Objective:To investigate the use of computed tomography (CT) and magnetic resonance imaging (MRI) in diagnosing primary retroperitoneal tumors.Methods:The study included 100 patients suspected of having primary retroperitoneal tumors, who were admitted to Xidian Group Hospital between February 2017 and February 2023. All patients underwent pathological biopsy, with the pathological diagnosis serving as the "gold standard." Additionally, each patient underwent both CT and MRI examinations. The diagnostic value of CT and MRI alone or in combination for primary retroperitoneal tumors was compared. Receiver operating characteristic curve was used to analyze the diagnostic efficacy of CT and MRI alone or in combination for primary retroperitoneal tumors.Results:Among the 100 patients with suspected primary retroperitoneal tumors, 90 were pathologically diagnosed with primary retroperitoneal tumors. These included 21 cases of liposarcoma, 18 of schwannoma, 17 of malignant lymphoma, 14 of malignant fibrous histiocytoma, 12 of leiomyoma, and 8 of lipoma. CT confirmed 81 positive cases, MRI confirmed 83 positive cases, and the combined CT and MRI diagnosis identified 89 cases as positive. Receiver operating characteristic curve analysis revealed that the sensitivity and specificity of the combined CT and MRI diagnosis for primary retroperitoneal tumors were 98.9% and 90.0%, respectively, with an area under the curve of 0.944, which was superior to that of either CT or MRI alone.Conclusions:CT and MRI play a crucial role in the diagnosis of primary retroperitoneal tumors. The combined use of these two imaging techniques significantly improves both the sensitivity and specificity of diagnosis.

Objective To compare the effects of three nickel-titanium file systems,ProTaper Next,TruNatomy,and VDW.RO-TATE,on the morphology of the Danger Zone of the mesial buccal root of mandibular first molar after root canal preparation using Mi-cro-CT and 3D printing technology.Methods 3D-printed mandibular first molars were selected and designed for purpose.They were randomly divided into three groups according to the used NiTi files(n=20).Micro-CT was used to scan the cross-sectional images of the Danger Zone 2 mm below the furcation of the mesial buccal root before and after root canal preparation.The changes in the root ca-nal wall thickness,root canal volume,surface area,cross-sectional area,and root canal transportation in the Danger Zone were ob-served.Statistical analysis was performed using one-way ANOVA(P＜0.05).Results Statistically significant differences were observed before and after root canal preparation in the Danger Zone among the three groups(P＜0.05).Among the three groups,the PTN files caused the largest change before and after preparation,followed by VDW files,and the TRU files had the smallest change.Conclusion The study highlights TruNatomy's conservative shaping capacity,advocating its use in minimally invasive endodontics,whereas Pro-Taper Next may be reserved for cases requiring aggressive canal preparation.

Objective:To investigate the indications for prenatal diagnosis using copy number variation-sequencing (CNV-seq) and the abnormalities detected by the method.Methods:This retrospective analysis involved 17 994 singleton pregnant women who underwent prenatal CNV-seq at the First Affiliated Hospital of Zhengzhou University from January 2019 to December 2022. These cases were divided into five groups based on the following indications for CNV-seq: abnormal fetal ultrasound findings, high-risk results indicated by non-invasive prenatal testing (NIPT) or Down's syndrome serological screening (Down's screening), adverse pregnancy history, and advanced maternal age. The proportions of cases with the indications for prenatal CNV-seq, the detection rates of abnormalities (numerical abnormalities of chromosomes, pathogenic/likely pathogenic CNV in structural abnormalities) in the five groups, and the distribution of these abnormalities were analyzed. Statistical analysis was performed using Chi-square test. Results:Among the 17 994 pregnant women, the women with abnormal fetal ultrasound findings, high-risk NIPT results, high-risk Down's screening results, adverse pregnancy history, and advanced maternal age accounted for 32.65% (5 875/17 994), 11.90% (2 142/17 994), 31.62% (5 690/17 994), 11.70% (2 105/17 994), and 12.13% (2 182/17 994), respectively. The detection rates of abnormalities in the five groups were 10.60% (623/5 875), 34.64% (742/2 142), 4.69% (267/5 690), 2.99% (63/2 105), and 3.67% (80/2 182), respectively. The overall detection rate of abnormalities was 9.86% (1 775/17 994). The cases with numerical abnormalities of chromosomes accounted for 68.79% (1 221/1 775), trisomy 21 was predominant (49.30%, 602/1 221). Chromosomal structural abnormalities were detected in 31.21% (554/1 775) of the cases with abnormalities, with 57.76% (320/554) harboring pathogenic CNVs and 42.24% (234/554) harboring likely pathogenic CNVs. The detection rate of chromosomal numerical abnormalities was higher than that of structural abnormalities in the abnormal fetal ultrasound group, NIPT high-risk group, and advanced maternal age group [6.81% (400/5 875) vs. 3.80% (223/5 875), χ2=53.10; 27.96% (599/2 142) vs. 6.68% (143/2 142), χ2=338.40; 2.43% (53/2 182) vs. 1.24% (27/2 182), χ2=8.61; all P<0.01]. A total of 416 microdeletions and 255 microduplications were detected in the 554 cases. The top three regions with the highest frequencies in microdeletions were Xp22.31 (12.74%, 53/416), 22q11.21 (7.93%, 33/416), and 17q12 (5.77%, 24/416); in microduplications, they were 22q11.21 (14.90%, 38/255), 17q12 (3.53%, 9/255), and 7q11.23 (3.53%, 9/255). Conclusions:Abnormal fetal ultrasound findings accounted for the highest proportion of prenatal diagnostic indications. The overall detection rate of abnormalities by CNV-seq is relatively high, especially in those with high-risk NIPT results as an indication for prenatal diagnosis. Among the chromosomal structural abnormalities detected in this study, the frequencies of Xp22.31 microdeletion and 22q11.21 microduplication are higher.

