A 70-year-old male patient was admitted to a hospital on March 1,2024 due to"muscle soreness in his extremities for over a month".Diagnosis consideration:polymyalgia rheumatica(with a high likelihood,the possi-bility of a tumor needs to be excluded).The patient was treated with methylprednisolone.After discharge from the hospital,the patient's symptoms worsened due to self-withdrawal of medication(methylprednisolone treatment for 20 days),and developed fever and cough.He then revisited the hospital and was confirmed to have Legionella mar-ssiliensis infection through metagenomic sequencing of bronchoalveolar lavage fluid(nucleic acid of all microorga-nisms were extracted from the specimens and compared in the PMDB database to obtain species information of the suspected pathogenic microorganisms).Subsequently,the patient was treated with a combination of 0.75 g levo-floxacin intravenous infusion qd+0.1 g doxycycline enteric-coated capsules orally bid for anti-infective therapy.The patient's symptoms,such as cough and muscle pain,improved significantly after anti-inflammatory and anti-in-fective treatment,and he was discharged on March 18.As the first reported case of Legionella marssiliensis pulmo-nary infection in China,this case highlights that among the multiple species of Legionella,there is another bacte-rium that can infect the human body and cause disease.This case report is beneficial for improving medical staff's understanding on Legionella marssiliensis and providing reference for the diagnosis and treatment of future cases of Legionella marssiliensis infection.

Objective:To assess the feasibility and efficacy of transperineal laser ablation(TPLA)with single laser fiber in treating benign prostatic obstruction(BPO).Methods:From April 2021 to March 2024,a total of 13 BPO patients were selected from Beijing Friendship Hospital.TPLA was performed using a single laser fiber,which was guided by transrectal biplane ultrasound.The single laser fiber was used to undergo TPLA under the guidance of trans-rectal dual-plane ultrasound.The intraoperative time,ablation time,energy consumption,indwelling time of catheter,and complications were observed.The postoperative 6 months was chosen as the cut-off point of follow-up,and the pre and postoperative changes of international prostate symptom score(IPSS),quality of life index(QoL),prostate volume(PV),residual urine volume(RUV)and the maximum urine flow rate(Qmax)were compared.Results:All 13 patients successfully underwent TPLA with single laser fiber.The average operation time was(55.1±18.3)min,and the average ablation time was(16.3±1.7)min,and average energy consumption was(3951.6±459.7)J,and the median value of indwelling time of catheter was 7(7,10)days.The number of postoperative complication was 2 cases,and both them belonged to Clavien-Dindo grade II complication.At the postoperative 6th month,the IPSS,QoL,PV,Qmax and RUV of all patients were improved,all of which were better than preoperative these indicators,and the differences were significant(t=12.102,-3.228,-3.181,-2.581,-2.936,P<0.05).Conclusion:The application of single laser fiber in conducting TPLA operation is feasibility at technical aspect,and it can achieve the therapeutic goals of improving patients'symptoms and enhancing their quality of life.Although its operational time is slightly longer than that of using multiple fibers simultaneously,it can effectively reduce the cost of expenditure for consumables.

