Objective To explore the feasibility of using high-definition thoracoscopy to identify sympathetic ganglia during thoracic sympathicotomy for primary palmar hyperhidrosis. Methods The clinical data of patients with primary palmar hyperhidrosis who underwent high-definition thoracoscopic sympathicotomy in Taikang Xianlin Drum Tower Hospital from June to July 2023 were retrospectively analyzed. Intraoperative visualization rates and anatomical variations of sympathetic ganglia were recorded, and the consistency between white-light thoracoscopy and near-infrared fluorescence imaging was compared. Additionally, surgical videos from previous fluorescence-guided procedures were reviewed. Results Finally 100 patients were collected, including 54 females and 46 males, with an average age of (21.92±6.56) years. All patients underwent endoscopic thoracic sympathicotomy at R3 level. The overall intraoperative ganglion visualization rate was 92.5% (740/800), with G2-G5 rates of 95.5% (191/200), 94.0% (188/200), 94.0% (188/200), and 86.5% (173/200), respectively. Ganglion variations occurred in 32.0% (237/740), predominantly at G3 (29.8%) and G4 (42.6%). In 5 indocyanine green-enhanced patients, the concordance rate between white-light and near-infrared fluorescence imaging was 100.0% (38/38). Video analysis of 14 near-infrared fluorescence-guided surgeries demonstrated a 99.1% (107/108) consistency rate. Postoperative palmar hyperhidrosis improvement reached 100.0% (100/100) with no Horner’s syndrome. Conclusion With the wide clinical application of high-definition thoracoscopy, accurate thoracic sympathicotomy has the feasibility of clinical application.

As China has become the second largest market for medical devices in the world,the domestic medical device industry has been growing.As an important part of preclinical evaluation of medical devices,large animal research directly affects the research and application of medical devices.Large animals are widely used in the evaluation of safety and feasibility of medical devices because they are closer to humans in terms of body size,anatomical structure and physiological functions.In large animal experimental research,the selection of suitable experimental animals and the establishment of suitable animal disease models are the basis for ensuring the smooth progress of experiments.In this paper,the selection of experimental animals and the establishment of disease models in medical device large animal experimental research are systematically sorted out,and the existing problems and deficiencies are pointed out.

Objectives:To study the influence on stability and stress of posterior atlantoccipital transarticu-lar-clivus screw(TACL)in occipitocervical fixation using the finite element analysis method.Methods:Finite element models were established using the occipitocervical CT data of a volunteer,including an intact model,an unstable model,and six models of occipitocervical fixations:occipital screw(OS)+C1 lateral mass screw(C1LMS)+C2 pedicle screw(C2PS),OS+atlantoccipital transarticular screw(TA)+C2PS,OS+atlantoccipital transar-ticular-clivus screw(TACL)+C2PS,Occipital condyles screw(OcC)+C1LMS+C2PS,TA+C2PS,and TACL+C2PS.Material parameters were assigned to the models,and a vertical downward force of 40 N was applied to the upper surface of the occipital bone to simulate the weight of head.A torque of 1.5N·m was applied to in-duce flexion,lateral bending,and rotational movements.The stability,implant stress distribution,and bone stress distribution of each occipitocervical fixation model under different conditions were compared.Results:The range of motion(ROM)of the intact model under physiological conditions was similar to those reported in the literatures,and the ROMs under flexion,extension,lateral bending and rotation conditions was 19.53°,17.37°,10.44° and 38.74°,respectively.The ROMs of the unstable model under flexion,extension,lateral bending and rotation conditions were 26.17°,18.90°,10.99° and 42.30°,respectively,which were 34.00％,8.82％,5.34％and 9.20％higher than those of the intact model,respectively.The ROMs of the six fixation models were reduced under the same working conditions.Compared to the unstable model,TACL+C2PS cut 97.43％,94.06％,96.68％,and 99.01％of the ROM under the four working conditions.The peak internal fix-ation stresses were 241.00MPa,241.20MPa,166.94MPa,and 168.80MPa for TACL+C2PS,and 295.00MPa,295.00MPa,73.54MPa,and 81.40MPa for OS+TACL+C2PS in the same working conditions;The internal fixa-tion stresses were concentrated in the middle of the connecting rod and the tail of the TACL,and both mod-els applying the TACL fixation technique had less cutting stress on the bone,which had a more reasonable stress distribution than other occipital fixation techniques.Conclusions:Posterior TACL as a technique for occipital fixation can meet the mechanical strength requirements for occipitocervical fixation and has superior stability and stress distribution compared with other occipital fixation techniques applied alone,and its combined application with posterior occipital screws provides greater mechanical stability.

