ObjectiveTo analyze the influencing factors for recurrence in successfully treated pulmonary tuberculosis patients with isoniazid-resistant and rifampicin-sensitive in Shaoxing City, Zhejiang Province. MethodsData on general demographic information, treatment information and drug susceptibility test results for pulmonary tuberculosis patients admitted to the designated tuberculosis medical institutions and registered in the tuberculosis information management system was collected in Shaoxing City from January 2011 to August 2024. A total of 428 patients with isoniazid resistance (including isoniazid single resistance and multiple resistance) but who were successfully treated were included in the study. Information for the recurrence after successful treatment of the patients was analyzed. The Cox proportional hazards models were used to analyze the influencing factors of recurrence in patients. ResultsAmong the 428 successfully treated patients included in the study, 31 cases (accounting for 7.24%) had recurrence by the end of the observation period, with a recurrence rate density of 1.31 per 100 person-years and a median recurrence time of 0.99 (0.08, 8.27) years. Among the relapsed population, 51.61% of the patients relapsed within one year after successful treatment. 77.42% of the patients relapsed within two years after successful treatment. Multivariate Cox regression analysis showed that when isoniazid resistance was discovered, the diagnosis classification of relapse (HR=4.115, 95%CI: 1.734‒9.767) and positive 0-month sequence smear (HR=4.457, 95%CI: 1.053‒18.866) were risk factors for recurrence after successful treatment in patients. ConclusionRegular follow-up should be strengthened for at least two years after the successful treatment of isoniazid-resistant pulmonary tuberculosis patients. Special attention should be paid to the treatment effect and regular re-examination and monitoring after the end of the treatment course of isoniazid-resistant pulmonary tuberculosis patients who have been re-treated and were sputum smear positive at baseline, so as to prevent recurrence and disease progression in high-risk populations.

The clinical manifestations of colorectal polyps are consistent with the characteristics of dampness, stickiness and heaviness. The TCM constitutions in the prone population are mostly related to dampness. The pathological changes of intestinal flora imbalance, intestinal micro inflammation, neuroendocrine immune network and abnormal aquaporin in colorectal polyps are consistent with the research results of modern mechanism of dampness pathogen. This article believed that the TCM pathogenesis of colorectal polyps caused by damp pathogen is the accumulation of spleen deficiency and dampness caused by improper diet, poor emotion and other factors, and the interweaving of various diseases and pathogens to form tangible foreign bodies. According to the pathogenic characteristics of damp pathogen and the pathogenic factors of colorectal polyps, the influence of damp pathogen on the pathogenesis of colorectal polyps was discussed, in order to provide an effective TCM theoretical basis for the diagnosis and treatment of colorectal polyps in clinic.

Objective:To develop a grading system for necrosis of pedicled flaps in reconstruction of foot and ankle, and to verify its effectiveness and repeatability.Methods:A retrospective observational study was conducted. A total of 40 necroses of foot and ankle pedicled flaps were selected by 2 senior surgeons based on the flap surgery performed by the same surgical group in Department of Orthopaedic Surgery, the 920 Hospital of Joint Logistic Support Force of PLA from January 2010 to January 2022. A grading system for pedicled flap necrosis was proposed by a working group and the 40 necrotic flaps were graded. The coincidence rate was calculated to evaluate the effectiveness of the grading system through correlation studies between grading and clinical treatment. One photo of a typical postoperative necrotic flap was collected from each of the 40 flaps. Then 5 extramural surgeons were asked to grade the necroses shown on the photos according to the proposed grading system. Moreover, weighted Kappa analysis was performed on the results of proposed grading system and also on the standard grading currently in use, to evaluate the repeatability of the proposed grading system. Evaluated data were expressed by Mean±SD, and the coincidence rate was expressed by percentage. The reproducibility was studied by weighted Kappa analysis.Results:Of the 40 necrotic flaps, 7 flaps were classified in Grade I, 16 in Grade Ⅱ, 12 in Grade Ⅲ and 5 in Grade IV. In comparison with the actual treatment methods, the overall coincidence rate of the grading system was 92.5%. It indicated that the proposed grading system could effectively guide the selection of a treatment procedure. The average weighted Kappa coefficient of surgeons was at 0.628 with a 95% confidence interval (95%CI) between 0.460-0.796, which was strongly consistent with the standard of the grading system currently in use.Conclusion:The grading system for necrosis of pedicled flap in reconstruction of foot and ankle proposed in this study is simple and clear. It is able to effectively guide the treatment of flap necrosis. The preliminary validation shows that the classification system has good repeatability.