Objectives:Comparative analysis of the beagles acute-phase electrocardiographic,hemodynamic,left ventricular flow field status,and energy consumption characteristics of pacing at different sites of conduction system may help to elucidate the scientific mechanism of left bundle branch pacing(LBBP)as a option of physiological pacing therapy.Methods:Eight healthy adult beagles were used in this study.Initially,an active fixation lead was implanted in the right atrial appendage,followed by implantation of another active fixation lead at the right ventricular apex,distal His bundle,and left bundle septal branch,respectively.After connecting a dual-chamber pacemaker,electrocardiographic and acute phase hemodynamic parameters under sinus rhythm,right ventricular apex pacing(RVAP),distal His bundle pacing(DHBP),and LBBP states were collected and analyzed.Three complete cardiac cycles of standard apical three-chamber color Doppler dynamic images were acquired under vector flow mapping(VFM)mode.Offline analysis was performed on obtained parameters including isovolumic contraction period,rapid ejection period,isovolumic relaxation period,rapid filling period,atrial contraction period,and left ventricular intracavitary energy consumption.These parameters were compared under pacing at different sites and the linear correlations of major parameters were analyzed.Results:The QRS duration of baseline intrinsic sinus rhythm,RVAP,DHBP and LBBP were(45.0±4.0)ms,(98.4±6.2)ms,(50.0±4.5)ms and(62.0±4.7)ms,respectively.The LBBP-QRS duration was significantly wider than intrinsic sinus rhythm and DHBP,but significantly narrower than RVAP(all P<0.01).Compared with baseline AOO mode(the pacing rate was performed at 10 beats/min above the intrinsic heart rate),the change of acute phase maximum left ventricular pressure rise rate(LVdP/dtmax)in RVAP,DHBP and LBBP was([-7.89±5.67]% ),([0.74±2.05]% )and([-0.14±3.59]% ),respectively.There was no significant difference in LVdP/dtmax changes between DHBP and LBBP(P=0.667),but both pacing modalities were significantly better than RVAP(all P<0.01).The average energy consumption of the left ventricle under RVAP was significantly higher than that of intrinsic sinus rhythm,DHBP,and LBBP in isovolumic contraction period,rapid ejection period,isovolumic relaxation period,rapid filling period,and atrial contraction period(all P<0.01).However,there was no statistically significant difference in energy consumption among intrinsic sinus rhythm,DHBP,and LBBP during the above five phases(all P>0.05).DHBP and LBBP did not show a significant increase in the number of left ventricular vortices,vortex area,and circulation intensity compared to intrinsic sinus rhythm,and LBBP did not show a significant increase in vortex area and circulation intensity compared to DHBP.Conclusions:Although LBBP canines significantly prolonged the paced QRS duration,it showed no significant differences in acute phase left ventricular hemodynamics,left ventricular flow field status,and energy consumption compared to intrinsic sinus rhythm and DHBP.Performance of LBBP was superior to RVAP.This study may contribute to revealing the theoretical basis of LBBP as a feasible physiological pacing therapy.

BACKGROUND:Natural biomaterials such as allogeneic materials are highly susceptible to bacterial contamination during the production process.Among them,bacterial endotoxin released by Gram-negative bacteria can cause human fever,coagulation,shock,and even death.There is no relevant research on the method of endotoxin removed from allogeneic materials while maintaining their natural structure and biological activity.OBJECTIVE:To explore the method and effect of endotoxin removed from allogeneic materials and other natural biological materials and to control the residual H2O2.METHODS:The endotoxin was removed from allogeneic bone materials by H2O2/ultrasound.The influence of ultrasound and the concentration of H2O2 on the endotoxin removal process was explored.The concentration of H2O2 was set as 1％,2％,3％,4％,and 5％by mass.The power of ultrasound was set as 80,120,140,160,and 200 W.The duration of ultrasound was 20,30,40,50,and 60 minutes.The temperature was 30,35,40,45,and 50 ℃.The optimal combination of conditions for treating allogeneic bone materials was selected by endotoxin content detection for subsequent experiments.The microstructure,H2O2 residue,and cytotoxicity of allogeneic bone materials after endotoxin removal were detected,and the effects of different concentrations of H2O2 residue on the survival rate of L929 mouse fibroblasts were explored.RESULTS AND CONCLUSION:(1)According to the results of the endotoxin removal process,when the concentration of H2O2 was 4％,the power of ultrasound was 200 W,with the duration of ultrasound of 50 minutes,and the temperature 50 ℃,it would effectively remove endotoxin from allogeneic bone materials.The optimal combination was selected to remove endotoxins from allogeneic bone materials.(2)After endotoxin removal,the residual H2O2 content of allogeneic bone materials was less than 47.551 mg/kg after being placed in a 60 ℃ water bath and changing the solution 6 times,which had no effect on the viability of L929 mouse fibroblasts.(3)Optical microscopy and scanning electron microscopy observations exhibited that the use of H2O2 solution in conjunction with ultrasonic treatment had no effect on the structure of allogeneic bone materials.(4)The results indicate that the H2O2 solution in conjunction with ultrasonic treatment has the characteristics of efficient and rapid removal of endotoxins,which can ensure the safety of allogeneic bone materials.

