Immune checkpoint inhibitors(ICIs)have revolutionized the treatment paradigm for urothelial carcinoma, yet their efficacy exhibits marked differences due to the dynamic evolution and intrinsic heterogeneity of the tumor microenvironment(TME).At the genomic level, FGFR mutations and APOBEC signatures modulate neoantigen generation, influencing the predictive utility of tumor mutation burden(TMB).Within the TME, cancer-associated fibroblasts(CAFs)drive immune suppression through CXCL12/TGF-β signaling, and the spatial proximity between CD8~+ T cells and CAFs determines T-cell exhaustion phenotypes. Metabolically, ferroptosis-related genes(FRGs)reshape the immunosuppressive microenvironment through lipid peroxidation.Emerging biomarkers, such as the LAG-3/FGL1 axis, ctDNA dynamic monitoring, and glycogen metabolic reprogramming, provide new directions for predicting treatment response.Multi-omics integration models and combination therapies demonstrate significant potential for clinical translation, yet challenges remain in standardization and dynamic monitoring technologies.This review aims to systematically explore the multidimensional characteristics of biomarkers for immunotherapy in urothelial carcinoma, offering a theoretical foundation for optimizing treatment strategies.

ObjectiveTo explore the association between metabolic score for visceral fat（METS-VF） and cardiometabolic multimorbidity（CMM） as well as cognitive function in the elderly population， revealing the role of METS-VF as an assessment tool in this population， and providing evidence and new perspectives for the early screening and intervention strategies of CMM and cognitive function. MethodsThis study is based on cross-sectional data from the Hubei memory and aging cohort study（HMACS）， which includes elderly individuals aged 60 and above. The METS-VF index was calculated and divided into quartiles（Q1-Q4）. CMM was assessed through a questionnaire， defining CMM as the coexistence of at least two of the following conditions： diabetes， heart disease， and stroke. Standardized cognitive tests were used to evaluate overall cognition， memory， language， executive function， and attention. Logistic and Linear regression analysis was performed to explore the association between METS-VF and the risk of CMM as well as cognitive function. A restricted cubic spline was used to test the dose-response relationship， and subgroup analysis was conducted to assess the variation of METS-VF in different populations. Additionally， multinomial unordered logistic regression was used to evaluate the performance of METS-VF in predicting CMM morbidity patterns. ResultsA total of 3 790 elderly participants aged 60 and above were included. After adjusting for confounding factors， compared with the lowest quartile（Q1）， the Q4 group of METS-VF was associated with a higher risk of CMM ［OR=3.00，95%CI （2.18， 4.16）］， and with lower scores in overall cognition ［b=-0.12， 95%CI （-0.21，-0.04）］， attention ［b=-0.14， 95%CI （-0.24，-0.05）］， and executive function ［b=-0.10， 95%CI （-0.20，-0.00）］. Dose-response analysis did not show a nonlinear relationship between METS-VF and either CMM or cognitive function （P for nonlinear > 0.05）. Subgroup analysis revealed that the male group with higher METS-VF had lower overall cognitive scores， while the female group showed lower executive function scores （P for interaction ＜ 0.05 for both）. Multinomial unordered logistic regression analysis indicated that the METS-VF index was associated with an increased risk of diabetes with coronary heart disease ［OR=2.62，95%CI （1.66， 4.15）］ or concomitant stroke ［OR=2.66，95%CI （1.73， 4.09）］， especially in the group with both diabetes and stroke and coronary heart disease， where the association between METS-VF and the risk was strongest. ConclusionsAn increased METS-VF is associated with a higher risk of CMM and lower scores in overall cognition， attention， and executive function in the elderly population. Diabetes may be a key driving factor in the multimorbidity model. The METS-VF index can serve as a dual-purpose tool for screening cardiovascular metabolic risks and assessing cognitive function.