Objective To compare the safety and efficacy of flexible terminal suction ureteral access sheath(FTS-UAS)and negative pressure ureteral access sheath(NPUAS)in flexible ureteroscopic lithotripsy with holmium laser in treatment of renal calculi less than 2 cm in diameter.Methods A total of 68 patients(largest diameter of stone＜2 cm)with renal calculi treated in Yangjiang Hospital Affiliated to Guangdong Medical University during Nov.2022 and Aug.2023 were divided into FTS-UAS group(n=34)and NPUAS group(n=34)according to different surgical methods.The perioperative parameters and stone-free rate(SFR)were compared between the two groups.Results The average SFR on the first day after operation was significantly higher in the FTS-UAS group than in the NPUAS group[85.3％(29/34)vs.61.8％(21/34),P=0.028].The operation time was significantly lower in the FTS-UAS group than in the NPUAS group[(65.85±13.16)min vs.(75.59±20.21)min,P=0.022].For lower calyceal renal calculi,the SFR was significantly higher in the FTS-UAS group than in the NPUAS group[82.4％(14/17)vs.43.8％(7/16),P=0.032].One month after operation,the SFR was higher in the FTS-UAS group than in the NPUAS group[94.1％(32/34)vs.85.3％(29/34),P=0.452].There were no significant differences in hemoglobin reduction,serum creatinine level,postoperative complications,hospital stay and hospitalization costs between the two groups(P＞0.05).Conclusion FTS-UAS in flexible ureteroscopic lithotripsy can shorten the operation time and improve stone-clearance rate,which is safe,effective,and worthy of clinical promotion.

Objective: To investigate the spatio-temporal clustering characteristics of pulmonary tuberculosis (PTB) aged 60 years and above in Shaoxing City from 2019 to 2023, so as to provide insights into prevention and control of PTB among the elderly. Methods: Data of PTB cases aged 60 years and above in Shaoxing City from 2019 to 2023 were collected from Tuberculosis Management Information System of Chinese Disease Prevention and Control Information System. The population data were collected from Shaoxing Statistical Yearbook. Vector map information was collected from Shaoxing Geographic Information Public Service Platform. The spatio-temporal clustering characteristics of PTB cases aged 60 years and above were analyzed using global spatial autocorrelation, local spatial autocorrelation and spatio-temporal scanning. Results: Totally 3 722 PTB cases aged 60 years and above were registered in Shaoxing City. The average annual registration rate was 61.71/105, showing no significant trend (P>0.05). Totally 2 548 pathogenetically positive cases were registered, with an average annual registration rate of 42.25/105. Spatial autocorrelation analysis showed there was a positive spatial correlation of PTB in 2019 and 2021 (both Moran's I>0, both P<0.05). Shengzhou City showed a high-low clustering, and Keqiao District and Shangyu District showed a low-low clustering. Spatio-temporal scanning analysis showed that a class Ⅰ cluster was located in Shengzhou City, with aggregation time from March 1, 2019 to August 31, 2021. The class Ⅱ clusters were located in Zhuji City, Shangyu City and Keqiao District, with aggregation time from March 1, 2021 to August 31, 2023, from April 1, 2021 to September 30, 2023, and from June 1, 2021 to November 30, 2023, respectively. Conclusion The PTB cases aged 60 years and above in Shaoxing City from 2019 to 2023 mainly concentrated in Shengzhou City, where the prevention and control of PTB among the elderly should be strengthened.

