Objective To explore the efficacy and safety of treatment of intramural ureteral tumors via transurethral resection. Methods A retrospective analysis was conducted on the clinical data of 26 patients with ureteral cancer who underwent transurethral resection of intramural ureteral tumors at the First Affiliated Hospital of Naval Medical University from May 2020 to May 2023. All patients were treated using the “outer-wedge, inner-rotation” resection technique, with ureteral stents placed intraoperatively. Clinical indicators including operation time, intraoperative blood loss, length of postoperative hospital stay, ureteral stent indwelling duration, intraoperative and postoperative complications, postoperative pathological results, and bladder tumor recurrence rate were analyzed. Results All surgeries were successfully completed. The operation time was 45(35, 60) min, intraoperative blood loss was 5(3, 10) mL, length of postoperative hospital stay was 4(3, 5) d, and the ureteral stent indwelling duration was (33.8±9.7) d. All patients did not experience intraoperative complications, the postoperative hydronephrosis rate was 3.8%. Postoperative pathology confirmed urothelial carcinoma in all cases, including 6 cases of stage pT_a, 16 cases of pT₁, and 4 cases of pT_2a. The follow-up period ranged from 12 to 48 months. Intravesical recurrence occurred in 2 patients, and recurrence rate was 7.7%. There were no tumor-related deaths during the follow-up period. Conclusions Transurethral resection of intramural ureteral tumors is minimally invasive, resulting in less blood loss, and has low rates of postoperative complications such as hydronephrosis and hydroureter. It achieves favorable surgical outcomes while better preserving renal function.

ObjectiveTo observe the analgesic efficacy and safety of Qihuang acupuncture theory combined with opioid analgesics in patients with moderate to severe cancer pain due to lung cancer. MethodsPatients with moderate to severe cancer pain from lung cancer were randomly divided into Qihuang acupuncture group and control group， with 33 cases in each group. The control group was treated with long-acting opioid analgesics at maintenance doses and supplementary analgesic medications as needed. In case of breakthrough pain， short-acting opioids were used for rescue. The Qihuang acupuncture group received Qihuang acupuncture treatment in addition to the treatment used in the control group， administered once every other day， with 3 sessions constituting one treatment course. The treatment duration for both groups was 5 days. The primary outcome was the change in pain intensity， measured using the numerical rating scale （NRS） before and after treatment， and the NRS change rate was calculated. Secondary endpoints included the daily NRS change rate， the Eastern Cooperative Oncology Group （ECOG） Performance Status （PS） score， the European Organization for Research and Treatment of Cancer Quality of Life Core Questionnaire （EORTC QLQ-C30） score， and the 24-hour equivalent hydrocodone sustained-release tablet dose. Laboratory tests， including routine blood， urine， stool， liver function， and kidney function， were performed before and after treatment. Adverse events were recorded throughout the trial. ResultsAll patients completed the trial， and both groups showed a decrease in average NRS scores and PS scores after treatment， with the Qihuang acupuncture group showing lower average NRS scores and PS scores than the control group （P＜0.05 or P＜0.01）. After treatment， the NRS change rate in the Qihuang acupuncture group was （0.42±0.17）， significantly higher than that in the control group （0.14±0.27， P＜0.01）. The daily NRS change rate during treatment was also higher in the Qihuang acupuncture group compared to the control group （P＜0.01）. The Qihuang acupuncture group showed an increase in overall health status and functional scores in the EORTC QLQ-C30， and a decrease in symptom scores for fatigue， nausea and vomiting， pain， dyspnea， insomnia， appetite loss， constipation， and financial difficulties. In contrast， overall health status and constipation scores in the control group increased， while scores of fatigue， nausea and vomiting， pain， and appetite loss decreased （P＜0.05 or P＜0.01）. After treatment， the 24-hour equivalent hydrocodone sustained-release tablet dose did not show significant difference in the Qihuang acupuncture group （P＞0.05）， while the control group showed a significant increase in the 24-hour dose （P＜0.01）. No significant abnormalities were observed in laboratory tests before and after treatment in either group. During the study， the incidence of nausea and vomiting as well as constipation in the Qihuang acupuncture group was both 3.03% （1/33）， while the incidence in the control group was 27.27% （9/33） and 36.36% （12/33）， respectively， with the Qihuang acupuncture group showing significantly lower incidence （P＜0.01）. No serious adverse reactions were observed in either group. ConclusionQihuang acupuncture therapy combined with opioid analgesics is more effective than using opioids alone in relieving pain in patients with moderate to severe cancer pain due to lung cancer. It can improve the patients' physical condition and quality of life， reduce the dose of opioid analgesics， and has good safety.

