Objective To evaluate the efficacy and safety of super-mini percutaneous nephrolithotomy(SMP)and standard percutaneous nephrolithotomy(sPCNL)in the treatment of 2-4 cm renal calculi, so as to provide reference for the management of medium-sized renal calculi. Methods A retrospective analysis was conducted on 168 patients with 2-4 cm renal calculi who underwent either SMP or sPCNL at our hospital during Sep. 2020 and Mar. 2025. The patients were divided into the SMP group(n=85)and sPCNL group(n=83). The baseline characteristics, stone features, operation time, perioperative complications, transfusion rate, postoperative hemoglobin drop, pain score, hospital stay, and stone-free rate(SFR)were compared between the two groups. Results There were no significant differences in baseline characteristics, stone features, and SFR between the two groups(P＞0.05). Compared to the sPCNL group, the SMP group had a longer operation time [(71.76±22.49)vs.(64.22±15.01)min, P=0.034]. However, it had lower postoperative pain score [(2.51 ±0.85)vs.(4.11±0.47), P＜0.001], shorter hospital stay [(3.16±1.45)vs.(4.30±1.06)days, P＜0.001], lower hospitalization costs [(19982.67±4267.80)vs.(21688.53±4575.74)RMB, P=0.004], a slighter decrease in hemoglobin [(6.64±10.56)vs.(12.22±11.50)g/L, P=0.032], and a significantly higher tubeless rate(83.53% vs. 0%, P＜0.001). There was no statistically significant difference in the overall complication rate between the two groups(P＞0.05). Conclusion For 2—4 cm renal calculi, SMP achieves a comparable SFR as sPCNL. Although the operation time with SMP is slightly longer, it offers significant advantages, including reduced postoperative pain, shorter hospitalization, lower costs, less bleeding, and a higher tubeless rate. SMP is a valuable technique worthy of broader clinical application.

ObjectiveTo compare the clinical efficacy of traditional Chinese medicine （TCM） manipulative reduction combined with small splint fixation versus surgical treatment for type A distal radius fracture （DRF） and to explore the factors influencing the choice of treatment. MethodsA multi-center retrospective study was conducted， collecting data from 1237 type A DRF patients treated in 11 hospitals in Jiangsu province from September， 2023 to April， 2025. Among them， 851 patients in the TCM group received manipulative reduction combined with small splint fixation， and 386 patients in the surgical group underwent open reduction and internal fixation. Visual analog scale （VAS） scores for pain and radiographic indicators including palmar tilt， ulnar deviation， and radial height were compared before treatment， 5-7 days after treatment， and 4-6 weeks after treatment. The wrist joint function scores including Dienst and Gartland-Werley scores at 12 weeks after treatment were recorded. Subgroup analysis was conducted for the excellent rate of Dienst and Gartland-Werley scores， stratified by age （＜50， 50-59， 60-69， ≥70 years old） and AO subtypes （A1， A2， A3）. A multivariate logistic regression model was used to identify independent factors influencing treatment choice. ResultsOn 5-7 days after treatment， the surgical group had lower VAS scores than the TCM group， while 4-6 weeks after treatment， the TCM group showed lower VAS scores than the surgical group （P＜0.01）. In terms of radiographic indicators， except for the palmar tilt before treatment being higher in the surgical group than in the TCM group （P＜0.01）， there were no significant differences in palmar tilt， ulnar deviation， and radial height at other timepoints （P＞0.05）. Twelve weeks after treatment， the surgical group had a higher average Gartland-Werley score and the excellent rate than the TCM group （P＜0.01）. Subgroup analysis showed that in patients with A2 type DRF aged 50-59 and 60-69 years old， the excellent rates of Dienst and Gartland-Werley scores in the TCM group were higher than those in the surgical group （P＜0.05）. Multivariate logistic regression analysis revealed that age， palmar tilt， ulnar deviation， and the degree of swelling on the affected side were independent factors influencing the choice of treatment （P＜0.05）. ConclusionBoth TCM manipulative reduction combined with small splint fixation and surgical treatment for type A DRF can achieve good therapeutic effects. TCM manipulative reduction combined with small splint fixation has certain advantages in medium- and long-term pain relief， especially in elderly patients， where wrist joint function recovery is more stable. Age， palmar tilt， ulnar deviation， and swelling degree are the main factors influencing the treatment choice.

