ObjectiveTo explore the effect of Shenge Bushen Capsules （SBC） on sexual development in normal 3-week-old mice. MethodsThe experiment consisted of two parts. In the first part， mice were divided into four groups： The control group and the low， medium， and high-dose SBC groups （234.7， 469.4， 938.7 mg·kg^-1， respectively）. In the second part， mice were divided into four groups： Control group， Pseudostellariae Radix polysaccharide （PRP） group， total flavonoids group， and SBC group， all receiving a dose of 469.4 mg·kg^-1. After 7 days of administration， the vaginal opening of female mice and the descent of testes and scrotum in male mice， as well as the ovarian and testicular organ indices， were observed. After 4 weeks of administration， female and male mice were housed together for 2 days， and the pregnancy rate of females was monitored. After delivery， the pregnant female mice continued receiving the treatment for 4 weeks， and the sexual development of their offspring， including vaginal opening， testicular descent， and organ indices of ovaries and testes， was observed. Serum sex hormones were measured by enzyme-linked immunosorbent assay （ELISA）， and the expression of gonadotropin-releasing hormone （GnRH） and growth hormone （GH） proteins in the hypothalamus was assessed by Western blot. ResultsCompared with the control group， there was no significant effect on the vaginal opening of female mice or the descent of testes in male mice after 7 days of SBC administration. After 4 weeks of administration， the pregnancy rate in the low-dose group was significantly reduced （P<0.05）， but no significant effects were observed in the other groups. The three doses of SBC did not significantly affect the ovarian or testicular organ indices， and there was no significant upregulation in the expression of GnRH or GH in the hypothalamus. The primary component of SBC， Pseudostellariae Radix polysaccharide， significantly reduced the vaginal opening in female mice after 7 days of administration （P<0.05）. After 4 weeks， the serum estradiol levels of non-pregnant female mice were decreased （P<0.05）， but there was no significant effect on the expression of GnRH or GH proteins in the hypothalamus of either male or female mice. Additionally， there were no significant effects on precocious puberty indicators， such as vaginal opening and testicular descent， in the offspring mice. ConclusionSBC does not significantly promote precocious puberty in young mice， and it does not have any noticeable effects on the pregnancy rate of adult mice or the sexual development of their offspring.

This paper systematically summarizes the practical experience of the 2025 Dingri earthquake emergency medical rescue in Tibet. It analyzes the requirements for earthquake medical rescue under conditions of high-altitude hypoxia, low temperature, and low air pressure. The paper provides a detailed discussion on the strategic layout of earthquake medical rescue at the national level, local government level, and through social participation. It covers the construction of rescue organizational systems, technical systems, material support systems, and information systems. The importance of building rescue teams is emphasized. In high-altitude and cold conditions, rapid response, scientific decision-making, and multi-party collaboration are identified as key elements to enhance rescue efficiency. By optimizing rescue organizational structures, strengthening the development of new equipment, and promoting telemedicine technologies, the precision and effectiveness of medical rescue can be significantly improved, providing important references for future similar disaster rescues.

To evaluate the effectiveness and safety of 8-ring assisted traction in endoscopic submucosal dissection (ESD), a total of 13 patients with 15 gastric lesions who underwent 8-ring traction-assisted ESD in Nanjing Drum Tower Hospital from July 2021 to January 2022 were included in the retrospective cohort study. All patients successfully completed the operation. The median procedure time was 56 min, and the dissected area per unit time was 0.20±0.02 cm 2/min. The en bloc resection rate, the complete resection rate and the curative resection rate were 93.3% (14/15), 80.0% (12/15) and 80.0% (12/15), respectively. There were no ESD-related complications, such as delayed bleeding or intraperative and postoperative perforation. No deaths occurred. As a novel internal traction technology, 8-ring traction method is simple to operate, providing a good field of vision during ESD to improve the dissection efficiency and reduce complications, which is worthy of further clinical research and promotion.

Liver metastases (LMs) are common in lung cancer. Despite substantial advances in diagnosis and treatment, the survival rate of patients with LM remains low as the immune-suppressive microenvironment of the liver allows tumor cells to evade the immune system. The impact of LMs on the outcomes of immune checkpoint inhibitors in patients with solid tumors has been the main focus of recent translational and clinical research. Growing evidence indicates that the hepatic microenvironment delivers paracrine and autocrine signals from non-parenchymal and parenchymal cells. Overall, these microenvironments create pre- and post-metastatic conditions for the progression of LMs. Herein, we reviewed the epidemiology, physiology, pathology and immunology, of LMs associated with non-small cell lung cancer and the role and potential targets of the liver microenvironment in LM in each phase of metastasis. Additionally, we reviewed the current treatment strategies and challenges that should be overcome in preclinical and clinical investigations. These approaches target liver elements as the basis for future clinical trials, including combinatorial interventions reported to resolve hepatic immune suppression, such as immunotherapy plus chemotherapy, immunotherapy plus radiotherapy, immunotherapy plus anti-angiogenesis therapy, and surgical resection.

