BACKGROUND:Rheumatoid arthritis is widely prevalent worldwide,with its high incidence and universality that considerably affects patients' quality of life.Previous studies have focused on a few immune cells or cytokines,whereas this study comprehensively provides a more complete view of the immune mechanisms in rheumatoid arthritis.OBJECTIVE:To explore the causal relationship between 731 immune cell phenotypes and rheumatoid arthritis using the Mendelian randomization method,thereby providing evidence of causality.METHODS:The 731 immune cell phenotypes used in this study were sourced from the GWAScatalog database,jointly developed by the National Human Genome Research Institute(NHGRI)and the European Bioinformatics Institute(EBI).The rheumatoid arthritis data were from the Finngen database,developed by the Finnish Institute for Molecular Medicine(FIMM).The inverse variance weighting method was employed as the primary analytical approach.Additionally,multiple analytical methods,including MR-Egger,weighted mode,simple mode,and weighted median,were concurrently utilized to complement the final results.Sensitivity analyses(Cochran's Q test,MR-Egger regression,and MR-presso analysis)were also conducted to verify the stability and feasibility of the data.RESULTS AND CONCLUSION:(1)After excluding results through heterogeneity testing,the inverse variance weighting analysis indicated that 10 absolute cell counts,15 median fluorescence intensities of surface antigen levels,1 morphological characteristic,and 9 relative cell counts had a causal relationship with the occurrence of rheumatoid arthritis.(2)According to cell classification,this study found that seven types of B cells,seven types of classical dendritic cells,six types of mature T cells,four types of monocytes,three types of myeloid cells,three types of TBNK cells(lymphocyte subset T cells,B cells and natural killer cells),and five types of Tregs had a causal association with the occurrence of rheumatoid arthritis.(3)Through comprehensive bidirectional two-sample MR analysis,we demonstrated the complex causal relationships between multiple immune phenotypes and rheumatoid arthritis,highlighting the intricate interaction patterns between the immune system and rheumatoid arthritis.These results provide new biomarkers for the early screening and diagnosis of rheumatoid arthritis in China,and help to improve the diagnostic accuracy and sensitivity.

BACKGROUND:Rheumatoid arthritis is widely prevalent worldwide,with its high incidence and universality that considerably affects patients' quality of life.Previous studies have focused on a few immune cells or cytokines,whereas this study comprehensively provides a more complete view of the immune mechanisms in rheumatoid arthritis.OBJECTIVE:To explore the causal relationship between 731 immune cell phenotypes and rheumatoid arthritis using the Mendelian randomization method,thereby providing evidence of causality.METHODS:The 731 immune cell phenotypes used in this study were sourced from the GWAScatalog database,jointly developed by the National Human Genome Research Institute(NHGRI)and the European Bioinformatics Institute(EBI).The rheumatoid arthritis data were from the Finngen database,developed by the Finnish Institute for Molecular Medicine(FIMM).The inverse variance weighting method was employed as the primary analytical approach.Additionally,multiple analytical methods,including MR-Egger,weighted mode,simple mode,and weighted median,were concurrently utilized to complement the final results.Sensitivity analyses(Cochran's Q test,MR-Egger regression,and MR-presso analysis)were also conducted to verify the stability and feasibility of the data.RESULTS AND CONCLUSION:(1)After excluding results through heterogeneity testing,the inverse variance weighting analysis indicated that 10 absolute cell counts,15 median fluorescence intensities of surface antigen levels,1 morphological characteristic,and 9 relative cell counts had a causal relationship with the occurrence of rheumatoid arthritis.(2)According to cell classification,this study found that seven types of B cells,seven types of classical dendritic cells,six types of mature T cells,four types of monocytes,three types of myeloid cells,three types of TBNK cells(lymphocyte subset T cells,B cells and natural killer cells),and five types of Tregs had a causal association with the occurrence of rheumatoid arthritis.(3)Through comprehensive bidirectional two-sample MR analysis,we demonstrated the complex causal relationships between multiple immune phenotypes and rheumatoid arthritis,highlighting the intricate interaction patterns between the immune system and rheumatoid arthritis.These results provide new biomarkers for the early screening and diagnosis of rheumatoid arthritis in China,and help to improve the diagnostic accuracy and sensitivity.

Guided by the pathogenesis of"structure-activity imbalance of lung collaterals",this paper proposes that structure-activity imbalance of lung collaterals is the initial factor of idiopathic pulmonary fibrosis(IPF)and elucidates the pathogenesis of abnormal changes in biomechanical properties of IPF.It is postulated that the changes of biomechanical properties of lung tissue are closely related to the injury of lung qi collaterals,the abnormal mechanical stress are closely related to the injury of lung blood collaterals,and the biomechanical response of intrapulmonary resident cells is closely related to the structure-activity imbalance of lung collaterals,which ultimately leading to abnormal increase in lung tissue stiffness and progressive scarring formation in lung tissue.Integrating traditional pathogenesis concepts with microscopic pathological changes,and the in-depth exploration of the correlation between the structure-activity imbalance of lung collaterals and the biomechanical properties of IPF can provide direction for exploring IPF medical-engineering cross research,which are of great significance for enriching the syndrome and treatment system of lung collateral diseases.

