Objective: To investigate the efficacy and safety of intelligent temperature-pressure-controlled flexible ureteroscopy combined with negative-pressure suction sheath lithotripsy in the treatment of upper urinary tract stones ≤2.5 cm. Methods: The clinical data of 225 patients with ≤2.5 cm upper urinary tract stones treated with this surgical method in our department during Aug. 2023 and Jul. 2024 were retrospectively analyzed. The patients were divided into the dual-control group (n=36) and conventional group (n=189) according to whether or not the intelligent temperature and pressure control device was used during operation. In the dual-control group，the intraoperative temperature and pressure in the renal pelvis were monitored and controlled in real time by the temperature and pressure sensors distributed at the end of the ureteral soft lens. The perioperative parameters，stone-removal rate，complication rate and renal function were compared between the two groups. Results: All operations were successfully completed in both groups. The postoperative procalcitonin (PCT) level [(22.75±5.85) ng/L vs. (29.08±6.60) ng/L，P=0.001]，difference in the white blood cell (WBC) level [(0.24±2.12)×10 cells/L vs. (1.19±2.17)×10 cells/L，P=0.016]，incidence of fever (2.8% vs. 16.9%，P=0.028) and overall complication rate (5.6% vs. 19.6%，P=0.042) were significantly lower in the dual-control group than in the conventional group，while the stone-clearance rate was slightly higher (88.9% vs. 82.5%，P=0.346)，with no significant difference. Conclusion: For upper urinary tract stones ≤2.5 cm，intelligent temperature-pressure-controlled ureteroscopy combined with negative-pressure suction sheath lithotripsy has a satisfactory stone-removal rate and a low rate of complications，which is worthy of clinical promotion.

Objective To explore the mechanism underlying the protective effect of α2-macroglobulin (A2M) against glucocorticoid-induced femoral head necrosis. Methods In a human umbilical vein endothelial cell (HUVEC) model with injuries induced by gradient concentrations of dexamethasone (DEX;10-8-10-5 mol/L), the protective effects of A2M at 0.05 and 0.1 mg/mL were assessed by examining the changes in cell viability, migration, and capacity of angiogenesis using CCK-8 assay, Transwell and scratch healing assays and angiogenesis assay. The expressions of CD31 and VEGF-A proteins in the treated cells were detected using Western blotting. In BALB/c mouse models of avascular necrosis of the femoral head induced by intramuscular injections of methylprednisolone, the effects of intervention with A2M on femoral trabecular structure, histopathological characteristics, and CD31 expression were examined with Micro-CT, HE staining and immunohistochemical staining. Results In cultured HUVECs, DEX treatment significantly reduced cell viability, migration and angiogenic ability in a concentration- and time-dependent manner (P<0.05), and these changes were obviously reversed by treatment with A2M in positive correlation with A2M concentration (P<0.05). DEX significantly reduced the expression of CD31 and VEGF-A proteins in HUVECs, while treatment with A2M restored CD31 and VEGF-A expressions in the cells (P<0.05). The mouse models of femoral head necrosis showed obvious trabecular damages in the femoral head, where a large number of empty lacunae and hypertrophic fat cells could be seen and CD31 expression was significantly decreased (P<0.05). A2M treatment of the mouse models significantly improved trabecular damages, maintained normal bone tissue structures, and increased CD31 expression in the femoral head (P<0.05). Conclusion A2M promotes proliferation, migration, and angiogenesis of DEX-treated HUVECs and alleviates methylprednisolone-induced femoral head necrosis by improving microcirculation damages and maintaining microcirculation stability in the femoral head.

