal repair have the highest reported rate. Lichtenstein has the longest interval time and the lowest reported rate. The most frequently eroded organs are sigmoid colon, bladder and small intestine. The common clinical manifestations of sigmoid colon erosion are hematochezia, abdominal wall fistula and colitis, hematuria and recurrent urinary tract infection in bladder erosion cases, intestinal obstruction and abdominal wall fistula in intestinal erosion case, sigmoid-bladder fistula and intestinal-bladder fistula in multiple organ erosion cases. Resection or repair of corresponding organs with mesh removal have good efficacies in most patients. The authors summarize and analyze researches on mesh-related visceral complications after tension-free inguinal hernia repair from 1994 to 2021, review their advances, in order to raise awareness of such complications in clinicians.

Objective To investigate the indications and clinical outcomes of total knee arthroplasty or osteotomy for knee osteoarthritis subsequent to previous femur fractures.Methods Six patients (three male and three female) with knee osteoarthritis subsequent to previous femur fractures were analyzed retrospectively between February 2006 and February 2017.The average age of patients was 58.2± 10.3 years old,ranged from 51 to 79 years.Four patients underwent total joint replacement and two underwent osteotomy.The average age of patients in joint replacement group was 60.5±12.3 years old.The age of the two patients in the osteotomy group was 51 and 55 years old,respectively.The extra-articular deformity angle of the coronal plane of the femur,lateral distal femur angle of mechanical axis,hip-knee-ankle angle (HKA) of preoperative and postoperative were determined on long-standing radiography.The mean angle of the extra-articular deformity in the joint replacement group was 17.0±7.7 degrees.The angle of the extra-articular deformity in the osteotomy group was 34 and 20 degrees.Lateral distal femur angle of mechanical axis in the joint replacement group was within the range of 87±7 degrees.Lateral distal femur angle of mechanical axis in the osteotomy group was out of the range of 87±7 degrees.The mean preoperative HKA of the joint replacement group was 161.8±8.0 degrees.The preoperative HKA of the osteotomy group was 155 and 160 degrees,respectively.Knee function was estimated according to knee range of motion and Knee Society Score (KSS).The results of postoperative hip-knee-ankle angle,knee range of motion (ROM) and knee society score were compared between the two groups.Results The mean HKA of the joint replacement group reached 176.0±2.8 degrees at one year postoperatively.The HKA of the osteotomy group improved to 177 and to 175 degrees at one year postoperatively.The average preoperative knee ROM improved significantly from 71 ± 16 degrees preoperatively to 113 ±5degrees postoperatively.The mean knee ROM of the joint replacement group was 113.0±6.8 degrees.The knee ROM of two patients in the osteotomy group was 110 and 115 degrees,respectively.The average preoperative KSS score improved significantly from 46±3 preoperatively to 88±3 postoperatively.The mean KSS of the joint replacement group was 88.8±3.0,while the KSS of the osteotomy group was 85 and 82.No bone nonunion was observed in the two patients in osteotomy group.Conclusion For patients with knee osteoarthritis subsequent to previous femur fractures,satisfactory short-term clinical outcomes could be obtained by total knee arthroplasty or osteotomy with the strict selection of proper operative indications.