Objective:To propose a deep learning（DL）-based ultrasound imaging auxiliary tool for automatic segmentation and recognition of the brachial plexus（BP），and to enhance the accuracy and safety of clinical procedures.Methods:It was a multicenter study that collected 773 healthy subjects from Peking University Third Hospital and its branch campuses，the Third Medical Center of the Chinese PLA General Hospital，and Shanghai Eighth People's Hospital between August 2024 and February 2025. Brachial plexus（BP）images in the interscalene groove were captured used high-frequency ultrasound by senior sonographers，a dataset comprising 1 289 standardized images were constructed and the improved model（CHA-TransUNet）was trained. The test set was input into 6 different models（CHA-TransUNet，R50-Unet，TransUnet，SegFormer，SwinUnet，MISSFormer）for segmentation. Segmentation accuracy was evaluated using metrics including the Dice similarity coefficient（DSC），95% Hausdorff distance（HD95）and mean intersection over union（mIoU），and was compared with the segmentation results of 3 ultrasound physicians with varying experience levels（junior physicians and senior physicians）to validate the model's segmentation efficacy.Results:The CHA-TransUNet model established based on a dataset of 1 289 standardized images achieved segmentation results for the BP with a DSC of 90.15%，mIoU of 91.02%，and HD95 of 8.08. Its accuracy was higher than other mainstream models（DSC：90.15% vs. 87.60%，87.77%，81.35%，84.78%，84.55%），significantly better than junior physicians（DSC：90.15% vs. 68.73%， Z=-127.76， P<0.001），and approached the level of senior physician（DSC：90.15% vs. 86.15%， Z=-31.33， P=0.549）. The model demonstrated superior boundary recognition in complex anatomical structures（e.g.，C6/C7 nerve roots）compared to ultrasound physicians（junior and senior）（HD95：8.08 vs. 26.34，17.44，56.80）. Conclusions:This study proposes an analysis model for BP ultrasound images，CHA-TransUNet. This model achieves segmentation and recognition of the BP with relatively complex pathways and structures. The model exhibits high accuracy and stability，outperforming current mainstream network models and junior physicians while approaching the performance level of senior physicians. It assists junior physicians or trainees in more accurately identifying and localizing the BP.

Objectives:To develop a cervical kyphosis frailty index (CK-FI) and explore its clinical value in identifying high-risk patients undergoing cervical kyphosis correction surgery.Methods:In this retrospective case series, clinical data from 53 patients who underwent cervical kyphosis correction at the Department of Orthopedics, Beijing Tiantan Hospital, Capital Medical University, between January 2019 and December 2023 were analyzed. All patients had a minimum follow-up of 12 months. There were 27 males and 26 females, with an age of (53.4±14.5) years (range: 15 to 83 years). Demographic data, comorbidities, laboratory results, radiographic parameters, and functional assessments were collected. Fifteen key indicators related to physiological reserve and stress tolerance in cervical kyphosis patients were identified via Pearson correlation analysis to establish the CK-FI. Differences in demographic characteristics, clinical outcomes, postoperative complications, and length of hospital stay among CK-FI subgroups were analyzed using independent sample t-tests, one-way ANOVA,Wilcoxon signed-rank tests, Mann-Whitney U tests, Kruskal-Wallis tests, and chi-square or Fisher′s exact tests. Binary logistic regression was employed to determine independent risk factors for postoperative complications. Receiver operating characteristic (ROC) curve analysis was used to assess the predictive performance of CK-FI for postoperative complications. Results:Based on CK-FI scores, patients were classified into non-frail (CK-FI<0.3), frail (0.3≤CK-FI≤0.5), and severely frail (CK-FI>0.5) groups. The 30-day postoperative complication rate was 26.4% (14/53). Both univariate and multivariate analyses indicated that frailty ( OR=6.892, 95% CI: 1.239 to 38.353, P=0.028) and severe frailty ( OR=10.313, 95% CI: 1.877 to 56.659, P=0.007) were independent risk factors for postoperative complications. ROC analysis revealed that CK-FI had an area under the curve of 0.777 (95% CI: 0.637 to 0.917, P=0.001), with a specificity of 70.3% and a sensitivity of 81.3% in predicting postoperative complications. Conclusions:The CK-FI serves as a valuable tool for early detection of high-risk patients with cervical kyphosis, aiding in individualized perioperative management, optimizing preoperative preparation, reducing postoperative complications, and ultimately improving patient outcomes.