Osteoporosis （OP） is a systemic metabolic bone disease characterized by bone microstructure degeneration and bone mass loss， which has a high prevalence and disability rate. Effective prevention and treatment of OP is a major difficulty in the medical community. The nature of OP is that multiple pathological factors lead to the imbalance of human bone homeostasis maintained by osteoblasts and osteoclasts. Ferroptosis is a non-apoptotic cell death pathway， and its fundamental cause is cell damage caused by iron accumulation and lipid peroxidation. Studies have shown that ferroptosis is involved in and affects the occurrence and development of OP， which leads to OP by mediating the imbalance of bone homeostasis. Ferroptosis is an adjustable form of programmed cell death. The intervention of ferroptosis can regulate the damage degree and death process of osteoblasts and osteoclasts， which is beneficial to maintain bone homeostasis， slow down the development process of OP， improve the clinical symptoms of patients， reduce the risk of disability， and improve their quality of life. However， there are few studies on ferroptosis in OP. Traditional Chinese medicine （TCM） is a medical treasure with unique characteristics and great application value in China. It has been widely used in China and has a long history. It has the multi-target and multi-pathway advantages in the treatment of OP， with high safety， few toxic and side effects， and low treatment cost， and has a significant effect in clinical application. The intervention of TCM in ferroptosis to regulate bone homeostasis may be a new direction for the prevention and treatment of OP in the future. This article summarized the regulatory mechanisms related to ferroptosis， discussed the role of ferroptosis in bone homeostasis， and reviewed the current status and progress of active ingredients in TCM compounds and monomers in the regulation of OP through ferroptosis， so as to provide a theoretical basis for the participation of TCM in the prevention and treatment of OP in the future.

Objective To explore the mechanism underlying the protective effect of α2-macroglobulin (A2M) against glucocorticoid-induced femoral head necrosis. Methods In a human umbilical vein endothelial cell (HUVEC) model with injuries induced by gradient concentrations of dexamethasone (DEX;10-8-10-5 mol/L), the protective effects of A2M at 0.05 and 0.1 mg/mL were assessed by examining the changes in cell viability, migration, and capacity of angiogenesis using CCK-8 assay, Transwell and scratch healing assays and angiogenesis assay. The expressions of CD31 and VEGF-A proteins in the treated cells were detected using Western blotting. In BALB/c mouse models of avascular necrosis of the femoral head induced by intramuscular injections of methylprednisolone, the effects of intervention with A2M on femoral trabecular structure, histopathological characteristics, and CD31 expression were examined with Micro-CT, HE staining and immunohistochemical staining. Results In cultured HUVECs, DEX treatment significantly reduced cell viability, migration and angiogenic ability in a concentration- and time-dependent manner (P<0.05), and these changes were obviously reversed by treatment with A2M in positive correlation with A2M concentration (P<0.05). DEX significantly reduced the expression of CD31 and VEGF-A proteins in HUVECs, while treatment with A2M restored CD31 and VEGF-A expressions in the cells (P<0.05). The mouse models of femoral head necrosis showed obvious trabecular damages in the femoral head, where a large number of empty lacunae and hypertrophic fat cells could be seen and CD31 expression was significantly decreased (P<0.05). A2M treatment of the mouse models significantly improved trabecular damages, maintained normal bone tissue structures, and increased CD31 expression in the femoral head (P<0.05). Conclusion A2M promotes proliferation, migration, and angiogenesis of DEX-treated HUVECs and alleviates methylprednisolone-induced femoral head necrosis by improving microcirculation damages and maintaining microcirculation stability in the femoral head.