Objective To explore the application value of simple drawing line puncture combined with visual articular process arthroplasty in lateral foraminoscopy.Methods A retrospective analysis was performed on 89 patients with single-segment lumbar disc herniation treated with lateral foraminoscopy from May 2019 to December 2022,including traditional transforaminal endoscopic spine system(TESSYS)technology(conventional group,35 cases)and simple drawing line puncture combined with visual articular process arthroplasty(modified group,54 cases).The fluoroscopy times,puncture time,and operation time of the two groups were compared.The Visual Analogue Score(VAS),Oswestry Disability Index(ODI),and MacNab criteria were used to evaluate the surgical effect at 3 d after surgery and at the last follow-up.Results All the operations were successfully completed without conversion to open surgery.In the conventional group,there was 1 case of L4 nerve root injury,who was considered intraoperative nerve root compression injury.There was no abnormality in lower limb muscle strength after surgery,but hyperalgesia and numbness in the innervated cutaneous area accompanied by nocturnal cramps.The patient was given treatment with pregabalin,mecobalamin,vitamin B1 and B6 for 2 months,and returned to normal at 1 year of follow-up.The other cases had no complications such as dural injury,abdominal organ injury,or incision infection.Recurrence occurred in 1 case in the conventional group and 2 cases in the modified group,and all the 3 cases occurred within 3 months after operation.Among them,2 patients had severe symptoms and underwent endoscopic revision again,and the other patient improved after conservative treatment.Compared with the conventional group,the puncture times[(1.8±0.7)times vs.(7.5±1.1)times,t=27.543,P=0.000].fluoroscopy times[(5.7±1.8)times vs.(23.2±2.2)times,t=41.235,P=0.000]and operation time[(72.7±7.2)min vs.(92.7±7.7)min,t=12.317,P=0.000]in the modified group were significantly reduced or shortened,and there was no significant difference in postoperative hospital stay[(3.2±0.6)d vs.(3.3±0.6)d,t=0.062,P=0.951]between the two groups.The conventional group was followed up for(14.0±1.3)months and the modified group was followed up for(13.6±1.2)months.There were no significant differences in VAS scores[(1.5±0.6)points vs.(1.6±0.7)points,t=0.751,P=0.455].ODI[(10.8±3.4)％vs.(11.8±3.9)％,t=1.284,P=0.202].and excellent and good rate of MacNab criteria[100％(54/54)vs.100％(35/35),Z=-0.981,P=0.327]between the two groups at the last follow-up.Conclusions Simple drawing line puncture combined with visual articular process arthroplasty can significantly improve the accuracy of intervertebral foramen aspiration,with simple operation,reduced X-ray exposure for doctors and patients,shortened operation time,and improved surgical safety.It is worthy of promotion and application in percutaneous foraminoscopy.

Objective:To construct an internal quality evaluation system based on the structure-process-outcome(SPO)model,and to analyze its applied effect in the quality management for equipment in the ward of neurology of third-level grade-A hospital.Methods:The internal quality evaluation system for medical equipment based on SPO model realized comprehensive management for medical equipment in the ward of neurology of third-level grade-A hospital through structural design,platform management and outcome feedback.Thirty using medical equipment in the wards of the neurology of Shenzhen Longhua District Central Hospital from May,2022 to April,2024 were selected.The equipment that were used from May,2022 to April,2023 were managed by using conventional management method,and the equipment that were used from May 2023 to April 2024 were managed by using internal quality evaluation system(SPO model management method)based on SPO model.A self-made questionnaire was adopted to investigate and research the satisfaction degree of 35 equipment-related managers,and the operating quality of equipment,error rate of clinical operation and increased degree of equipment benefit of the two management methods were compared.Results:The execution rate of equipment,standard rate of disinfection,timely rate of failure treatment and pass rate of quality detection of adopting SPO model management method were respectively(94.15±4.63)%,(92.69±3.36)%,(93.65±4.36)%and(90.62±3.14)%,which were higher all than these of conventional management method,and the differences of them between two methods were statistically significant(t=14.218,14.582,11.813,14.859,P<0.05).The occurrences of misuse,operation error and human error were respectively one,one and two equipment in 30 equipment by using SPO model management method,and the incidence rates of them were respectively 3.333%,3.333%and 6.667%,which were lower all than those of conventional management method,and the differences of them between two methods were statistically significant(x2=11.882,13.416,12.272,P<0.05).The average scores of 35 managers for convenience,used effect,emergency use and automatic warning efficiency of adopting SPO model management method to use equipment were respectively(92.36±3.14)points,(93.21±4.36)points,(91.25±3.36)points and(94.23±4.36)points,all of which were higher than those of conventional management method,and the differences of them between two methods were statistically significant(t=12.849,11.894,11.417,11.401,P<0.05).The average values of the increased degrees of cost-benefit and social-benefit of equipment of using SPO model management method were respectively(4.36±0.96)%and(3.25±0.65)%,which were higher than these of conventional management method,while the average value of the increased degree of maintenance management expenditure of using SPO model management method was(1.56±0.69)%,which was lower than that of conventional management method,and the differences of them between two methods were statistically significant(t=11.754,14.438,16.320,P<0.05).Conclusion:The application of the internal quality evaluation system based on SPO model for medical equipment in the management for medical equipment in neurology wards of third-level grade-A hospital can improve the operation quality of equipment,and reduce the error rate of operating equipment,and enhance the satisfaction of relevant managers in using equipment.