Chronic pancreatitis is a chronic inflammatory disease characterized by progre-ssive fibrosis of pancreatic tissue. Its pathological features primarily include parenchymal fibrosis, intraductal stone formation or calcification deposits, as well as segmental stenosis and dilation of the pancreatic duct. Prolonged chronic inflammatory stimulation not only leads to progressive pancreatic dysfunction but may also trigger the formation of pancreatic pseudocysts and even malignant transformation. In the comprehensive treatment of chronic pancreatitis, the core clinical goals are the removal of pancreatic duct stones, restoration of unobstructed pancreatic duct drainage, and preservation of residual pancreatic function. Traditional treatment strategies have been based on the principle of progressive intervention and early surgical management. In recent years, with advancements in extracorporeal shock wave lithotripsy, the application of new techniques such as endoscopic retrograde cholangiopancreatography combined with laser lithotripsy under direct cholan-gioscopic visualization, and improvements in pancreas-preserving surgical approaches, the debate over the superiority of progressive intervention versus early surgical treatment has intensified. Against this backdrop, the treatment mode of Xi′an Jiaotong University Pancreatic Disease Center (hereinafter referred to as "Western Pancreas") has emerged, emphasizing a personalized, multimodal treatment strategy based on different types of pancreatic duct stones. The treatment mode of "Western Pancreas" integrates lithotripsy, endoscopic treatment, and surgical interventions to optimize patient outcomes. By conducting a comprehensive analysis of domestic and international pancreatic duct stone classi-fication systems and drawing from our team′s clinical experience in managing over a thousand cases of chronic pancreatitis, the authors have further refined and proposed a classification system for pancreatic duct stones under the treatment mode of "Western Pancreas". This refinement aims to enhance the overall diagnostic and therapeutic standards for chronic pancreatitis.

Indwelling urinary catheterization is one of the most widely used invasive procedures in clinical practice, playing a critical role in disease diagnosis, treatment, and monitoring. In 2024, the European Association of Urology Nurses (EAUN) released the Best Practice Guidelines for Indwelling Urinary Catheterization in Adults-Transurethral and Suprapubic Catheterization (hereinafter referred to as the Guideline), aiming to provide evidence-based clinical guidance and health education information for healthcare professionals. This article interprets the section on "Nursing Principles" within the Guideline, which spans the entire process of catheter management. Key aspects covered include pre-insertion preparation, catheter insertion procedure, catheter maintenance and securement, observation of urine color, prevention of constipation, and catheter removal. The aim is to help urology nurses and related healthcare personnel gain an in-depth understanding of the recommendations in the Guideline, promote its standardized application in clinical practice, improve the quality of indwelling catheter care, and ensure patient safety.

