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 summarize the preliminary clinical experience of utilizing ureteral balloon dilation catheter in the treatment of "difficult ureter" during ureteroscopic lithotripsy, and to discuss the efficacy and safety of the technique.Methods:Clinical data of 28 patients (30 sides) with upper urinary tract calculi admitted to Beijing Tsinghua Changgung Hospital Affiliated to Tsinghua University from April 2021 to July 2022 were retrospectively analyzed. There were 23 males (82.1%) and 5 females (17.9%), with age of (51.5±13.6) years. Among the 30 sides, 20 (66.7%) on the left and 10(33.3%) were on the right. Calculi were either located in the renal pelvis or calyxes in 7 sides (23.3%), upper ureter in 17 sides (56.7%), and lower ureter in 6 sides (20.0%). The maximum diameter of the stones was (9.4±4.2)mm, and 23 sides (76.7%) were combined with hydronephrosis before surgery. When "difficult ureter" was encountered during the procedure, that is, it was difficult to insert ureteroscope or ureteral access sheath (UAS) due to small ureteral lumen, balloon catheter was used for dilation in the first stage, in which the balloon diameter was 4 mm on 22 sides and 5mm on 8 sides. The instrument was retrogradely inserted through the working channel of F8 semi-rigid ureteroscope, and the small site of the ureteral lumen was dilated under direct endoscopic view. After a single dilation, the balloon catheter was withdrawn, and the effect of dilation was evaluated by semi-rigid ureteroscopy to determine whether to proceed with the following procedures. The intraoperative data were recorded, including surgical method, stage of "difficult ureter" occurred, site of the small part of the ureter, related data of utilizing ureteral dilatation balloon catheter, grade of ureteral injury after dilatation (according to the 0-4 grading classification of endoscopic ureteral injuries), total operation time, balloon catheter-related adverse events, stone-free rate, and time of removing ureteral stents.Results:Among the 30 sides, 29 (96.7%) had difficulty in the stage of ureteroscope insertion, and 1(3.3%) had difficulty in the stage of UAS insertion. A total of 37 small sites of ureter were involved, including 18 in the intramural segment, 10 in the lower part, 2 in the middle part, and 7 in the upper part. Each site was dilated once with a median time of 3 (0.5, 5.0) minutes and a median maximum balloon pressure of 1 215.9(1 215.9, 1 443.9)kPa[12.0(12.0, 14.3)atm]. There were 28 sites of grade Ⅰ injury, 8 sites of grade Ⅱinjury, and 1 site of grade Ⅲinjury. The total duration of unilateral procedure was (73.4±30.3) min. Ureteroscope or UAS insertion was successful in 28 sides(93.3%) after balloon dilation, and failed in 2 sides(6.7%), both of which were in the stage of inserting ureteroscope and ureteral stent was indwelled for the second-stage procedures. On the first day after surgery, the hemoglobin level was (134.1±12.9)g/L, which was significantly different from the preoperative parameters ( P<0.01), and serum creatinine level was (86.7±23.2)μmol/L, which showed no significant difference from the preoperative one ( P=0.263). The primary stone-free rate was 92.9% (26/28), and the total postoperative complication rate was 13.3% (4/30), including 3 of grade Ⅰ (lateral lower abdominal pain requiring additional analgesic drugs) and 1 of grade Ⅱ (postoperative hematuria requiring intravenous hemostatic drugs). Follow-up was conducted for 3 months. All of the 28 successful sides had their ureteral stents removed before the last follow-up, and the time of removal was (36.9±11.5) days. No hydronephrosis was found in the ipsilateral kidney by ultrasound 3 months after operation. Conclusions:Balloon dilation technique showed good efficacy and safety in the treatment of "difficult ureter" during ureteroscopic lithotripsy.