Xiaoaiping (XAP) Injection demonstrates the anti-prostate cancer (PCa) effects, yet the underlying mechanism remains unclear. This study aims to investigate the impact of XAP on PCa and elucidate its mechanism of action. PCa cell proliferation was evaluated using a cell counting kit-8 (CCK-8) assay. Cell apoptosis was assessed through Hoechst staining and Western blotting assays. Proteomics technology was employed to identify key molecules and significant signaling pathways modulated by XAP in PCa cells. To further validate potential key genes and important pathways, a series of assays were conducted, including acridine orange (AO) staining, transmission electron microscopy, and immunofluorescence assays. The molecular mechanism of XAP against PCa in vivo was examined using a PC3 xenograft mouse model. Results demonstrated that XAP significantly inhibited cell proliferation in multiple PCa cell lines. In C4-2 and prostate cancer cell line-3 (PC3) cells, XAP induced cellular apoptosis, evidenced by reduced B-cell lymphoma 2 (Bcl-2) levels and elevated Bcl-2-associated X (Bax) levels. Proteomic, immunofluorescence, and quantitative reverse transcription-polymerase chain reaction (qRT-PCR) investigations revealed a strong correlation between forkhead box O3a (FoxO3a) autophagic degradation and the anti-PCa action of XAP. XAP hindered autophagy by reducing the expression levels of autophagy-related protein 5 (Atg5)/autophagy-related protein 12 (Atg12) and enhancing FoxO3a expression and nuclear translocation. Furthermore, XAP exhibited potent anti-PCa action in PC3 xenograft mice and triggered FoxO3a nuclear translocation in tumor tissue. These findings suggest that XAP induces PCa apoptosis via inhibition of FoxO3a autophagic degradation, potentially offering a novel perspective on XAP injection as an effective anticancer therapy for PCa.
Male ; Humans ; Prostatic Neoplasms/physiopathology* ; Autophagy/drug effects* ; Animals ; Drugs, Chinese Herbal/pharmacology* ; Proteomics ; Mice ; Apoptosis/drug effects* ; Cell Line, Tumor ; Cell Proliferation/drug effects* ; Forkhead Box Protein O3/genetics* ; Xenograft Model Antitumor Assays ; Mice, Nude ; Mice, Inbred BALB C