Medical ultrasound technology is widely used for diagnosis and therapy in clinical practice.Ultrasound probes,which are directly contact with patients,pose a potential risk of pathogen transmission.This expert consen-sus was developed by a multidisciplinary team based on international guidelines,standards in China,and the results of a national survey,aiming to reduce the risk of healthcare-associated infection through standardizing reprocessing of medical ultrasound probes,and formulating consensus recommendations with the Delphi method.The consensus clarifies the reprocessing principles for three types of ultrasound probes of different infection risks:external-use ul-trasound probes,interventional percutaneous ultrasound probes,and internal-use ultrasound probes,puts forward systematic suggestions on the reprocessing standards and disinfection levels of ultrasound probe isolation covers and coupling agents,the reprocessing procedures and methods of ultrasound probes,as well as architectural layout and management of reprocessing,so as to provide a scientific prevention and control framework for ensuring ultrasound diagnosis and therapy safety.

Objective To analyze the effect of percutaneous transhepatic cholangial drainage(PTCD)combined with percutaneous transhepatic papillary balloon dilation(PTPBD)in the treatment of common bile duct stone in elderly patients.Methods The clinical data of elderly patients treated with PTCD combined with PTPBD under digital subtraction angiography(DSA)for common bile duct stone were retrospectively collected,the changes in liver function,postoperative complications,and prognosis were analyzed.Results All 70 patients were successfully treated with PTCD,and other 3 patients died after PTCD operation,mainly due to severe infection combined with a variety of underlying diseases.Among the remaining 67 patients,65 cases(97.00%)were successfully treated with PTPBD,while other 2 cases(3.00%)experienced technical failure due to excessive stone size(>20 mm).Among the 70 cases after the pro-cedure,there were 5 cases with abdominal pain,2 cases with bleeding,4 cases with fever,and no serious complications occurred,such as bile duct perforation,intestinal perforation,or pancreatitis.The symptoms of 67 patients were improved from 3 to 7 days after PTCD,and the changes in leukocyte,total bilirubin,alanine aminotransferase and C-reactive protein before and after surgery were sta-tistically significant(P<0.05).Conclusion PTCD combined with PTPBD is a minimally invasive treatment method for common bile duct stone with a high success rate,safety,and effectiveness,which is especially suitable for elderly patients with multiple under-lying diseases,an inability to tolerate surgical and endoscopic treatments.It is worthy of clinical promotion and application.

Idiopathic pulmonary fibrosis （IPF） can be classified as pulmonary collateral disease，and its pathogenesis is mainly characterized by the loss of Qi meridian nourishment，the loss of Yin meridian nourishment，and the formation of blood stasis in the blood vessels. Qi Yin deficiency is the pathological basis that runs through IPF，and obstruction of meridians and collaterals is a key element in the development of the disease. The dysfunction of "spleen being in charge of the defensive function" is closely related to the formation of the pathological pattern of "lung deficiency and collateral stasis" in IPF. The term "spleen being in charge of the defensive function" originated from the Yellow Emperor's Inner Canon. If the spleen is healthy，the Qi will be filled with vitality. Positive energy is stored inside，evil cannot be dried up. Its concept is quite similar to the immune defense function in modern medicine. If the principle of "spleen being in charge of the defensive function" is lost，the key structure and function of the IPF alveolar epithelial barrier may be abnormal，and it can interact with various innate immune cells to promote inflammation and fibrosis processes. Therefore，this article explains the imbalance of immune homeostasis in IPF alveolar epithelium from two aspects：the barrier function of alveolar epithelial cells（AECs） and their interaction with innate immune cells. And based on the theory of "spleen being in charge of the defensive function"，using traditional Chinese medicine for strengthening the spleen and nourishing Qi to treat IPF from the perspective of the spleen. This not only strengthens the scientific connotation of "spleen being in charge of the defensive function" in the pathogenesis of IPF，but also provides new research directions and ideas for its future clinical prevention and treatment.