Exosomes are closely related to the occurrence and development of various diseases. Exosomes from different sources and the bioactive molecules they carry can participate in the formation process of urinary calculi through mechanisms such as regulating inflammatory responses，autophagy，and crystal nucleation. In addition，exosomes can also serve as delivery platforms for precise treatment of urinary calculi patients based on targeted markers，which has become a new hot spot in the research of the mechanism and treatment of urinary calculi in recent years. This article reviews the current research progress of exosomes in the formation mechanism of urinary calculi.

Objectives:To study the influence on stability and stress of posterior atlantoccipital transarticu-lar-clivus screw(TACL)in occipitocervical fixation using the finite element analysis method.Methods:Finite element models were established using the occipitocervical CT data of a volunteer,including an intact model,an unstable model,and six models of occipitocervical fixations:occipital screw(OS)+C1 lateral mass screw(C1LMS)+C2 pedicle screw(C2PS),OS+atlantoccipital transarticular screw(TA)+C2PS,OS+atlantoccipital transar-ticular-clivus screw(TACL)+C2PS,Occipital condyles screw(OcC)+C1LMS+C2PS,TA+C2PS,and TACL+C2PS.Material parameters were assigned to the models,and a vertical downward force of 40 N was applied to the upper surface of the occipital bone to simulate the weight of head.A torque of 1.5N·m was applied to in-duce flexion,lateral bending,and rotational movements.The stability,implant stress distribution,and bone stress distribution of each occipitocervical fixation model under different conditions were compared.Results:The range of motion(ROM)of the intact model under physiological conditions was similar to those reported in the literatures,and the ROMs under flexion,extension,lateral bending and rotation conditions was 19.53°,17.37°,10.44° and 38.74°,respectively.The ROMs of the unstable model under flexion,extension,lateral bending and rotation conditions were 26.17°,18.90°,10.99° and 42.30°,respectively,which were 34.00％,8.82％,5.34％and 9.20％higher than those of the intact model,respectively.The ROMs of the six fixation models were reduced under the same working conditions.Compared to the unstable model,TACL+C2PS cut 97.43％,94.06％,96.68％,and 99.01％of the ROM under the four working conditions.The peak internal fix-ation stresses were 241.00MPa,241.20MPa,166.94MPa,and 168.80MPa for TACL+C2PS,and 295.00MPa,295.00MPa,73.54MPa,and 81.40MPa for OS+TACL+C2PS in the same working conditions;The internal fixa-tion stresses were concentrated in the middle of the connecting rod and the tail of the TACL,and both mod-els applying the TACL fixation technique had less cutting stress on the bone,which had a more reasonable stress distribution than other occipital fixation techniques.Conclusions:Posterior TACL as a technique for occipital fixation can meet the mechanical strength requirements for occipitocervical fixation and has superior stability and stress distribution compared with other occipital fixation techniques applied alone,and its combined application with posterior occipital screws provides greater mechanical stability.

As China has become the second largest market for medical devices in the world,the domestic medical device industry has been growing.As an important part of preclinical evaluation of medical devices,large animal research directly affects the research and application of medical devices.Large animals are widely used in the evaluation of safety and feasibility of medical devices because they are closer to humans in terms of body size,anatomical structure and physiological functions.In large animal experimental research,the selection of suitable experimental animals and the establishment of suitable animal disease models are the basis for ensuring the smooth progress of experiments.In this paper,the selection of experimental animals and the establishment of disease models in medical device large animal experimental research are systematically sorted out,and the existing problems and deficiencies are pointed out.