Objective:To investigate the prevalence and risk factors of overweight and obesity among Chinese children aged 3-18 years from 11 provinces, antonomous regions, or municipalities.Methods:This national cross-sectional community health survey utilized a multistage stratified cluster-random sampling method to recruit 193 997 nationally representative participants from 11 provinces, autonomous regions, or municipalities between January 2017 and December 2019. All participants underwent physical examinations, and their caregivers completed questionnaires assessing participants′ dietary, lifestyle, familial, and perinatal information. Multilevel multinomial logistic regression models were employed to identify the potential risk factors.Results:The cohort comprised 193 997 children (102 178 boys, 91 819 girls),aged (10±4) years. Overall prevalence rates were 30 574(15.8%)overweight children and 17 217(8.9%) obesity children. Boys exhibited higher overweight and obesity rates than girls (17.0% (17 368/102 178) vs. 14.4% (13 206/102 178), 11.3% (11 553/91 819) vs. 6.2% (5 664/91 819), χ2=249.12,1 578.69,both P<0.001). The detection rates of obesity in Tanner stage 2 and 3 were the highest in boys and girls, with 13.4%(2 231/16 665) and 8.6%(880/10 221) respectively. Risk factors for obesity included parental overweight (paternal OR=2.34 and maternal OR=2.29), annual household income of 100 000-200 000 yuan (compared with<100 000 yuan, OR=1.04), higher paternal education (compared with below high school,high school and a college education OR=1.09,1.14), birth weight >4.0 kg (≤5 and>5 years old OR=1.74, 1.44,respectively), and western food consumption≥1 time/month (compared with<1, 1-2, 3-4,>4 times/month OR=1.36, 1.30, 1.67(≤5 years), 1.19, 1.16, 1.15 (>5 years), respectively) (all P<0.05). Conversely, coarse grain intake≥1 times/week (compared with<1 times/week, every day, 3-4, 1-2 times/week OR=0.74, 0.80, 0.71 (≤5 years), 0.75, 0.87, 0.90(>5 years), respectively, all P<0.05) was associated with reduced obesity risk. Conclusions:Obesity epidemiology in children demonstrates significant heterogeneity across age, gender, geographic regions, and pubertal stages. It is necessary to establish a personalized prevention and control strategy.

Objective:To investigate the efficacy and safety of transurethral incision for the treatment of ureterocele in infants.Methods:A retrospective analysis of 28 cases of ureterocele admitted from March 2012 to May 2023 were reviewed, all of which were less than 1 year old, 16 male and 12 female, with an average age of(5.7±3.5)months. The ureterocele was located on the left side in 8 cases, on the right side in 15 cases, and bilaterally in 5 cases. There were 12 cases of single system ureterocele, of which 7 cases were unilateral and 5 cases were bilateral. Duplex system ureterocele was observed in 16 cases, all of which were unilateral. Clinical manifestations: urinary tract infection in 13 cases, 11 cases of ureterocele or hydronephrosis and ureteral dilation were found during antenatal examination, and 4 cases of ureterocele were found after birth. Urological ultrasound, intravenous pyelography(IVP) and voiding cystourethrography(VCUG) were performed in all children, and 17 cases underwent magnetic resonance urolography (MRU), and confirm the diagnosis of ureterocele preoperatively. All of the cases were performed the transurethral incision.The ureterocele was punctured and incised 1-2 mm at the base of the bulge, and 2-4 points were punctured according to the bulge atrophy. Bilateral ureteroceles were punctured and incised simultaneously. Postoperative urine routine test, urinary tract color ultrasound and VCUG were performed to determine if there is urinary tract infection, hydronephrosis, ureteral dilation and bulging, and whether a second surgery is needed.Results:All operations were conducted successfully. The intraoperative bleeding was less than 3 ml and no intraoperative complications. The operative time was (28.4±10.3) min. The median postoperative follow-up was 34 (32, 36) months. Six cases underwent postoperative VCUG examination. Eleven children were recovered well with single systemic ureterocele. One child developed grade Ⅳ vesicoureteral reflux(VUR)and combined with bladder diverticulum, and ureterocele underwent open diverticulotomy and ureteral reimplantation six months after surgery. Nine children were recovered well with duplex systemic ureterocele. Six cases of children developed infection, of which 2 cases had an infection once within one month after TUI, and the other four cases still had intermittent infections after six months and VCUG was performed, and one case showed grade Ⅲ VUR of the lower ureter, which was observed conservatively, while the other three cases had enlarged cysts but no VUR, and upper heminephrectomy was performed, and the patients recovered well after surgery. Except for these 6 exceptions, in another case, after ten years of follow-up, the ureterocele became larger but no VUR, and the results were good after a second transurethral incision. There was no significant difference in the postoperative infections, new VUR cases, and secondary surgeries between the two groups.Conclusions:Transurethral incision has good surgical effect on children with single system ureterocele and duplex system ureterocele, and has advantages of easy operation, less trauma, safety and effectiveness, and few complications. It deserves to be recommended as the treatment of choice, especially for infants and young children.