Objective:To evaluate the efficacy and outcomes of early removal of lumen-apposing metal stent (LAMS) in the treatment of pancreatic wall-off necrosis (WON).Methods:A retrospective analysis was performed on 51 patients with WON who underwent endoscopic ultrasound (EUS)-guided transluminal drainage (ETD) and direct endoscopic necrosectomy (DEN) using LAMS at Nanjing Drum Tower Hospital from January 2018 to December 2022. Patients were divided into the early removal group (within two weeks, n=24) and the traditional removal group (after two weeks, n=27) based on the timing of LAMS removal. The short-term effects, safety and long-term outcomes of WON were compared between the two groups. Results:The technical success rate of LAMS placement in 51 patients reached 100%, and all patients underwent ETD and DEN. The median number of necrosectomy sessions in the early removal group was significantly lower than in the traditional removal group, 2.0 sessions vs 3.0 sessions and the difference was statistically significant ( P<0.05). Postoperatively, 15.7% of patients required percutaneous catheter drainage (PCD) and 5.9% required surgery, with no significant difference between the two groups. The clinical success rate and mortality rate in the early removal group were 79.2% and 8.3%, respectively, compared to 81.5% and 3.7% in the traditional removal group, with no statistically significant difference. In terms of safety, the early removal group exhibited a significantly lower rate of adverse events during stent retention with statistically significant difference (12.5% vs 37.0%, P<0.05) compared to the traditional removal group. A total of 46 patients were followed up for six months. In the early removal group, the rates of disease recurrence, need for endoscopic reintervention and occurrence of long-term complications were 20.0%, 10.0% and 20.0%, respectively. These rates did not show a significant increase compared to the traditional removal group, which were 7.7%, 3.8% and 38.5%, respectively, without significant differences between the groups. Conclusions:In the treatment of WON, early removal of LAMS is safe and effective to a certain extent. In comparison to the traditional practice of removing LAMS after two weeks, early removal does not reduce clinical success rates, nor does it increase the rates of disease-related mortality, recurrence, or long-term complications. On the contrary, it may reduce the occurrence of adverse events during stent retention and decrease the number of necrosectomy procedures subsequently.

Objective:To assess the safety and efficacy of single metal clip traction-assisted endoscopic submucosal dissection (ESD) for the treatment of duodenal lesions.Methods:Data of 45 patients with duodenal lesions who underwent ESD in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School between April 2021 and October 2022 were retrospectively recruited. Among them, 19 patients received single metal clip traction- assisted ESD while 26 patients received traditional ESD. The incidence of complications, dissection speed, en bloc resection rate and R0 resection rate of the two groups were mainly observed. Secondary observation indexes included specimen longer diameter, shorter diameter and area.Results:All 45 procedures were successfully completed, with the procedure time of 44.0 (27.0, 67.0) min for the single metal clip traction- assisted ESD group and 34.0 (24.0, 43.5) min for the traditional ESD group ( Z=-1.678, P=0.093). In the single metal clip traction-assisted ESD group, 2 cases (10.5%) had complications, including 1 intraoperative perforation and 1 postoperative bleeding (approximately 20 mL). There were three cases (11.5%) of complications in the traditional ESD group, including 1 case of postoperative bleeding (approximately 50 mL) and 2 cases of postoperative perforation, with no significant intergroup variation ( P=1.000). The dissection speed of the single metal clip traction-assisted ESD group was 16.0 (11.0, 25.8) mm 2/min, significantly larger than that of the traditional ESD group [5.3 (2.2, 21.1) mm 2/min, Z=-2.287, P=0.022]. The en block resection rate and R0 resection rate of the single metal clip traction-assisted ESD group were both 100.0% (19/19). Additionally, the specimen longer diameter, shorter diameter and area of the single metal clip traction-assisted ESD group were 34.0 (22.0, 45.0) mm, 25.0 (20.0, 34.0) mm, and 745.8 (380.0, 1 342.4) mm 2, respectively, significantly larger than those of the traditional ESD group of 20.0 (12.8, 30.3) mm ( Z=-3.119, P=0.002), 14.0 (8.8, 21.3) mm ( Z=-3.417, P=0.001), 190.4 (84.0, 498.7) mm 2 ( Z=-3.275, P=0.001). Conclusion:Single metal clip traction is safe and effective for duodenal ESD, demonstrating a notable improvement in the dissection speed, especially suitable for large duodenal lesions.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Objective To investigate the clinical significance of peripheral blood Th17 cells and their cytokines in the patients with tongue squamous cell carcinoma.Methods Sixty-six cases of tongue squamous cell carcinoma in our hospital from January 2013 to January 2016 served as the research subjects and contemporaneous 42 volunteers undergoing healthy physical examination were selected as the control group.Peripheral blood was collected in all subjects.The proportion of peripheral blood Th17 cells was detected by flow cytometry.The IL-17,TGF-β and IL-6 cytokine levels were detected by ELISA.Results The proportion of peripheral blood Th17 cells,IL-17,TGF-β and IL-6 in the observation group and the control group were (1.46±0.41)% vs.(0.31±0.12)%,(123.36±21.20)pg/mL vs.(20.76±8.95)pg/mL,(215.80±21.52)pg/mL vs.(26.90±10.41)pg/mL,(17.32±8.02)pg/mL vs.(5.85±1.49)pg/mL respectively,the differences were statistically significant(P<0.05).The proportion of peripheral blood Th17 cells,IL-17,TGF-β and IL-6 levels were increased with the increase of tongue squamous cell carcinoma clinical stage (P<0.01).The TGF-β level was positively correlated with the IL-17 level (r=0.626,P=0.021),the IL-6 level was positively correlated with the proportion of Th17 cells and IL-17 (r=0.626,0.597,P=0.021,0.034).Conclusion The increase of Th17 cells and IL-17 expression plays an important role in the development and progression of tongue squamous cell carcinoma,Th17 cells and IL-17 cytokine can become the important target spots of anti-tumor therapy.