Exosomes are closely related to the occurrence and development of various diseases. Exosomes from different sources and the bioactive molecules they carry can participate in the formation process of urinary calculi through mechanisms such as regulating inflammatory responses，autophagy，and crystal nucleation. In addition，exosomes can also serve as delivery platforms for precise treatment of urinary calculi patients based on targeted markers，which has become a new hot spot in the research of the mechanism and treatment of urinary calculi in recent years. This article reviews the current research progress of exosomes in the formation mechanism of urinary calculi.

Immune checkpoint inhibitors (ICIs) have demonstrated unparalleled clinical responses and revolutionized the paradigm of tumor treatment, while substantial patients remain unresponsive or develop resistance to ICIs as a single agent, which is traceable to cellular metabolic dysfunction. Although dysregulated metabolism has long been adjudged as a hallmark of tumor, it is now increasingly accepted that metabolic reprogramming is not exclusive to tumor cells but is also characteristic of immunocytes. Correspondingly, people used to pay more attention to the effect of tumor cell metabolism on immunocytes, but in practice immunocytes interact intimately with their own metabolic function in a way that has never been realized before during their activation and differentiation, which opens up a whole new frontier called immunometabolism. The metabolic intervention for tumor-infiltrating immunocytes could offer fresh opportunities to break the resistance and ameliorate existing ICI immunotherapy, whose crux might be to ascertain synergistic combinations of metabolic intervention with ICIs to reap synergic benefits and facilitate an adjusted anti-tumor immune response. Herein, we elaborate potential mechanisms underlying immunotherapy resistance from a novel dimension of metabolic reprogramming in diverse tumor-infiltrating immunocytes, and related metabolic intervention in the hope of offering a reference for targeting metabolic vulnerabilities to circumvent immunotherapeutic resistance.
Humans ; Neoplasms/pathology* ; Immunotherapy/methods* ; Immune Checkpoint Inhibitors/therapeutic use*

Objective:To investigate the clinical significance of a new classification system for atlas fractures based on pre- and post-treatment CT features, with a focus on diagnosis and treatment.Methods:A retrospective analysis was conducted on 75 cases of cervical vertebra fractures treated at the Sixth Hospital of Ningbo City between January 2015 and December 2020. The study included 44 males and 31 females, with an average age of 53.3±13.0 years (range: 27-81 years). The fractures were classified according to the Landells classification, resulting in 12 cases of type I, 13 cases of type II, 33 cases of type III, 9 cases that were difficult to classify due to fracture lines located at anatomical junctions, and 8 cases that could not be classified using the Landells classification due to diverse injury mechanisms. To establish a new preliminary classification for cervical vertebra fractures, the researchers considered whether the fracture line in the CT images involved the facet joint surface of the atlas, the impact on bilateral half-rings, and the displacement distance of the fracture ends. Five spinal surgeons were randomly selected to classify the CT images of the 75 patients using the new classification method. After one month, the imaging data of the 75 cases of cervical vertebra fractures were randomized and reclassified to assess the reliability and repeatability of the classification.Results:The new cervical vertebra fracture classification method comprised three types based on whether the fracture line involved the facet joint surface of the atlas: type A (no involvement of the facet joint surface of the atlas), type B (involvement of one side of the facet joint surface with intact contralateral half-ring), and type C (involvement of one side of the facet joint surface with fractured contralateral half-ring). Additionally, based on the maximum displacement distance between the fracture ends (>4 mm), six subtypes were identified: subtype 1 (≤4 mm displacement) and subtype 2 (>4 mm displacement). Consequently, the subtypes were classified as A1, A2, B1, B2, C1, and C2. According to the new classification method, the 75 patients included 17 cases of A1, 12 cases of A2, 7 cases of B1, 13 cases of B2, 12 cases of C1, and 14 cases of C2. The classification demonstrated excellent consistency, as assessed by the five doctors, with Kappa values of 0.85 and 0.91 for reliability and repeatability, respectively. At the final follow-up, all conservatively treated patients achieved bone healing, while four surgically treated patients experienced non-union of the fracture ends but exhibited good fusion between the atlas and axis. The remaining surgically treated patients achieved bony union without complications such as loosening or fracture of internal fixation.Conclusion:The new cervical vertebra fracture classification method, based on CT imaging features, comprehensively covers common clinical cases of cervical vertebra fractures and demonstrates excellent consistency. It provides valuable clinical guidance for the diagnosis and treatment of cervical vertebra fractures.

