By systematically sorting out the theoretical origin， manipulation key points， and clinical applications of sparrow-pecking needling， it is believed that sparrow-pecking needling method involves performing small-amplitude， high-frequency lifting and thrusting of the needle tip in the original position， with heavy thrusting and light lifting， starting slowly and then becoming rapid， thus forming a characteristic needling sensation that spreads to the surroundings in a wavelike manner. The sparrow-pecking needling plays a role in stimulating the conduction of channel qi and regulating the circulation of qi and blood. Additionally， this paper summarized the clinical applications of sparrow-pecking needling in five aspects， regulating mind， regulating channel sinews， regulating zang-fu organs， regulating ying-wei （nutrient and defense qi）， and regulating yang qi， so as to provide references for inheriting and expanding the theory and clinical application of sparrow-pecking needling.

Radical cystectomy combined with pelvic lymph node dissection is the standard procedure for the treatment of muscle invasive bladder cancer and complex non-muscle invasive bladder cancer.Our department has routinely carried out laparoscopic radical cystectomy(ELRC)through the extraperitoneal approach in 340 cases.This article summarizes the establishment of the peritoneal space,the expansion of the peritoneal space,the operation steps of bladder resection and lymph node dissection through the peritoneal channel,and how to shorten the operation time and reduce the difficulty of the operation.During the surgery,the bladder is removed periperitoneally without destroying the peritoneum to preserve the functions of peritoneum support,secretion,protection and lubrication,which has little impact on the abdominal organs,reduces the incidence of complications,and provides favorable conditions for subsequent treatment.

Objective:To explore the relationship between the expression of tumor necrosis factor receptor-associated factor 5 (TRAF5) and interferon regulatory factor 5 (IRF5) in intestinal mucosa of patients with ulcerative colitis and gut microbiota and intestinal mucosal barrier function.Methods:A total of 126 patients with ulcerative colitis in Qingdao Municipal Hospital from April 2021 to April 2023 were collected, according to the condition, there were 76 patients in the active phase and 50 patients in the remission phase, another 50 patients with intestinal polyps were taken as controls, intestinal mucosal tissues were collected from patients in three groups. Immunohistochemical staining was applied to detect the expression of TRAF5 and IRF5, the relationship between the expression of TRAF5 and IRF5 in intestinal mucosa of patients with ulcerative colitis and clinical symptoms, gut microbiota, and intestinal barrier function indicators was analyzed. Spearman method was applied for correlation analysis.Results:The positive expression rates of TRAF5 and IRF5 in intestinal mucosa of patients with active phase and remission phase ulcerative colitis were higher than those of patients with intestinal polyps: 85.53% (65/76) and 80.00% (40/50) vs. 40.00% (20/50), 81.58% (62/76) and 76.00% (38/50) vs. 50.00% (25/50), and the difference was statistically significant ( P<0.05); the expression of TRAF5 and IRF5 in intestinal mucosa of patients with ulcerative colitis was related to diarrhea, abdominal pain, purulent stool, tumor necrosis factor-α (TNF-α), Interleukin-6 (IL-6), C-reactive protein (CRP), erythrocyte sedimentation rate, Baron endoscopic score, inflammatory bowel disease questionnaire score, Mayo index score and Geboes index ( P<0.05). Compared with patients with negative expression of TRAF5 and IRF5, patients with positive expression of TRAF5 and IRF5 had fewer bifidobacteria and lactobacilli, and more enterobacteria and enterococcus: (8.72 ± 0.43) cfu/g vs. (6.85 ± 0.47) cfu/g, (9.74 ± 0.31) cfu/g vs. (8.26 ± 0.27) cfu/g, (9.73 ± 0.46) cfu/g vs. (11.06 ± 0.48) cfu/g, (7.64 ± 0.31) cfu/g vs. (8.47 ± 0.34) cfu/g; (8.82 ± 0.44) cfu/g vs. (6.73 ± 0.47) cfu/g, (9.13 ± 0.30) cfu/g vs. (8.22 ± 0.27) cfu/g, (11.09 ± 0.48) cfu/g vs. (9.87 ± 0.46) cfu/g, (7.76 ± 0.32) cfu/g vs. (8.48 ± 0.34) cfu/g, and the difference was statistically significant ( P<0.05). The levels of diamine oxidase, lipopolysaccharide and D-lactic acid in patients with positive expression of TRAF5 and IRF5 were obviously higher than those in patients with negative expression of TRAF5 and IRF5: (12.18 ± 2.75) mg/L vs. (7.56 ± 2.49) mg/L, (76.14 ± 13.86) ng/L vs. (37.57 ± 12.51) ng/L, (18.15 ± 4.83) U/L vs. (9.87 ± 3.25) U/L; (12.39 ± 2.72) mg/L vs. (7.65 ± 2.66) mg/L, (77.21 ± 13.79) ng/L vs. (40.87 ± 13.04) ng/L, (18.36 ± 4.75) U/L vs. (10.67 ± 3.86)U/L, and the difference was statistically significant ( P<0.05). The expression of TRAF5 in the intestinal mucosa of patients with ulcerative colitis was negatively correlated with the numbers of bifidobacteria and lactobacilli ( r = - 0.645 and - 0.646; P<0.05), and positively correlated with the number of enterobacteria, number of enterococcus, diamine oxidase, lipopolysaccharide and D-lactic acid ( r = 0.629, 0.589, 0.509, 0.606 and 0.596; P<0.05). The expression of IRF5 was negatively correlated with the numbers of bifidobacteria and lactobacilli ( r = - 0.701 and - 0.690; P<0.05), and positively correlated with the number of enterobacteria, number of enterococcus, diamine oxidase, lipopolysaccharide and D-lactic acid ( r = 0.690, 0.624, 0.605, 0.595 and 0.568; P<0.05). Conclusions:The positive rates of TRAF5 and IRF5 in intestinal mucosa of patients with ulcerative colitis is high, which is closely related to the imbalance of gut microbiota and the damage of intestinal mucosal barrier function.