Objective To observe the value of preoperative MRI radiomics models for predicting risk stratification of endometrial cancer(EC).Methods Data of 219 EC patients who underwent pelvic MR examination before surgery were retrospectively analyzed.The patients were divided into high risk group(n=104)or low risk group(n=115)according to postoperative pathological findings,also assigned into training set(n=153)or test set(n=66)according to examination time and further divided into high or low risk subgroups in each set.ROI was manually sketched on MRI using 3D Slicer,and each 1 130 features were extracted from axial and sagittal fat suppression(FS)T2WI as well as axial and sagittal enhanced FS-T1WI,respectively.Then the least absolute shrinkage and selection operator(LASSO)was used to select a total of 54 merged MRI features,including 12,14,16 and 12 features,respectively.Finally,25 merged LASSO features were reduced dimensionality and selected by reusing LASSO.Extremely randomized trees algorithm was used to construct radiomics models based on each single sequence features,merged MRI features and merged LASSO features,respectively.Receiver operating characteristic curves were drawn,the area under the curve(AUC),the accuracy and F1 score were obtained to evaluate the predicting efficacy of each model.AUC was used to evaluate the predictive efficacy of the models and subjective diagnosis of test set.Results In training set,the accuracy(0.784,0.777),F1 score(0.730,0.731)and AUC(0.835,0.855)of modelmerged MRI and modelmerged LASSO were both higher than those of each single sequence model,while in test set,the sensitivity(0.794,0.882),specificity(0.909,0.969)and AUC(0.904,0.934)of modelmerged MRI and modelmerged LASSO were both higher than those of subjective diagnosis and each single sequence model.The predictive effiency of modelmerged LAsSo was better than that of modelmerged MRI,which was the best model.Conclusion Preoperative MRI radiomics model was effective for predicting risk stratification of endometrial cancer.Modelmerged LASSO had the best performance.

Objective:To assess the efficacy and safety of 100 units of botulinum toxin A (BTX-A) intradetrusor injection in patients with overactive bladder.Methods:From April 2016 to December 2018, 17 tertiary hospitals were selected to participate in this prospective, multicenter, randomized, double-blind, placebo-controlled study. Two phases of study were conducted: the primary phase and the extended phase. This study enrolled patients aged 18 to 75 years who had been inadequately managed by anticholinergic therapy (insufficient efficacy or intolerable side effects) and had spontaneous voiding with overactive bladder. Exclusion criteria included patients with severe cardiac, renal and hepatic disorders, patients with previous botulinum toxin treatment for 6 months or allergic to BTX-A, patients with urinary tract infections, patients with urinary stones, urinary tract tumors, diabetes mellitus, and bleeding tendency. Eligible patients were randomly assigned to BTX-A group and placebo control group in a ratio of 2∶1. Two groups of patients received 20 intradetrusor injections of BTX-A 100U or placebo at the depth of the submucosal muscle layer respectively under cystoscope, including 5 injections at the base of the bladder, 3 injections to the bladder triangle, 5 injections each to the left and right walls and 2 injections to the top, sparing the bladder neck. As a placebo control group, patients received same volume of placebo containing no BTX-A and only adjuvant freeze-dried preparations for injection with the same method. A combination of gelatin, sucrose, and dextran served as adjuvants. Average micturition times per 24 hours, urinary incontinence (UI) episodes per day, average micturition volume per day, OAB symptom score(OABSS), and quality of life (QOL) score were recorded at baseline and the 2nd, 6th and 12th week after treatment. The primary efficacy endpoint was the change from baseline in the average micturition times per 24 hours at the 6th week after treatment. The secondary efficacy endpoints included the change from baseline in the average micturition times per 24 hours at 2nd and 12th week, as well as the change from baseline in the OABSS, QOL score, average frequency of urgency and UI episodes per day, urgency score, average micturition volume per day at 2nd, 6th and 12th week after treatment. Patients were followed for 12 weeks to assess adverse events (AEs). After assessed at week 12, if the