OBJECTIVE To explore and establish the working mechanism for prevention and control of hospital-as-sociated infections in regional oral medical institutions so as to standardize the prevention and control of the hospi-tal-associated infections in the regional oral medical institutions.METHODS Taking an administrative division of Chongqing as example,the matrix evaluation was carried out based on the quality control mode for management of hospital-associated infections in oral medical institutions' action planning,training guidance,quality control super-vision,summary review' organically in combination with'quality control plus law enforcement',a color-co-ded management of the oral medical institutions in the region was implemented,and the effectiveness of improved work in infection control was examined.RESULTS From the perspective of the grade of medical institution,the qualified rates of hospital infection management system construction,architectural layout and process,cleaning,disinfection and sterilization of oral instruments,environmental cleaning and disinfection,isolation,safe injection,use of occupational protection supplies and disposal of medical waste of the primary and unrated medical institu-tions were respectively 26.51％,49.40％,24.10％,37.35％,31.33％,46.99％,67.47％and 51.81％before the improvement and were respectively increased to 67.47％,63.86％,45.78％,66.27％,63.86％,73.49％,84.34％and 66.27％after the improvement,and there were significant differences(P＜0.05).From the perspec-tive of the property of the medical institution,the qualified rates of the above items of the private medical institu-tions were respectively 24.66％,47.95％,21.92％,34.25％,31.51％,45.21％,69.86％and 50.68％before the improvement and were respectively increased to 65.75％,61.64％,42.47％,64.38％,63.01％,71.23％,84.93％and 63.01％after the improvement,and there were significant differences(P＜0.05).CONCLUSION The working mechanism on prevention and control of hospital-associated infections in regional oral medical institu-tions that is established based on'quality control plus law enforcement'with the introduction of social credit can effectively raise the qualified rates of the infection prevention and control measures,which achieves more remarka-ble improvement effectiveness in grass-roots oral medical institutions such as the private,primary and unrat-ed medical institutions.

Thoracic anesthesia with spontaneous respiration represents a form of precision anesthesia meticulously customized to individual patients.Considering the more stringent requirements this anesthesia approach imposes on the regulation of respiratory function,the writing group of the"Consensus of Experts on the Management of Thoracic Anesthesia with Spontaneous Respiration"has formulated elaborate guidelines regarding indications and contraindications,preoperative evaluation,anesthesia implementation,common complications,and treatment strategies.This was accomplished by referencing relevant domestic and international literature and integrating it with actual clinical requirements.The objective is to standardize the rational application of this anesthesia method.

Pancreatic cancer is highly aggressive and often diagnosed at an advanced stage,leaving most patients ineligible for radical resection.This study retrospectively analyzed four patients with locally advanced or advanced pancreatic cancer to evaluate the clinical efficacy and safety of high-intensity focused ultrasound(HIFU)ablation combined with chemotherapy as a neoadjuvant and conversion therapy.All cases were reviewed and individualized treatment plans were formulated through a multidisciplinary team evaluation.All patients received HIFU plus gemcitabine and nab-paclitaxel chemotherapy,with assessments of tumor volume,vascular involvement,surgical conversion,symptom relief,and adverse events.Three patients achieved marked tumor shrinkage and reduction of vascular invasion,enabling successful R0 resection without recurrence during follow-up.The remaining patient achieved disease stability,significant pain relief,and maintained good quality of life under repeated HIFU therapy.All treatments were well tolerated,and no severe adverse reactions occurred.The combination of HIFU and chemotherapy demonstrated synergistic local and systemic effects,effectively achieving tumor downstaging,improving resectability,and alleviating symptoms.As a safe,noninvasive,and repeatable therapeutic approach,this strategy offers a promising option for patients with advanced pancreatic cancer.Further large-scale prospective studies are warranted to validate its long-term efficacy and elucidate underlying mechanisms.