【Objective】 To explore the safety and efficacy of a modified one-piece posterior laparoscopic total nephroureterectomy with cystic sleeve resection in the treatment of upper urinary tract uroepithelial carcinoma (UTUC). 【Methods】 A total of 24 patients treated during Jan. and Jun. 2022 were involved, including 16 males and 8 females, aged 62 to 90 (average 73) years. The UTUC was in the left side in 15 cases, and in the right side in 9 cases. There were 10 cases of renal pelvis tumor, 6 cases of upper ureteral tumor and 8 cases of lower ureteral tumor. 【Results】 All operations were successful without conversion to open surgery. The operation time ranged from 60 to 100 minutes, average (71.25±9.80) minutes. The intraoperative bleeding volume was 20 to 200 mL, average (30.03±8.13) mL. No significant intraoperative or postoperative complications occurred. The postoperative hospital stay was 4 to 7 days, average (5.83±1.44) days. Bladder perfusion chemotherapy was performed after surgery. 【Conclusion】 The modified one-piece posterior laparoscopic total nephroureterectomy plus cystic sleeve resection for UTUC is an effective and feasible procedure with satisfactory tumor control, which is worth further promotion in clinical practice.

【Objective】 To investigate the efficacy and safety of single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy in the treatment of upper tract urothelial carcinoma (UTUC). 【Methods】 Clinical data of 31 UTUC cases treated in our hospital during Nov.2018 and Jun.2022 were retrospectively analyzed, including 11 tumors in the right side, and 20 in left side. There were 14 cases of renal pelvic carcinoma, 16 cases of ureter carcinoma, and 1 case of renal pelvic carcinoma plus ureter carcinoma. 【Results】 All surgeries were successfully performed without conversion to open surgery. The mean operation time was (81.45±19.80) min, and the estimated blood loss was (69.03±24.13) mL. No serious perioperative complications were observed. The average postoperative hospital stay was (6.13±2.44) d, and the median follow-up was 28 (3.0-49.0) months. At the last follow-up, 2 patients died, 3 had recurrence, but no contralateral recurrence was observed. 【Conclusion】 Single position transabdominal and extraperitoneal laparoscopic radical nephroureterectomy is safe, effective and feasible in the treatment of UTUC. It is worth clinical popularization.