micturition times has decreased less than 50% compared to baseline and the patient is willing to receive retreatment, then patients could enter the extended trial phase. In that phase, patients in both groups were injected with 100 units BTX-A from 12th week onwards and then followed up the same indicators for 12 weeks.Results:216 patients were enrolled in this trial (144 cases in the BTX-A group and 72 cases in the placebo control group). Baseline characteristics such as age (47.75±14.20 in the BTX-A group and 46.39±15.55 in the control group), sex (25 male/117 female in the BTX-A group and 10/61 in the control group), and disease duration (0.51 years in the BTX-A group and 0.60 years in the control group) were balanced between the two groups( P>0.05). A marked reduction from baseline in average micturition times per 24 hours was observed in all treatment groups at the 6th week and the reduction of the two groups was statistically different ( P<0.001 and P=0.008 respectively). Compared with the baseline, the average micturition times per 24 hours at the 6th week decreased from baseline by 2.40(0.70, 4.60)times for the BTX-A group and 0.70(-1.00, 3.30) times for the placebo control group respectively, and the difference between the two groups was considered to be statistically significant ( P=0.003). The change rates of average micturition times per 24 hours from baseline at the 6th week of the two groups were (16±22)% and (8±25)% respectively, and the difference between the two groups was statistically significant ( P=0.014). Compared with the baseline, the average micturition times per 24 hours at 2nd and 12th week decreased by 2.00(0.00, 4.00)and 3.30(0.60, 5.03)for the BTX-A group, 1.00(-1.00, 3.00)and 1.70(-1.45, 3.85)for the placebo control group respectively. The difference between two groups was considered to be statistically significant ( P=0.038 and P=0.012); the changes of average urgency times per day for the BTX-A group and the control group at the 2nd, 6th and 12th week were 2.00(0.00, 4.30)and 2.40(0.30, 5.00), 3.00(0.30, 5.70)and 0.70(-1.30, 2.70), 0.70(-1.30, 3.00) and 1.35(-1.15, 3.50), respectively. There were significant differences between two groups at the 2nd, 6th and 12th week, ( P=0.010, P=0.003 and P=0.025, respectively). The OABSS of the BTX-A group and the control group at the 6th week decreased by 1.00(0.00, 4.00)and 0.50(-1.00, 2.00) compared with the baseline, and the difference between the two groups was statistically significant ( P=0.003). 47 cases of BTX-A group and 34 cases of placebo control group entered the extended trial phase, and 40 and 28 cases completed the extended trial phase, respectively. The average micturition volume per 24 hours changed by -16.60(-41.60, -0.60)ml and -6.40(-22.40, 13.30)ml, (-35.67±54.41)ml and(-1.76±48.69)ml, (-36.14±41.51)ml and (-9.28±44.59)ml, (-35.85±43.35)ml and(-10.41±40.29)ml for two groups at the 12th, 14th, 18th and 24th week, and the difference between two groups was statistically significant at each follow-up time ( P=0.01, 0.006, 0.012 and 0.016, respectively). There was no significant difference in other parameters( P>0.05). However, adverse reactions after intradetrusor injection included increased residual urine volume (27 in the BTX-A group and 3 in the control group), dysuria (21 in the BTX-A group and 6 in the control group), urinary infection (19 in the BTX-A group and 6 in the control group), bladder neck obstruction (3 in the BTX-A group and 0 in the control group), hematuria (3 in the BTX-A group and 1 in the control group), elevated alanine aminotransferase (3 in the BTX-A group and 0 in the control group), etc. During the follow-up period, there was no significant difference in the other adverse events between two groups except the increase of residual urine volume( P<0.05). In the primary trial phase, among the 27 cases with increased residual urine volume in BTA group, only 1 case (3.70%) with PVR more than 300 ml; the PVR of 3 patients in the placebo group was less than 100 ml. The increase of residual urine volume caused by the injection could be improved or disappeared with the passage of time. Conclusions:Intradetrusor injection of Chinese BTX-A improved the average micturition times per 24 hours, the average daily urgent micturition times, OABSS, and average micturition volume per time, and reduced the adverse effects in patients with overactive bladder.Chinese BTX-A at dose of 100U demonstrated durable efficacy and safety in the management of overactive bladder.