Objective To study the relationship between serum urine regulator protein and cystatin C levels and pathological characteristics and prognosis in patients with hypertensive nephropathy.Methods A total of 100 patients admitted in the hospital from August 2021 to October 2022 were selected as the study group,and 40 healthy persons who underwent the physical examination in the hospital were selected as the control group,complete data of all patients were collected and analyzed,the levels of serum urinary regulatory protein and cystatin C in each group were tested,and the relationship between serum urinary regulatory protein and cysta-tin C levels,pathological characteristics,and prognosis was analyzed.Results The urine regulatory protein and glomerular filtration rate in the study group were lower than those in the control group,but cystatin C,u-rea nitrogen,and blood creatinine were all higher than those in the control group,and the differences were sta-tistically significant(P＜0.05).Urinary regulatory protein was negatively correlated with urea nitrogen and blood creatinine,but positively correlated with glomerular filtration rate(P＜0.05).Cystatin C was positively correlated with urea nitrogen and blood creatinine,but negatively correlated with glomerular filtration rate(P＜0.05).Urinary regulatory protein level was related to crescent formation,renal tubular atrophy/intersti-tial fibrosis(P＜0.05),while level the expression of cystatin C was related to glomerular segmental sclerosis,glomerular glomerular sclerosis,and glomerular ischemic shrinkage(P＜0.05).The survival rate of the high urinary regulatory protein level group(≥126.49 ng/mL)was higher than that of the low urinary regulatory protein level group(＜126.49 ng/mL),while the survival rate of the high cystatin C level group(≥2.43 mg/L)was lower than that of the low cystatin C level group(＜2.43 mg/L)(P＜0.05).Urinary regulatory protein,cystatin C,renal tubular atrophy/interstitial fibrosis were factors that affected the occurrence of end-stage renal disease in hypertensive nephropathy(P＜0.05).Conclusion Hypertensive kidney disease patients u-sually have higher levels of cystatin C and lower levels of urinary regulatory protein,among which cystatin C is closely related to pathological features of glomerular segmental sclerosis,glomerular glomerular sclerosis,and glomerular is-chemic shrinkage,and urinary regulatory protein is closely related to crescent formation,renal tubular atrophy/intersti-tial fibrosis.In addition,urinary regulatory protein and cystatin C have a significant impact on the development of hy-pertensive nephropathy into end-stage renal disease,and could become important indicators for evaluating patient prognosis.

Objective To analyze the influencing factors of clinical pregnancy and live birth rates in patients undergoing frozen-thawed embryo transfer(FET)for the first time.Methods The clinical data of 1 458 patients who underwent FET cycle-assisted pregnancy for the first time were retrospectively analyzed and divided into four groups according to clinical pregnancy and live bith outcomes.The clini-cal data were compared to analyze the factors affecting clinical pregnancy and live birth rates in FET cycles that were included in multiple logistic regression analysis.Results Of the 1458 cycles,the clinical pregnancy and live birth rates were 44.0% and 34.0%,respectively.The mean age of the clinical pregnancy and live birth groups was lower than that in non-clinical pregnancy and stillbirth groups(P<0.05).The clinical pregnancy and live birth rates of patients aged<35 years were higher than those aged≥35 years(P<0.05).The clinical preg-nancy and live birth rates of patients with≥8 mm endometrial thickness were higher than those with<8 mm endometrial thickness(P<0.05).The clinical pregnancy rate of natural cycles of endometrial preparation regimen was higher than that of HRT cycles(P<0.05).The clinical pregnancy and live birth rates of double-embryo transfers were higher than that of single-embryo transfers(P<0.05).The clinical pregnancy and live birth rates of blastocyst transfers were higher than those of cleavage stage(P<0.05).Conclusion Age,endometrial thickness,number of transplanted embryos,and embryo morphology were the independent factors influencing clinical pregnancy and live birth outcomes during FET cycle transplantation.

Adrenocortical carcinoma (ACC) is a rare and highly aggressive endocrine malignancy. This paper provides a review of the pathways involved in the development of ACC and the progress of targeted drug therapy. The pathways reviewed include Wnt/β-catenin, P53, epithelial-mesenchymal transition(EMT), insulin growth factor(IGF) and fibroblast growth factor(FGF) signalling pathways.