ObjectiveTo observe the clinical efficacy and radiographic outcomes of manipulative reduction combined with small splint fixation in the treatment of distal radius fractures. MethodsThe clinical data of 1051 patients with distal radius fractures were retrospectively collected from five hospitals included in the Jiangsu Diagnosis and Treatment Data Platform for Traditional Chinese Medicine（TCM） Dominant Diseases. Propensity score matching at a 1∶4 ratio was applied， resulting in 580 cases selected for final analysis， which comprised 448 patients in the TCM group（manipulative reduction plus small splint fixation） and 132 in the surgical treatment group（open reduction and internal fixation）. Each group was further stratified into type A， B， and C subgroups based on AO fracture classification. Radiographic indicators including palmar tilt， radial inclination， and radial height were compared between groups before treatment and 1 day， 1 week， and 4-6 weeks after treatment， and pain visual analog scale（VAS） scores before treatment and 1 week and 4-6 weeks after treatment were also compared. Wrist joint function was assessed 12 weeks after treatment， using the Dienst wrist function score and the Gartland and Werley（G-W） wrist function score. Additionally， the radiographic indicators at different timepoints and the 12-week wrist function levels were compared between groups across different fracture types. ResultsNo statistically significant difference was observed in radiographic indicators and VAS scores at all timepoints before and after treatment， as well as wrist joint function grades assessed by the Dienst score and the G-W score at 12 weeks after treatment （P＞0.05）. Compared to those before treatment， both groups showed increased palmar tilt， radial inclination， and radial height 1 week and 4-6 weeks after treatment， and decreased VAS scores （P＜0.05）. Compared to those 1 week after treatment， both groups showed a decrease in palmar tilt， an increase in radial inclination and radial height， and a reduction in VAS score 4-6 weeks after treatment（P＜0.05）. In type A and B subgroups， the surgical treatment group had a higher radial inclination than the TCM group 4-6 weeks after treatment， while in the type C subgroup， a higher radial height was shown in the surgical treatment group than in the TCM group 4-6 weeks after treatment（P＜0.05）. In type C subgroup， there was significant difference between groups in the wrist joint function by G-W scores 12 weeks after treatment（P＜0.05）. ConclusionManipulative reduction combined with small splint fixation can maintain fracture alignment and alleviate pain in treating distal radius fractures， which achieves therapeutic outcomes comparable to surgical treatment. It is particularly suitable for type A and B fractures and can be considered an effective treatment option for distal radius fractures.

ObjectiveTo construct an automatic measurement model for palmar tilt and radial inclination suitable for traditional Chinese medicine （TCM） clinical scenarios， and to validate its accuracy and efficiency in TCM manipulative reduction settings. MethodsData on anteroposterior （AP） and lateral X-rays of distal radius fractures were collected from patients admitted to 18 TCM/ integrated TCM and western medicine hospitals in Jiangsu province between September 1st， 2023， and September 1st， 2024， via the Jiangsu Diagnosis and Treatment Big Data Platform for TCM Dominant Diseases. A medical image segmentation framework based on multi-scale feature fusion and edge-awareness was employed， combined with anatomical knowledge specific to TCM orthopedics， to optimize the feature extraction strategy of an artificial intelligence （AI） model. This framework enabled automatic segmentation of fracture regions and measurement of distal radius palmar tilt and radial inclination. The accuracy of the AI model in measuring radial inclination and volar tilt was validated， and the measurement time and average time gain rate of the AI model were compared to those of manual measurement. ResultsA total of 15,444 AP and lateral X-ray images of distal radius fractures were collected， and were divided into a training set （11,144 images， 5066 AP and 6078 lateral）， a validation set （3700 images， 1840 AP and 1860 lateral）， and an independent test set （600 images， 300 AP and 300 lateral） after preprocessing. In the measurement of 300 AP X-rays in the independent test set for radial inclination， when the degree error between AI measurement and manual measurement was ＜3° and ＜5°， AI measurement accuracy was 83% and 93%， respectively. In 300 lateral X-rays in the test set for palmar tilt， when AI measurements had an error of ＜3° and ＜5° compared to manual measurements， corresponding accuracy rate was 78% and 90%， respectively. For 50 X-ray images， AI measurement time was （1.37±0.05） min for radial inclination while manual measurement time was （22.57±2.52） min （P＜0.001）； in terms of palmar tilt， the AI measurement time was （1.33±0.14） min， shorter than （23.70±2.80） min for manual measurement time （P＜0.001）. Average time gain rates for manual and AI measurements were 93.93% and 94.39% respectively. ConclusionAn automatic measurement model for palmar tilt and radial inclination in distal radius fractures has been established， enabling more accurate and efficient assessment as well as providing a tool to support the quantitative evaluation of the efficacy of TCM manipulative reduction and large-sample clinical research.