Objective:To investigate the changes and clinical significance of blood coagulation function and von Willebrand factor antigen (vWF:Ag) in patients with HELLP syndrome (hemolysis, elevated liver function, low platelet count).Methods:The clotting data of patients with severe preeclampsia and HELLP syndrome (observation group) admitted to the department of critical care medicine of the Fifth Center Hospital in Tianjin from May 2015 to December 2019 were retrospectively analyzed, and normal late pregnancy women with the same period were enrolled as the control group. The coagulation indexes such as prothrombin time (PT), activated partial thrombin time (APTT), antithrombin (AT), fibrinogen (Fib), D-dimer and plasma vWF:Ag level were compared between the two groups, and among patients with HELLP syndrome with different disease degree.Results:① Sixty-five patients with HELLP syndrome and 65 normal pregnant women with third trimester were included. Both groups were women of childbearing age, and there were no significant difference in the baseline data. ② The levels of Fib, D-dimer in both groups increased, but they were significantly higher in the observation group than those in the control group [Fib (g/L): 4.94 (4.76, 5.85) vs. 3.58 (2.97, 4.14), D-dimer (mg/L): 3.34 (2.55, 4.32) vs. 1.72 (1.29, 2.08), both P < 0.05], the AT was obviously reduced [62.00 (49.00, 73.00)% vs. 97.50 (90.75, 107.00)%, P < 0.01], and both PT and APTT were in the normal reference range in the two groups. In addition, the plasma vWF:Ag level in the observation group was significantly higher than that in the control group [516.50 (467.20, 563.00)% vs. 246.45 (189.95, 274.10)%, P < 0.01]. ③ According to thrombocytopenia, among the 65 patients with HELLP syndrome, 26 cases were mild [platelet count (PLT) > 100×10 9/L], 22 cases were moderate [PLT (50-100)×10 9/L], and 17 cases were severe (PLT < 50×10 9/L). With the aggravation of the disease, the D-dimer, Fib, vWF:Ag levels in the mild, moderate, severe patients significantly increased, while the AT level significantly decreased, and there was statistically significant difference between the two groups [D-dimer (mg/L): 2.63 (2.60, 2.73), 3.15 (2.55, 3.73), 3.84 (3.52, 4.23); Fib (g/L): 4.23 (4.06, 4.47), 4.72 (4.34, 5.04), 5.43 (5.14, 5.76); vWF:Ag: 465.20 (437.20, 495.40)%, 500.10 (472.40, 534.50)%, 543.50 (521.30, 563.00)%; AT: 67.50 (61.60, 78.00)%, 63.70 (53.30, 70.40)%, 54.40 (44.00, 61.20)%; all P < 0.05]. Conclusion:Patients with HELLP syndrome may show hypercoagulability and excessive expression of peripheral blood vWF:Ag level, which can induce platelet aggregation, leading to thrombocytopenia and thrombotic microangiopathy, and the clinicians should pay attention to that.

Objective:To investigate the clinical significance of preserving supraclavicular nerve in the reduction and fixation of clavicular fracture.Methods:A retrospective study was conducted of the 68 pa-tients with clavicular fracture who had been treated surgically from October 2016 to April 2018 at Department of Orthopedics and Traumatology, Heyuan Hospital of Traditional Chinese Medicine.They were 35 males and 33 females, aged from 25 to 45 years (average, 34.8 years).The supraclavicular nerve was preserved in the re-duction and fixation of clavicular fracture in 32 patients (reservation group) but not in the other 36 ones (control group).The 2 groups were compared in terms of operation time, intraoperative blood loss, fracture healing time; postoperative pain tolerance, feeling (by the British Medical Research Council assessment), shoulder function (by the Constant-Murley scoring) and impact of numbness on life.Results:The 2 groups were compatible due to insignificant differences in the general clinical data between them ( P>0.05).All the 68 patients were followed up for 12 to 26 months (average, 15 months).There was no significant difference between the 2 groups either in intraoperative blood loss or fracture healing time ( P>0.05).The preservation group had significant longer operation time (72.6 min±7.2 min) than the control group (47.3 min±7.4 min), but a significantly lower rate of analgesic usage on the postoperative day [6.3%(2/32)] than the control group [91.7%(33/36)] (both P<0.05).By the British Medical Research Council assessment, the postoperative feeling was rated as S3 or S4 in 93.8%(30/32) of the patients in the preservation group, significantly higher than the 72.2% (26/36) of the control group ( P<0.05).The preservation group was also significantly better than the control group in Constant-Murley scores of the injured shoulder [100.0 (93.5, 100.0) versus 87.0 (81.0, 89.0)] and impact of numbness on life [0 versus 50.0%(18/36)] (both P<0.05). Conclusion:In surgical treatment of clavicular fracture, preservation of the supraclavicular nerve can have a positive effect on reducing postoperative pain in the operative area and impact of numbness on life.