BACKGROUND:Allogeneic tendons are often used in clinical treatment of tendon and ligament injuries,which need to be treated before clinical application.At present,allogeneic tendons will face multiple freeze-thaw cycles after cryopreservation,but there is no relevant research on the changes in the properties of the treated allogeneic tendon after several freeze-thaw cycles.OBJECTIVE:To explore the changes in mechanical properties and composition of allogeneic tendon after multiple freeze-thaw cycles.METHODS:The treated allogeneic tendon was frozen and thawed 3,6,and 10 times at-40 ℃(or-80 ℃),respectively.The mechanical test,DNA content,glycosaminoglycan sulfate,hydroxyproline content and total protein content of the allogeneic tendon after freezing and thawing were detected.RESULTS AND CONCLUSION:(1)There was no significant difference in the maximum load,maximum load elongation,tensile strength and elastic modulus between groups after freezing-thawing cycles for 3,6,and 10 times at-40 ℃(P＞0.05).There was no significant difference in the maximum load and maximum load elongation between the groups after freezing-thawing cycles for 3,6,and 10 times at-80 ℃(P＞0.05).The tensile strength of the group with 3 cycles of freezing and thawing was higher than that of the groups with 6 and 10 cycles of freezing and thawing(P＜0.05).The elastic modulus of the group with 3 cycles of freezing and thawing was higher than that of the group with 10 cycles of freezing and thawing(P＜0.05).(2)The freezing and thawing times did not affect the contents of DNA,hydroxyproline,total protein,and sulfated glycosaminoglycan in allogeneic tendon when stored at-40 ℃(or-80 ℃).(3)These findings suggest that in-40℃ storage,the performance of the allogeneic tendon should not be affected by taking out and putting back the tendon less than 10 times,while in-80 ℃ storage,the allogeneic tendon should be taken out and put back less than 6 times.

A 70-year-old male patient was admitted to a hospital on March 1,2024 due to"muscle soreness in his extremities for over a month".Diagnosis consideration:polymyalgia rheumatica(with a high likelihood,the possi-bility of a tumor needs to be excluded).The patient was treated with methylprednisolone.After discharge from the hospital,the patient's symptoms worsened due to self-withdrawal of medication(methylprednisolone treatment for 20 days),and developed fever and cough.He then revisited the hospital and was confirmed to have Legionella mar-ssiliensis infection through metagenomic sequencing of bronchoalveolar lavage fluid(nucleic acid of all microorga-nisms were extracted from the specimens and compared in the PMDB database to obtain species information of the suspected pathogenic microorganisms).Subsequently,the patient was treated with a combination of 0.75 g levo-floxacin intravenous infusion qd+0.1 g doxycycline enteric-coated capsules orally bid for anti-infective therapy.The patient's symptoms,such as cough and muscle pain,improved significantly after anti-inflammatory and anti-in-fective treatment,and he was discharged on March 18.As the first reported case of Legionella marssiliensis pulmo-nary infection in China,this case highlights that among the multiple species of Legionella,there is another bacte-rium that can infect the human body and cause disease.This case report is beneficial for improving medical staff's understanding on Legionella marssiliensis and providing reference for the diagnosis and treatment of future cases of Legionella marssiliensis infection.