Objective To analyze the influencing factors of respiratory failure in patients with sepsis, and to construct and validate a risk prediction model. Methods A total of 308 patients with sepsis in Ganzi Tibetan Autonomous Prefecture People's Hospital from August 2021 to September 2024 were enrolled and divided into a modeling group and a validation group. According to whether respiratory failure occurred during hospitalization, the patients were divided into a respiratory failure group and a non-respiratory failure group. Single-factor and binary logistic regression analysis were used to construct a risk prediction model, and the ROC, calibration, and DCA curves were used to assess the model's predictive performance. Results The incidence of respiratory failure was 20.83% (45/216) in the modeling group and 20.65% (19/92) in the validation group. Albumin, D-dimer, serum calcium, procalcitonin at admission, and sequential organ failure assessment were independent influencing factors of respiratory failure in patients with sepsis. The ROC curve analysis nomogram model predicted that the AUC of respiratory failure in the modeling group was 0.994 (95%CI: 0.985-1.000), and the AUC of the validation group was 0.897 (95%CI: 0.826-0.968). The calibration curve analysis showed that the calibration curve fit well with the ideal curve. DCA curve analysis showed that the net benefit was greater than 0 across all threshold probability ranges. Conclusion The risk prediction model constructed in this study is highly effective and can provide reference for medical staff to evaluate respiratory failure in patients with sepsis.

[Objective] To compare the clinical efficacy of super pulse thulium laser enucleation of the prostate (SPThuLEP) with "open tunnel" and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH), in order to provide reference for the treatment options of BPH. [Methods] The clinical data of 112 BPH patients treated in our hospital during Jan.2023 and Jul.2023 were retrospectively analyzed, including 65 treated with SPThuLEP with "open tunnel" and 57 with HoLEP.The operation time, postoperative hemoglobin decrease, postoperative bladder irrigation, catheter indwelling time, hospitalization time and complications were compared between the two groups.The changes of maximum urine flow rate (Qmax), international prostate symptom score (IPSS), quality of life score (QoL), postvoid residual (PVR) and prostate-specific antigen (PSA) were compared between the two groups before operation and one month after operation. [Results] All operations were successful without conversion to open or transurethral plasmakinetic resection.The postoperative decrease of hemoglobin in SPThuLEP group was lower than that in HoLEP group [(13.12±6.72) g/L vs. (21.02±6.51) g/L], with statistical difference (P<0.05). There were no significant differences in the operation time [(63.35±15.73) min vs.(61.02±17.55) min], postoperative bladder irrigation time [(1.07±0.45) d vs. (1.06±0.36) d], catheter indwelling time [(2.98±0.56) d vs. (3.01±0.63) d] and hospitalization time [(3.63±0.61) d vs.(3.79±0.76) d] between the two groups (P>0.05). No blood transfusion, secondary bleeding or unplanned hospitalization occurred, and there were no serious complications such as transurethral electroresection syndrome (TURS), urethral stricture and urinary incontinence.One month after operation, the Qmax, IPSS, QoL, PVR and PSA of the two groups were significantly improved compared with those before operation (P<0.05), but with no statistical difference between the two groups (P>0.05). [Conclusion] SPThuLEP with "open tunnel" has comparable efficacy as HoLEP in the treatment of BPH.With advantages of small amount of bleeding and high safety, this minimally invasive technique can be widely popularized in clinical practice.

ObjectiveBased on ultra-performance liquid chromatography-quadrupole-electrostatic field orbitrap high resolution mass spectrometry（UPLC-Q-Orbitrap-MS）， the chemical constituents of Qili Qiangxin capsules was identified， and their distribution in vivo was analyzed. MethodsUPLC-Q-Orbitrap-MS was used to detect the sample solution of Qili Qiangxin capsules， as well as the serum， brain， heart， lung， spleen， liver and kidney tissues of mice after oral administration. Using the Thermo Xcalibur 2.2 software， the compound information database was constructed， and the molecular formulas of compounds corresponding to the quasi-molecular ions were fitted. Based on the information of retention time， accurate relative molecular mass and fragments， the compounds and their distribution in vivo were analyzed by comparing with the data of reference substances and literature. ResultsA total of 233 compounds， including 70 terpenoids， 60 flavonoids， 23 organic acids， 17 alkaloids， 20 steroids， 7 coumarins and 36 others， were identified or predicted from Qili Qiangxin capsules， 73 of which were identified matching with standard substances. Tissue distribution results showed that 71， 17， 38， 33， 32， 58 and 43 migrating components were detected in blood， brain， heart， lung， spleen， liver and kidney， respectively. Thirty-seven components were absorbed into the blood and heart， including quinic acid， benzoylaconitine benzoylmesaconine and so on. Fourteen components were absorbed into the blood and six tissues， including calycosin， methylnissolin， formononetin， alisol B， alisol A and so on. ConclusionThis study comprehensively analyzes the chemical components of Qili Qiangxin capsules and their distribution in vivo. Among them， astragaloside Ⅳ， salvianolic acid B， ginsenoside Rb₁， ginsenoside Rb₃， ginsenoside Rd， ginsenoside Rg₃， calycosin-7-glucoside， and sinapine may be the important components for the treatment of heart failure， which can provide useful reference for its quality control and research on pharmacodynamic material basis.