Alzheimer′s disease (AD) is an incurable disease in the field of major chronic diseases. Subjective cognitive decline (SCD) is a clinical risk factor for AD. The standardized screening and intervention in individuals with SCD are of great importance in early prevention and treatment of AD. According to the clinical criteria proposed by The characterisation of subjective cognitive decline, which was published online in Lancet Neurology, the article summarized the definition of SCD, the latest perspective of clinical standards in SCD, and the results of AD preclinical SCD research. The purpose of this work was to provide concrete guidance and recommendations for making clinical decisions in diagnosis and scientific research on SCD.

Objective:To study the prognostic risk factors of Enterobacteriaceae bloodstream infection in patients with sepsis.Methods:The medical records of patients with sepsis caused by Enterobacteriaceae bloodstream infection in our hospital from June 2017 to May 2019 were screened. The gender, age, admission department, basic disease, infection site, etiology examination and treatment plan were recorded in detail. The survival and death groups were divided according to the patient's survival status. The ratio of C-reactive protein (CRP) to serum prealbumin (PA) was recorded within 24 h after admission. The acute physiological and chronic health scores (APACHEⅡ score) and Pitt bacteremia score (PBS score) were calculated within 24 h, and based on the results of blood culture drug sensitivity test to analyze whether the initial experience treatment was appropriate. Logistic regression analysis was used to analyze the risk factors affecting the prognosis of patients, and the receiver operating characteristic curve (ROC curve) was drawn to predict the occurrence of poor prognosis in patients with sepsis.Results:Logistic regression analysis showed that CRP ( OR=1.021, P<0.01), CRP/PA ( OR=34.638, P<0.01), extended-spectrum β-lactamase production ( OR=0.244, P<0.01), inappropriate empirical antibacterial treatment ( OR=0.156, P<0.01), APACHE Ⅱ score ( OR=1.436, P<0.01), and PBS score ( OR=8.622, P<0.01) were risk factors affecting patient's prognosis. Multivariate regression analysis showed that CRP/PA ( OR=25.420, P<0.05), inappropriate empirical treatment ( OR=0.077, P<0.05), APACHEⅡ score ( OR=1.476, P<0.01), PBS score ( OR=12.042, P<0.01) were independent risk factors for death in patients with sepsis ( P<0.05). The higher the CRP/PA level, PBS score and APACHEⅡ score, the worse the prognosis. When CRP/PA ≥0.89, PBS score ≥3.5, APACHEⅡ score ≥17.5, the patient's risk of death increased significantly. In addition, inappropriate empirical treatment was also a key factor in patients with poor prognosis. Conclusions:CRP/PA, PBS score, APACHE Ⅱ score, and inappropriate empiricaltreatment are independent risk factors affecting the prognosis of patients with enterobacter hemorrhagic infection with sepsis. The PBS score and APACHEⅡ score can better predict the poor prognosis and risk of death. Compared with APACHEⅡscore, the former is simpler and practical and can be widely used.