BACKGROUND:Natural biomaterials such as allogeneic materials are highly susceptible to bacterial contamination during the production process.Among them,bacterial endotoxin released by Gram-negative bacteria can cause human fever,coagulation,shock,and even death.There is no relevant research on the method of endotoxin removed from allogeneic materials while maintaining their natural structure and biological activity.OBJECTIVE:To explore the method and effect of endotoxin removed from allogeneic materials and other natural biological materials and to control the residual H2O2.METHODS:The endotoxin was removed from allogeneic bone materials by H2O2/ultrasound.The influence of ultrasound and the concentration of H2O2 on the endotoxin removal process was explored.The concentration of H2O2 was set as 1％,2％,3％,4％,and 5％by mass.The power of ultrasound was set as 80,120,140,160,and 200 W.The duration of ultrasound was 20,30,40,50,and 60 minutes.The temperature was 30,35,40,45,and 50 ℃.The optimal combination of conditions for treating allogeneic bone materials was selected by endotoxin content detection for subsequent experiments.The microstructure,H2O2 residue,and cytotoxicity of allogeneic bone materials after endotoxin removal were detected,and the effects of different concentrations of H2O2 residue on the survival rate of L929 mouse fibroblasts were explored.RESULTS AND CONCLUSION:(1)According to the results of the endotoxin removal process,when the concentration of H2O2 was 4％,the power of ultrasound was 200 W,with the duration of ultrasound of 50 minutes,and the temperature 50 ℃,it would effectively remove endotoxin from allogeneic bone materials.The optimal combination was selected to remove endotoxins from allogeneic bone materials.(2)After endotoxin removal,the residual H2O2 content of allogeneic bone materials was less than 47.551 mg/kg after being placed in a 60 ℃ water bath and changing the solution 6 times,which had no effect on the viability of L929 mouse fibroblasts.(3)Optical microscopy and scanning electron microscopy observations exhibited that the use of H2O2 solution in conjunction with ultrasonic treatment had no effect on the structure of allogeneic bone materials.(4)The results indicate that the H2O2 solution in conjunction with ultrasonic treatment has the characteristics of efficient and rapid removal of endotoxins,which can ensure the safety of allogeneic bone materials.

BACKGROUND:Allogeneic tendons are often used in clinical treatment of tendon and ligament injuries,which need to be treated before clinical application.At present,allogeneic tendons will face multiple freeze-thaw cycles after cryopreservation,but there is no relevant research on the changes in the properties of the treated allogeneic tendon after several freeze-thaw cycles.OBJECTIVE:To explore the changes in mechanical properties and composition of allogeneic tendon after multiple freeze-thaw cycles.METHODS:The treated allogeneic tendon was frozen and thawed 3,6,and 10 times at-40 ℃(or-80 ℃),respectively.The mechanical test,DNA content,glycosaminoglycan sulfate,hydroxyproline content and total protein content of the allogeneic tendon after freezing and thawing were detected.RESULTS AND CONCLUSION:(1)There was no significant difference in the maximum load,maximum load elongation,tensile strength and elastic modulus between groups after freezing-thawing cycles for 3,6,and 10 times at-40 ℃(P＞0.05).There was no significant difference in the maximum load and maximum load elongation between the groups after freezing-thawing cycles for 3,6,and 10 times at-80 ℃(P＞0.05).The tensile strength of the group with 3 cycles of freezing and thawing was higher than that of the groups with 6 and 10 cycles of freezing and thawing(P＜0.05).The elastic modulus of the group with 3 cycles of freezing and thawing was higher than that of the group with 10 cycles of freezing and thawing(P＜0.05).(2)The freezing and thawing times did not affect the contents of DNA,hydroxyproline,total protein,and sulfated glycosaminoglycan in allogeneic tendon when stored at-40 ℃(or-80 ℃).(3)These findings suggest that in-40℃ storage,the performance of the allogeneic tendon should not be affected by taking out and putting back the tendon less than 10 times,while in-80 ℃ storage,the allogeneic tendon should be taken out and put back less than 6 times.