Objective:To investigate the dose characteristics of the Zeiss INTRABEAM system in air and water, providing dose reference for electronic brachytherapy.Methods:A Monte Carlo program was used to establish a three-dimensional model of a miniature X-ray source vacuum drift tube and a 4 cm spherical applicator. The process of electron beam bombardment on a gold target to generate X-rays was simulated, and parameters such as photon fluence spectrum, percentage depth dose, and half-value layer were calculated. Additionally, the radial dose uniformity in water was measured.Results:The average energy of X-rays at 3 cm in air was 20.8 keV, with a half-value layer of 0.08 mm Al. Under the influence of the applicator, the spectrum becomes hardened, with axial and radial average energies of 28.7 and 29.0 keV, respectively. In water, the percentage depth dose (PDD) curve follows an inverse cubic decay with depth, indicating strong dose concentration and rapid fall-off in near-field irradiation. The radial dose uniformity in water exceeded 99.5%.Conclusions:The INTRABEAM device emits low-energy X-rays characterized by shallow penetration depth, and concentrated dose delivery. Its highly uniform dose distribution ensures comprehensive coverage of the target area, making it particularly suitable for treating superficial tumors and for intraoperative radiotherapy at close range.

Objective:To evaluate the efficacy and safety of endoscopic submucosal dissection (ESD) for the treatment of ileocecal valve lipoma.Methods:A retrospective cohort study was performed on data of ileocecal lipoma patients who underwent ESD at the Endoscopy Center of Zhongshan Hospital, Fudan University from December 2013 to June 2023. According to the lesion location, the patients were divided into ileocecal valve group and cecum group. The operation time, operation speed, en bloc resection rate, complications, and follow-up outcomes between the two groups were compared.Results:A total of 59 patients with ileocecal lipoma were enrolled, including 31 patients in the ileocecal valve group and 28 patients in the cecum group.There were no significant differences in gender, age, specimen size, or lesion size between the two groups ( P>0.05). Lipomas in both the ileocecal valve group and the cecum group were successfully resected by ESD. The en bloc resection rates were 100.0% (31/31) and 92.9% (26/28) respectively, and the difference was not statistically significant ( χ2=0.033, P=0.133). Median operative duration significantly differed between the two groups ( ileocecal valve group 26 min VS cecum group 20 min, Z=-0.136, P=0.027), as did resection speed (ileocecal valve group 0.14 cm2/min VS cecum group 0.24 cm2/min, Z=-0.223, P=0.022). Adverse events included one postoperative fever in the ileocecal valve group and one delayed bleeding in the cecum group. During the median follow-up of 38 months (7-106 months), there was no case of residual tumor or recurrence. Conclusion:Despite technical challenges in ESD of ileocecal valve lipoma, it is still a safe, feasible and effective treatment method.

Objective:To evaluate the risk of developing pulmonary tuberculosis (PTB) among individuals with latent tuberculosis infection (LTBI) in schools and the protective effect of tuberculosis preventive treatment (TPT).Methods:A retrospective cohort study was conducted to collect data on 15 school outbreaks that occurred in Guangdong Province from 2017 to 2021. Baseline information on tuberculin skin test (TST) or interferon-gamma release test (IGRA) was obtained during contact surveys, as well as baseline information such as TPT. The incidence of PTB between 2017 and 2022 was queried using the Chinese Center for Disease Control and Prevention Information System. Poisson regression analysis was used to compare the incidence risk of PTB in the LTBI population under different TST states at baseline. Current cases, new cases and all cases (the sum of the two) were used as dependent variables. Cox regression models were used to analyze various risk factors affecting the risk of PTB in the LTBI population and evaluate the protective effect of TPT.Results:A total of 6 550 contacts were included in this study, of which 409 received TPT. Within 0-3 months after baseline survey, 119 cases were diagnosed as current cases [19.4‰, 119/(6 550-409)]. A total of 17 221.65 person-years of follow-up were conducted, during which 71 new cases were diagnosed (4.1/1 000 person-years, 71/17 221.65). The incidence density of PTB was 47.7/1 000 person-years, 6.6/1 000 person-years, 1.4/1 000 person-years, and 0.9/1 000 person-years, respectively, in TST strong/IGRA positive, TST moderate positive, TST generally positive, and TST and IGRA negative populations. The difference in PTB incidence density was statistically significant [likelihood ratio test LRT=153.16, P<0.001]. TPT was performed for individuals with strong TST or IGRA positivity, and the protection rate could reach 93% ( HR=0.07, 95% CI: 0.02-0.23). Conclusion:After the outbreak of the school epidemic, individuals with strong TST/IGRA positivity have a higher risk of developing PTB in the future. Targeted implementation of TPT can achieve better protection effects. In addition, the risk of developing PTB in individuals with moderate TST positivity is also worth noting.