Objective To evaluate the effects of flurbiprofen axetil administered at different time points on oxygenation in the patients undergoing one-lung ventilation (OLV).Methods Ninety patients of both sexes,aged 45-64 yr,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,undergoing elective thoracoscope-assisted pulmonary lobectomy,were assigned into 3 groups (n =30 each) using a random number table:control group (group C),preoperative administration group (group F1) and intraoperative administration group (group F2).Flurbiprofen axetil (10 mg/ml) and fat emulsion 10 ml were injected intravenously at 15 min before operation in F1 and C groups,respectively.Flurbiprofen axetil 10 ml was intravenously injected immediately after the beginning of OLV in group F2.At 15 min before operation (T1),15 and 30 min of OLV (T2,3),and 15 min after restoration of two-lung ventilation (T4),airway peak pressure (Ppeak) and dynamic lung compliance (Cdyn) were recorded,arterial blood samples were collected for blood gas analysis.The arterial oxygen partial pressure (PaO2) was recorded,and the oxygenation index (OI) and intrapulmonary shunt (Qs/Qt) were calculated.The concentrations of thromboxane B2 (TXB2) and 6-keto-prostaglandin F1α (6-K-PGF1α) in serum were measured by enzyme-linked immunosorbent assay,and TXB2/6-K-PGF1α ratio was calculated.The development of interrupting OLV due to SpO2＜90％ and postoperative dyspnea,pulmonary infection,atelectasis and length of hospital stay were recorded.Results Compared with group C,PaO2 and OI were significantly increased,and Qs/Qt was decreased at T2,3,the serum concentrations of TXB2 and 6-K-PGF1α were decreased,and TXB2/6-K-PGF1α ratio was increased at T2-4,the incidence of interrupting OLV was decreased (P＜0.05),and no significant change was found in the parameters mentioned above in group F2 (P＞0.05).Compared with group F1,PaO2 and OI were significantly decreased at T2,3,Qs/Qt was increased at T2,and the serum concentrations of TXB2 and 6-K-PGF1α were increased,and TXB2/6-K-PGF1α ratio was decreased at T2-4 in group F2 (P＜0.05).There was no significant difference in the incidence of postoperative dyspnea,pulmonary infection and atelectasis and length of hospital stay between the three groups (P＞0.05).Conclusion Flurbiprofen axetil injected at 15 min before operation can significantly improve oxygenation and prevent the development of hyoxemia in the patients undergoing OLV,however,flurbiprofen axetil administered immediately after the beginning of OLV has no such effect.

Objective To explore the value of transesophageal doppler in transurethral resection prostate.Methods Thirty-six patients (aged 60-85 years, falling into ASA grade Ⅰ-Ⅲ) of benign prostatic hyperplasia for undergoing transurethral resection prostate were enrolled.Through multifunction monitor, CVP, Narcotrend index(NI) were monitored before anesthesia induction (T0), 20 minutes after anesthesia induction (T1), after irrigating fluid of 5 000 ml (T2) and 10 000 ml (T3) and 15 000 ml (T4) and 20 000 ml (T5).By transesophageal doppler, FTc(corrected flowtime), SV(stroke volume), ΔPV(peak flow vaviable quantity) were monitored at T1-T5.Results CVP at T1-T5 were not significantly changed compared with that at T0.Compared with T1, FTc, SV at T3-T5were significantly increased and ΔPV at T2-T5were significantly decreased (P<0.05).CVP levels correlated significantly with both FTc (r=0.702, P<0.01) and SV (r=0.595, P<0.01).CVP negatively correlated significantly with ΔPV (r=-0.351, P<0.05).Furthermore, FTc correlated significantly with the concentrationof Na+(r=0.672,P<0.01).No patient had serum sodium ion concentration less than 125 mmol/L.Conclusion FTc of transesophageal doppler is as accurate as central venous pressure in monitoring hemodynamic changes, and even more sensitive than CVP.It is useful in early diagnosis and treatment of TURS.