Originating in Huangdi Neijing,this theory was pioneered by ZHANG Zhongjing,who established the principles of concurrent heart-lung treatment and integrated therapeutic approaches.It further developed during the Ming-Qing period and has been widely applied in modern clinical practice.This article systematically traces the developmental trajectory of the heart-lung correlation theory in traditional Chinese medicine and analyzes its clinical application in elucidating the pathogenesis and therapeutic strategies for lung cancer complicated by cardiovascular comorbidities.According to this theoretical framework,lung cancer accompanied by cardiovascular comorbidities exhibits a pathomechanism characterized by fundamental deficiency with symptomatic excess.The deficiency manifests as qi-blood depletion or impaired descent of gathering qi,while the excess is reflected in phlegm-stasis coagulation or heat-toxin accumulation.Key pathological features include progressive transformation,meridian disharmony,deteriorating vital substances,and disruption of inter-organ relationships.Treatment adheres to the principles of concurrent heart-lung intervention,integrated cardiopulmonary modulation,and reciprocal organ regulation.Core therapeutic strategies involve eliminating pathogenic factors,promoting circulation,tonifying deficiencies,and harmonizing functions with specific interventions determined through pattern differentiation.For the pattern of phlegm and blood stasis coagulation affecting both the heart and lung,treatment is guided by the principle of simultaneous treatment of phlegm and stasis,coordinated regulation of heart-lung function,and prioritization of qi circulation.Commonly used formulas include Gualou Xiebai Banxia Decoction and Xuefu Zhuyu Decoction.In cases of heat toxin accumulation in the heart and lungs,therapy follows the principle of clearing heart-lung fire and dredging collaterals,often using combinations of insect-derived medicines and vine-derived herbs,such as earthworm and Chinese star jasmine stem.In instances of heart-lung qi-blood deficiency,the therapeutic approach emphasizes simultaneous fortification and qi and blood circulation.Formulas such as modified Renshen Yangrong Decoction or Shengxian Decoction,combined with Taohong Siwu Decoction,are commonly used.These formulas strengthen qi without stagnating blood,promote blood circulation without harming healthy qi,and gradually eliminate pathogens.These three treatment approaches embody the characteristics of integrated heart-lung therapy,emphasizing dynamic regulation and holistic concepts.The focus remains on addressing both manifestation and root causes through flexible herb selection to achieve optimal therapeutic outcomes.

Objective To evaluate the quality of cisatracurium besilate injection produced by domestic manufacturers.Methods A comprehensive evaluation of 104 batches of samples was carried out using statutory testing methods combined withexploratory research,including related substances,1,5-pentanediol diacrylate,residual solvents,genotoxic impurities of benzenesulfonate esters,infrared spectrum,and endotoxin examination.The quality of domestic products and the controllability of current specifications were comprehensively evaluated.Results According to the statutory tests,the qualified rate of 104 batches of samples was 100.0％.The exploratory research showed that the results of related substances in the samples produced by 6 manufacturers were far below the limit,and no genotoxic impurities of benzenesulfonate esters were detected.However,the results showed that there was variability in 1,5-pentanediol diacrylate,as well as residual solvents.Conclusions The quality of the cisatracurium besilate injection is good,and the current specifications should be further improved and unified.It was proposed that the infrared spectrum,related substance,and 1,5-pentanediol diacrylate method be added or revised,and the limit of endotoxin strictly controlled.It was proposed that manufacturers pay attention to the quality of API and control injection production.