Objective To explore a new index for reflecting the topological information of brain functional networks in patients at high risk of Alzheimer disease using characteristics of resting-state functional connectivity strengths(FCS) in patients with amnestic mild cognitive impairment(aMCI). Methods Thirty-one aMCI patients and 42 age, gender and years of education matched normal controls were enrolled between September 2009 and April 2011 in this study. The resting-state functional MRI (rs-fMRI) data of all participants were acquired and preprocessed. Then the whole-brain functional connectivities were constructed for exploring the distribution characteristics of hub regions which had higher FCS values. Using two-sample t test to compare group differences in age, years of education and each neuropsychological assessment. In addition, using Chi-squared test to compare group differences in gender. Group differences in FCS values were analyzed by general linear model. Finally, correlation analyses were used to evaluate the relationships between the FCS values of the brain regions with group differences and behavioral scores in aMCI patients. Results The hub regions of the functional networks in the aMCI patients were mainly located in the association cortices such as the precuneuses, posterior cingulate cortices, medial prefrontal cortices, angular gyri, superior occipital gyri, fusiform gyri and lingual gyri. The distribution models in the aMCI patients were consistent with those in the normal controls. However, the FCS values of these brain regions were significantly lower in the aMCI patients than those in the normal controls. In comparison to the normal controls, the aMCI patients had significantly decreased FCS values in the bilateral fusiform gyri, lingual gyri, superior occipital gyri, left middle occipital gyrus and postcentral gyrus (the cluster was 389, 230, 187 and 107 voxels, respectively;P<0.05, respectively), and they had decreased trends of FCS values in the bilateral posterior cingulate cortices and right insulas. The correlation analysis with uncorrected conditions showed that the FCS values of the left postcentral gyri were correlatid with the clock drawing test (CDT) scores (r=0.436, P=0.026). Conclusions aMCI mainly attacks the hub regions of brain functional networks. The changes of functional connectivities in aMCI may reflect the early pathophysiologic alterations of AD.

Objective To determine the peripheral dose ( PD) of a Trilogy accelerator under different conditions and the feasibility of PD measurement using the semiconductor diode ionization chamber. Methods In a solid water phantom, a CC13 air?filled ionization chamber and a semiconductor diode ionization chamber were used for PD measurements with different distances (13 measurement locations within 1?31 cm) , depth ( 3, 5, 15 cm) , field sizes ( 10, 20, 30 cm) , wedge ( W15, W45, VW15, VW45) , and beam energy (6, 18 MV). The relationship of PD with PDleakage and PDscat er was determined by removing the scatter phantom. Simulating the patients with cervical cancer undergoing radiotherapy, a CIRS phantom received volumetric modulated arc therapy ( VMAT) , step?shoot intensity?modulated radiotherapy ( IMRT) , and sliding?window IMRT to measure PDs of the breast, thyroid, and lens. All the data were normalized to the isocenter. Results PD was gradually reduced with the increase in distance ( 13?41% at 1 cm from the edge to 0?25% at 31 cm from the edge) . With a fixed distance from the edge of the radiation field, there was no significant difference in PD between different depths. A radiation field with a size of 30 cm had a PD about two?fold higher than that with a size of 10 cm. PD increased with the increase in the physical wedge angle and increased by 1% compared with the open field;PD decreased with the increase in the virtual wedge angle and decreased by 2?3% compared with the open field. PD decayed from 13?35% at 1 cm to 0?23% at 31 cm under 6 MV X?ray and from 11?06% at 1 cm to 0?20% at 31 cm under 18 MV X?ray. Dscat er was dominant in the regions close to the edge of radiation field and decreased from 62?45% at 1 cm to 5?71% at 25 cm. In all measurements under 6 MV X?ray, the maximum proportion difference between CC13 ionization chamber and diode ionization chamber was less than 1%. PDs of the breast, thyroid, and lens were 6?72, 2?90, and 2?37 mGy in VMAT mode, 7?39, 4?05, and 2?48 mGy in step?shoot IMRT mode, and 9?17, 4?61, and 3?21 mGy in sliding?window IMRT mode, respectively. Conclusions For the measurement of PDs, the CC13 air?filled ionization chamber and semiconductor diode ionization chamber have good consistency and feasibility under 6 MV X?ray. In clinical practice, the understanding of the relationship of PD with different radiation conditions helps to reduce the doses to organs at risk. Shielding and protective techniques can further reduce dose deposition.

AIM: To evaluate the effects of hyperthermic peritoneal chemiotherapy (HPC) on cardiovascular system. METHODS: Twenty-six patients whose age was 31 to 75 receiving gastric cancer radical resection followed by HPC were involved in this trial. All hemodynamic parameters were recorded during whole procedures. RESULTS: The blood temperature(T) increased significantly during HPC; cardiac index increased immediately when HPC began( P