Pyroptosis is a form of programmed cell death that differs from classical apoptosis and passive necrosis.It plays a crucial role in activating innate immune responses,driving local inflam-matory reactions,regulating immune cell activation and infiltration,and remodeling the tumor immune microenvironment.In recent years,the role of pyroptosis in the initiation,progression,and treatment response of urological tumors has garnered increasing attention.Current studies have demonstrated that pyroptosis exhibits dual regulatory effects in various tumors:on the one hand,it exerts anti-tumor effects by inducing lytic death of tumor cells;on the other hand,under specific microenvironmental conditions,the chronic inflammatory response mediated by pyroptosis may promote immune escape,thereby driving tumor progression.This review systematically summarized the similarities and differ-ences in the molecular mechanisms of pyroptosis in three common urological tumors,namely renal cell carcinoma,bladder cancer,and prostate cancer.It also summarized the regulatory networks and po-tential therapeutic targets during tumor initiation and progression.Furthermore,it elucidated the re-search progress on enhancing the efficacy of immune checkpoint inhibitors by modulating pyroptosis pathways,aiming to provide novel strategies and theoretical foundations for the precise treatment of u-rological.

Guided by the pathogenesis of"structure-activity imbalance of lung collaterals",this paper proposes that structure-activity imbalance of lung collaterals is the initial factor of idiopathic pulmonary fibrosis(IPF)and elucidates the pathogenesis of abnormal changes in biomechanical properties of IPF.It is postulated that the changes of biomechanical properties of lung tissue are closely related to the injury of lung qi collaterals,the abnormal mechanical stress are closely related to the injury of lung blood collaterals,and the biomechanical response of intrapulmonary resident cells is closely related to the structure-activity imbalance of lung collaterals,which ultimately leading to abnormal increase in lung tissue stiffness and progressive scarring formation in lung tissue.Integrating traditional pathogenesis concepts with microscopic pathological changes,and the in-depth exploration of the correlation between the structure-activity imbalance of lung collaterals and the biomechanical properties of IPF can provide direction for exploring IPF medical-engineering cross research,which are of great significance for enriching the syndrome and treatment system of lung collateral diseases.

Objective:To analyse the clinical effect of percutaneous transhepatic papillary balloon dilatation (PTPBD) combined with lithotriptic basket in the treatment of large-diameter common bile duct stone (CBDS) after percutaneous transhepatic cholangia drainage (PTCD).Methods:The clinical data of 50 patients treated with PTPBD combined with lithotriptic basket after PTCD under digital subtraction angiography (DSA) for large-diameter CBDS in the Department of Interventional Radiology, the Second Affiliated Hospital of Nantong University from October 2021 to September 2024 were retrospectively analyzed, including 38 males and 12 females, aged (57.6±3.6) years. Clinical data, including gender, age, long diameter of the stone, and surgery-related complications, were recorded. Changes in leukocyte count, total bilirubin, alanine transaminase and C-reactive protein were compared before PTCD and on the 5th postoperative day.Results:All 50 cases were successfully treated with PTCD. Significant improvements were observed in white blood cell count [(7.35±2.36)×10 9/L vs. (11.34±2.81)×10 9/L], total bilirubin [(27.58±6.24) μmol/L vs. (74.35±12.26) μmol/L], alanine transaminase [(41.25±8.65) U/L vs. (141.41±29.16) U/L] and C-reactive protein [(39.34±13.45) mg/L vs. (81.43±31.35) mg/L] before and after PTCD (all P<0.001). The time interval between PTCD and PTPBD was (14.46±1.01) d. Among the 50 patients, 48 cases (96.0%) were successfully treated with PTPBD combined with a lithotriptic basket, while 2 cases (4.0%) failed due to the basket's inability to retrieve the stones. Among the 50 patients after PTCD, 2 cases (4.0%) of abdominal pain, 2 cases (4.0%) of bleeding, and 2 cases (4.0%) of fever. Following PTPBD with lithotriptic basket stone removal, abdominal pain occurred in 3 patients (6.0%) and fever in 2 (4.0%). Conclusion:PTPBD combined with lithotriptic basket in the second stage after PTCD under DSA is a minimally invasive treatment for large-diameter CBDS with safety and effectiveness.

Objective To investigate the clinical effect of digital subtraction angiography(DSA)-guided percutaneous transhepatic cholangial drainage(PTCD)in treatment of acute obstructive suppurative cholangitis(AOSC).Methods The relevant data of DSA-guided PTCD in treatment of AOSC patients were collected to analyze its safety and effectiveness.Results Among the 70 patients,there were 2 cases of bleeding,1 case of drainage tube blockage,and 1 case of drainage tube detachment,and no other serious surgical related complications occurred.The symptoms of 66 patients were improved from 3 to 7 d after PTCD compared with those before PTCD,and 4 patients died during hospitalization.The average daily bile drainage volume of patients was(650±130)m L,and the changes of leukocyte,total bilirubin,alanine aminotransferase and alkaline phosphatase indexes before and after surgery were statisti-cally significant(P<0.05).Conclusion DSA-guided PTCD in treatment of AOSC is a safe and effective minimally invasive method with high technical success rate,which can timely relieve obstruction,improve symptoms,reduce mortality,and create opportunities and conditions for secondary surgery or interventional therapy.