Objective:To retrospectively summarize disease characteristics and the clinical experience of minimally invasive endoscopy in the treatment of upper urinary tract obstruction caused by ureteropelvic encrusted inflammatory disease.Methods:Three patients with bilateral ureteropelvic encrusted inflammatory disease admitted to our hospital from March 2018 to July 2021 were involved. Case 1, male, 45 years old, admitted due to bilateral hydronephrosis for 5 months. The preoperative diagnosis were bilateral ureteropelvic stones (encrustation), right ureteral atresia, left ureteral stenosis, and systemic vasculitis. Left double J tube insertion and right nephrostomy were performed in another hospital. We conducted antegrade percutaneous nephroscopy combined with retrograde ureteroscopy surgery and assisted balloon dilation to treat bilateral lesions stage by stage. Case 2, Male, 12 years old, admitted due to bilateral abdominal pain for 6 weeks. The preoperative diagnosis were bilateral ureteral stones, bilateral hydronephrosis, and dermatomyositis. After the failure of double J tube insertion in another hospital, double nephrostomy was performed instead. We performed left percutaneous nephroscopy and right percutaneous nephroscopy combined with ureteroscopy for the treatment of bilateral lesions. Case 3, female, 32 years old, was admitted because of pain in the left lower back and abdomen for over 6 months. The preoperative diagnosis were bilateral ureteral stones, bilateral ureteral stenosis, and dermatomyositis. She underwent three times of ESWL and once URS before. We performed ureteroscopic surgery for bilateral lesions. During the surgery, various degrees of crusting in the renal pelvis or ureter were observed in all 3 cases, and the lesions were removed using pneumatic lithotripsy combined with forceps or baskets. After surgery, oral antibiotics were continuously used for 1-3 months. The efficacy and prognosis were evaluated based on the follow-up of urine, imaging, and endoscopic examinations at 3, 6, and 12 months after surgery.Results:All 3 surgeries were successfully completed. At 3, 6, and 12 months after surgery, follow-up CT showed no crusting in the left ureter, and endoscopy showed good mucosal wound healing and unobstructed lumen in case 1. There were still some crusting lesions and lumen stenosis in the right renal pelvis, and the right ureter reconstruction surgery was ultimately performed. There were no crusting on both sides and the urinary tract was unobstructed after 3, 6, and 12 months of follow-up in case 2 and case 3. Postoperative pathological examination showed chronic inflammation of urothelial mucosal tissue, small pieces of proliferative fibrous tissue with peripheral calcification. Calcification layer composition analysis showed magnesium ammonium phosphate and carbonate apatite. No related complications occurred in case 2 and case 3.Conclusions:Urothelial crusted inflammatory disease is rare clinically, and the diagnosis and treatment strategies are rarely reported domestically and internationally. Preoperative imaging examination, intraoperative findings and postoperative pathology or calcification composition analysis are of instruction for the diagnosis and treatment of this disease. Minimally invasive endoscopy treatment for upper urinary tract obstruction caused by ureteropelvic encrusted inflammatory disease has a good effect. Long-term efficacy and other adjuvant treatment need long-term follow-up and clinical practice.