ObjectiveTo explore the effect of nanoscale bubbles transfering gene in skeletal muscle cells in mice.MethodsPlasmid DNA encoding green fluorescent protein (GFP) was mixed with bubbles dissolved in saline and injected into the tibialis anterior (TA) muscle of C57B10 mice with and without ultrasound (US).The ultrasound frequency was 1 MHz and the pulse repetition frequency was 100 Hz with 20％ duty cycle.The spatial peak temporal peak intensity (ISPTP) power level was 2 W/cm2.The entire treatment period was 30 seconds.The efficiencies of GFP transgene expression were determined under different experinmental conditions.Mice were sacrificed 1 week after plasmid DNA injection.Fibres with fluorescence green signals were determined as GFP-positive fibres by fluorescence microscopy.Readout was performed on the section with the maximum number of transfected fibers.Results1 )Albumin nanobubbles:in the conditon of with or without ultrasound,albumin nanobubbles had significantly increased gene expression compared with negative control (P ＜0.05),but significantly decreased gene expression compared with positive control ( P ＜ 0.05 ).2) Phospholipid nanobubbles:In the conditon of without ultrasound,there were no significant differences compared with negative and positive control ( P ＞0.05).In the conditon of with ultrasound,phospholipid nanobubbles had significantly increased gene expression compared with negative control ( P ＜0.05).No significant difference was observed between phospholipid nanobubbles and positive control ( P ＞ 0.05).ConclusionsNanobubbles could enhance gene transfection efficiency for skeletal muscle fibres in mice.Nanobubbles with perfluoropropane gas and albumin have potentiality in gene-enhanced transfection.

ObjectiveTo evaluate the implication of ultrasonographic features of primary breast cancer tumors and axillary lymph nodes in predicting axillary lymph nodes metastasis in patients with breast cancer.MethodsA total of 108 patients with breast cancer were underwent examination of primary breast tumors and axillary lymph nodes by high frequency linear-array probes of ultrasound.The ages of patients,locations of primary tumors,numbers of tumors,maximum diameters of tumors,the longitudinal transverse axis ratio of tumors,mass boundary,ultrasonic patterns,micro-calcification,classification of blood supply,color pixel density(CPD),peak systolic velocity,resistance index,the longitudinal transverse axis ratio of axillary lymph nodes and maximum cortical thickness of axillary lymph nodes were recorded.ResultsOut of 108 patients with breast cancer,the longitudinal transverse axis ratio of tumor were greater than 1 in 75 (69.4 ％ ),micro-calcification in 57(52.8 ％ ),classification of blood supply were Ⅱ - Ⅲ in 57 (52.8％ ),CPD were greater than or equal to 10％ in 48 (44.4％),maximum cortical thickness of axillary lymph node were greater than or equal to 3 mm in 51 (47.2％),and longitudinal transverse axis ratio of lymph nodes were less than 1.5 in 59 (54.6％).Univariate analysis revealed that these six parameters were correlated to the axillary lymph node metastasis in breast cancer ( P ＜0.05).However,ages of patients,location of tumor in the breast,numbers of tumors,maximum diameters of tumors,mass boundary,ultrasonic patterns,peak systolic velocity and resistance index were not related to the axillary lymph node metastasis( P ＞0.05).Multivariate logistic regression analyses showed that CPD (OR:16.337,95％ CI:4.537- 58.826),longitudinal transverse axis ratio of lymph nodes (OR:3.754,95％ CI:1.269- 11.108) and microcalcificationand (OR:3.033,95 ％ CI:1.040 - 8.840) were risk factors of axillary lymph nodes metastasis in patients with breast cancer.ConclusionsThe application of ultrasonography in patients with breast cancer is useful in predicting axillary lymph nodes metastasis.