Objectives:Comparative analysis of the beagles acute-phase electrocardiographic,hemodynamic,left ventricular flow field status,and energy consumption characteristics of pacing at different sites of conduction system may help to elucidate the scientific mechanism of left bundle branch pacing(LBBP)as a option of physiological pacing therapy.Methods:Eight healthy adult beagles were used in this study.Initially,an active fixation lead was implanted in the right atrial appendage,followed by implantation of another active fixation lead at the right ventricular apex,distal His bundle,and left bundle septal branch,respectively.After connecting a dual-chamber pacemaker,electrocardiographic and acute phase hemodynamic parameters under sinus rhythm,right ventricular apex pacing(RVAP),distal His bundle pacing(DHBP),and LBBP states were collected and analyzed.Three complete cardiac cycles of standard apical three-chamber color Doppler dynamic images were acquired under vector flow mapping(VFM)mode.Offline analysis was performed on obtained parameters including isovolumic contraction period,rapid ejection period,isovolumic relaxation period,rapid filling period,atrial contraction period,and left ventricular intracavitary energy consumption.These parameters were compared under pacing at different sites and the linear correlations of major parameters were analyzed.Results:The QRS duration of baseline intrinsic sinus rhythm,RVAP,DHBP and LBBP were(45.0±4.0)ms,(98.4±6.2)ms,(50.0±4.5)ms and(62.0±4.7)ms,respectively.The LBBP-QRS duration was significantly wider than intrinsic sinus rhythm and DHBP,but significantly narrower than RVAP(all P<0.01).Compared with baseline AOO mode(the pacing rate was performed at 10 beats/min above the intrinsic heart rate),the change of acute phase maximum left ventricular pressure rise rate(LVdP/dtmax)in RVAP,DHBP and LBBP was([-7.89±5.67]% ),([0.74±2.05]% )and([-0.14±3.59]% ),respectively.There was no significant difference in LVdP/dtmax changes between DHBP and LBBP(P=0.667),but both pacing modalities were significantly better than RVAP(all P<0.01).The average energy consumption of the left ventricle under RVAP was significantly higher than that of intrinsic sinus rhythm,DHBP,and LBBP in isovolumic contraction period,rapid ejection period,isovolumic relaxation period,rapid filling period,and atrial contraction period(all P<0.01).However,there was no statistically significant difference in energy consumption among intrinsic sinus rhythm,DHBP,and LBBP during the above five phases(all P>0.05).DHBP and LBBP did not show a significant increase in the number of left ventricular vortices,vortex area,and circulation intensity compared to intrinsic sinus rhythm,and LBBP did not show a significant increase in vortex area and circulation intensity compared to DHBP.Conclusions:Although LBBP canines significantly prolonged the paced QRS duration,it showed no significant differences in acute phase left ventricular hemodynamics,left ventricular flow field status,and energy consumption compared to intrinsic sinus rhythm and DHBP.Performance of LBBP was superior to RVAP.This study may contribute to revealing the theoretical basis of LBBP as a feasible physiological pacing therapy.

Objective:To assess the feasibility and efficacy of transperineal laser ablation(TPLA)with single laser fiber in treating benign prostatic obstruction(BPO).Methods:From April 2021 to March 2024,a total of 13 BPO patients were selected from Beijing Friendship Hospital.TPLA was performed using a single laser fiber,which was guided by transrectal biplane ultrasound.The single laser fiber was used to undergo TPLA under the guidance of trans-rectal dual-plane ultrasound.The intraoperative time,ablation time,energy consumption,indwelling time of catheter,and complications were observed.The postoperative 6 months was chosen as the cut-off point of follow-up,and the pre and postoperative changes of international prostate symptom score(IPSS),quality of life index(QoL),prostate volume(PV),residual urine volume(RUV)and the maximum urine flow rate(Qmax)were compared.Results:All 13 patients successfully underwent TPLA with single laser fiber.The average operation time was(55.1±18.3)min,and the average ablation time was(16.3±1.7)min,and average energy consumption was(3951.6±459.7)J,and the median value of indwelling time of catheter was 7(7,10)days.The number of postoperative complication was 2 cases,and both them belonged to Clavien-Dindo grade II complication.At the postoperative 6th month,the IPSS,QoL,PV,Qmax and RUV of all patients were improved,all of which were better than preoperative these indicators,and the differences were significant(t=12.102,-3.228,-3.181,-2.581,-2.936,P<0.05).Conclusion:The application of single laser fiber in conducting TPLA operation is feasibility at technical aspect,and it can achieve the therapeutic goals of improving patients'symptoms and enhancing their quality of life.Although its operational time is slightly longer than that of using multiple fibers simultaneously,it can effectively reduce the cost of expenditure for consumables.