Subclinical ptosis is a common congenital abnormality of bilateral upper eyelid development; the clinical manifestations are upper eyelid skin covering the upper corneal margin of more than 2 mm, upper eyelid bloat, narrow lid fissure, often accompanied by epicanthus and eyebrow elevation when the eyes are opened. Patients often present with a single eyelid, which can be easily missed and misdiagnosed. The cause of subclinical ptosis is an increase in the afterload of the levator muscle during contraction due to a variety of reasons, such as gravitational, volumetric, and tensile loads; the clinical manifestations and the normalisation of the levator muscle strength are the main basis for diagnosis and identification of true ptosis. Depending on the type of afterload, different surgical treatments are available, such as blepharoplasty, orbicularis oculi myotomy, upper eyelid tissue reduction, fibrous mesh band release, anterior displacement of the levator complex, and shortening of the levator complex.

Objective To explore the application value of anhydrous ethanol as an alternative to methanol in the preparation of chromosomal specimens from peripheral blood lymphocytes, and to establish a set of quantitative analytical methods for objectively evaluating the effectiveness of specimen preparation. Methods Residual blood samples from routine laboratory slide preparation were used for lymphocyte culture. The standard slide preparation method was employed. The fixative in the control group was methanol and glacial acetic acid (3∶1). Four experimental groups were set up based on the ratio of anhydrous ethanol to glacial acetic acid in the fixative (volume ratios of 3∶1, 5∶1, 7∶1, and 9∶1 for experimental groups 1, 2, 3, and 4, respectively). A chromosomal analysis was conducted using an automated chromosome scanning/image analysis system to evaluate the morphology and dispersion of metaphase chromosomes in both control and experimental groups. Comparisons were made between the control and experimental groups regarding the dic + r aberration rate, ace aberration rate, chromosomal aberration rate, chromosome dispersion index, chromosome overlapping ratio, and dispersion index/overlapping ratio. Results Microscopic evaluation revealed that the preparation quality of experimental groups 1 and 2 was comparable to the control group. No statistically significant differences were observed in dic + r aberration rate between each of the experimental groups and the control (P > 0.05). All experimental groups except group 4 showed no significant differences in ace aberration rate and chromosome aberration rate compared with the control group (P > 0.05). Experimental groups 1 and 2 showed no significant differences in chromosome dispersion index, overlapping ratio, and dispersion index/overlapping ratio compared with the control group (P > 0.05). Conclusion A mixture of anhydrous ethanol and glacial acetic acid at a 5∶1 ratio is recommended for use as a fixative in the preparation of chromosomal specimens from peripheral blood lymphocytes. A quantitative index system for assessing the quality of chromosomal specimens was established, enabling objective evaluation of slide preparation effectiveness.

Objective To evaluate the protective effect of Schistosoma japonicum cystatin(rSj-Cystatin)in a mouse mode of"two-hit"sepsis.Methods Sixty male C57BL/6 mice randomized equally into sham-operated group,protein group,"two-hit"modeling group,and protein intervention group.In the former two groups,the mice received an intraperitoneal injection of 100 μL PBS followed by exposure of the cecum and then by intraperitoneal injection of 100 μL PBS or 25 μg rSj-Cystatin 30 min later;In the latter two groups,100 μL PBS containing LPS(5 mg/kg)was injected intraperitoneally 24 h before cecal ligation and puncture(CLP),and 100 μL PBS or 25 μg rSj-Cystatin were injected 30 min after CLP.At 12 h after rSj-Cystatin treatment,6 mice from each group were sacrificed for detection of TNF-α,IL-6,IL-10,TGF-β,iNOS and Arg-1 in the serum,spleen,liver,lung and kidney tissues using ELISA,for examinations of liver,lung and kidney pathologies with HE staining,and for analysis of CD3+CD4+CD25+Foxp3+T cell percentage in the spleen using flow cytometry.The remaining mice were observed for general condition and 72-h survival.Results The 72-h survival rates in the 4 groups were 100％,100％,0％and 20％,respectively,showing significant differences between the latter two groups.The mouse models of"two-hit"sepsis exhibited obvious tissue pathologies and significant elevations of TNF-α and IL-6 in both the serum and tissue homogenate,which were significantly ameliorated by rSj-Cystatin treatment.Treatment with rSj-Cystatin also increased IL-10 and TGF-β levels and spleen CD3+CD4+CD25+Foxp3+T cell percentage.The septic mouse models also showed increased iNOS levels in all the detected tissues and a decreased Arg-1 level in the kidney,and these changes were obviously improved by rSj-Cystatin treatment.Conclusion rSj-Cystatin has a protective effect against"two-hit"sepsis in mice by regulating the inflammatory microenvironment.