Objective:To explore the safety and feasibility of adrenal tumor resection under day surgery mode for the treatment of unilateral primary aldosteronism (UPA).Methods:The clinical data of 83 patients who underwent adrenalectomy for the treatment of UPA from January 2020 to January 2023 were retrospectively analyzed. There were 42 males (50.6%)and 41 females (49.4%), age (49.0±12.3)years old. Body mass index (25.4±3.6)kg/m 2. There were 17 patients with diabetes, 58 patients with preoperative hypertension, and the duration of hypertension was 8.2(1, 15)years. Systolic blood pressure was 151.8(137.0, 160.0)mmHg (1 mmHg=0.133 kPa), and diastolic blood pressure was 97.4(87.0, 107.0)mmHg. 20 cases had severe preoperative hypokalemia, with preoperative blood potassium levels of (2.9±0.6)mmol/L. The ratio of preoperative plasma aldosterone to renin activity was 54.1(13.0, 77.2). Tumors were located on the left side in 47 cases (56.6%)and on the right side in 36 cases (43.4%). The maximum diameter of the tumor is 1.5(1.0, 1.7)cm. Patients diagnosed with unilateral primary aldosteronism were included, and patients diagnosed with adrenal pheochromocytoma, adrenal malignancy, or severe cardiovascular disease that cannot tolerate surgery were excluded. The patient was admitted to the hospital on the same day, underwent surgery on the same day, and was evaluated after extubation within one day after surgery. The patient had no fever or lower back pain after surgery, was able to freely get out of bed, and had no obvious abnormalities in blood routine, electrolyte and other test indicators. The patient was discharged from the hospital and received continuous care outside the hospital. The patient was guided to undergo regular outpatient follow-up. Evaluate the efficacy using the Primary Aldosterone Hyperaldosteronism Surgical Outcome (PASO)criteria. Results:The patients had a mean length of hospital stay of 43.0(40.3, 44.6)hours, an operation time of 89.6(70.0, 103.0)minutes, and an operation cost of 23 820.2 (21 150.8, 24 948. 3)yuan. The postoperative free position time was 29.5(20.8, 39.7)hours, the postoperative time for fluid placement of the diet was 25.2(20.1, 27.8) hours, and 42.2(37.9, 41.9)hours of postoperative drain removal. The overall postoperative clinical remission rate was 85.5%. There were four postoperative complications, accounting for 4.8% of cases. These included two cases of interosseous vein thrombosis, one case of delayed healing, and one case of peritoneal rupture. No case of readmission was reported within 30 days.Conclusions:UPA adrenal tumour resection in ambulatory mode is safe and effective when strict inclusion and exclusion criteria are followed, adequate preoperative preparation is carried out, and expert physician assessment is provided.

Objective:To investigate the correlation between hearing loss and microvascular complications in diabetes.Methods:This cross-sectional study conducted the data from 572 patients with diabetes hospitalized in the Endocrinology Department of the General Hospital of Southern Theater Command from September 2022 to July 2023. All participants underwent electrical audiometry and acoustic immittance in the ENY department. Based on the audiometric results, participants were categorized into normal hearing group and hearing loss group. Additionally, 572 non-diabetic patients from the outpatient department were enrolled as the non-diabetic group. The general information and laboratory results were collected and compared using t test, rank sum test or χ2 test. Binary logistic regression analysis was used to evaluate the association of diabetic hearing loss with diabetic kidney disease(DKD), diabetic retinopathy (DR), and diabetic peripheral neuropathy (DPN). Results:Among 572 patients with diabetes, 429 suffered from hearing loss and 143 were normal. χ2 test showed significant differences in combined DKD and DPN between two groups, but not in DR. Multivariate binary logistic regression analysis identified DKD and DPN as risk factors for hearing loss, but no correlation was found with DR. Conclusion:Diabetic patients with DKD or DPN should be monitored for potential hearing loss. Early screening and treatment are crucial to prevent severe hearing impairment.