Objective:To analyze and compare the interfractional setup errors between two body posi-tioning fixation methods(lithotomy position with carbon fiber full-body fixation frame vs.conventional carbon fiber body fixation frame combined with thermoplastic membrane)in radical radiotherapy for pros-tate cancer,and to calculate the clinical target volume(CTV)to planning target volume(PTV)margin(MPTV)for both methods to optimize immobilization techniques and radiotherapy workflows.Methods:A retrospective analysis was conducted on 37 consecutive patients who underwent radical prostate radio-therapy at Peking University First Hospital between August 2021 and March 2023.The patients were di-vided into two groups based on the immobilization method:Group A(18 patients,450 CBCT image sets)used a carbon fiber whole-body fixator in the lithotomy position,while Group B(19 patients,461 CBCT image sets)used a conventional carbon fiber fixator combined with a thermoplastic mask.All the patients underwent daily cone-beam computed tomography(CBCT)image guidance.Bone registration combined with manual registration was used to obtain the setup error data in the left-right(X),cranio-caudal(Y)and anterior-posterior(Z)directions.The positioning errors of the two groups were compared by using the independent sample t-test,the Mann-Whitney U test and the chi-square test.The average positioning error,systematic positioning error(Σ)and random positioning error(δ)were calculated,and the CTV-PTV extension distance was calculated by using the(MPTV=2.5Σ+0.7δ).Results:The analysis of the setup errors in the three-dimensional direction showed significant differences between the two groups(all P＜0.01).Specifically,the median(quartile)absolute values of the errors in the X,Y,and Z di-rections of group A were[0.40(0.20,0.70)cm,0.50(0.30,0.80)cm,and 0.35(0.20,0.60)cm],respectively.In group B,the corresponding values were significantly reduced to[0.20(0.10,0.40)cm,0.40(0.20,0.70)cm and 0.20(0.10,0.40)cm].The results of Mann-Whitney U test showed that the differences in each direction were highly statistically significant(X:z=-6.86;Y:z=-2.76;Z:z=-5.71).The cumulative distribution ratio of the setup error displacement within 0.5 cm in the X,Y,and Z directions in group A and group B were 297(66.0％)and 408(88.5％)(P＜0.01),250(55.6％)and 285(61.8％)(P=0.055),308(68.4％)and 391(84.8％)(P＜0.01),re-spectively.The CTV-PTV margins in three directions were X 0.66 cm in group A and 0.35 cm in group B;Y0.67 cm and 0.45 cm;Z 0.54 cm and 0.42 cm.Conclusion:Conventional carbon fiber human body fixator combined with thermoplastic film can significantly reduce the setup error.However,the car-bon fiber whole-body fixator in the lithotomy position demonstrated larger setup errors in the X,Y,and Z directions compared with the conventional fixator combined with a thermoplastic mask,indicating the need for further workflow optimization.Given that the lithotomy position is essential for transperineal ultrasound-guided techniques,further research and improvements are required to achieve higher positioning accuracy.

Objective To investigate the clinical influencing factors for the occurrence of intracranial hemorrhage(ICH)in the elderly patients with massive ischemic stroke after endovascular therapy(EVT).Methods A retrospective study was conducted on 103 elderly hospitalized patients who underwent EVT due to anterior circulation acute arterial occlusion in our department from March 2021 to December 2023.All of them were diagnosed with massive ischemic stroke before treat-ment.Multivariate logistic regression analysis was used to identify the influencing factors for ICH after EVT treatment.Then based on the obtained factors,a nomogram model was constructed,and its performance efficiency was evaluated.Results After EVT treatment,95 patients had success-ful vascular recanalization,26(25.24％)experienced ICH,10 had symptomatic cerebral hemor-rhage,and 32(31.07％)obtained good functional outcomes after 90 d of follow-up.Multivariate logistic regression analysis that history of alcohol consumption(OR=3.795,95％CI:1.381-10.427,P=0.010),coronary heart disease(OR=2.969,95％CI:1.094-8.059,P=0.033)and bridging thrombolysis(OR=0.284,95％CI:0.091-0.884,P=0.030)were independently influen-cing factors for ICH occurrence in acute ischemic stroke patients after EVT.Our nomogram model based on these three factors had an AUC value of 0.759(95％CI:0.662-0.856).Conclusion Alcohol consumption,bridging thrombolysis,and history of coronary heart disease can predict adverse outcomes in elderly patients with massive ischemic stroke after EVT.

Objective:To study the relationship between serum adiponectin level and early vascular aging (EVA).Methods:The cross-sectional study method was used. Six hundred and seventy-two subjects who completed health checkup from June to December 2023 in the Affiliated Hospital of Qingdao University were selected. The subjects were divided into the EVA group (237 cases) and the control group (435 cases) based on brachial-ankle pulse wave velocity (baPWV). According to the adiponectin tertiles method, the subjects were divided into low adiponectin subgroup (2.4 to 6.6 mg/L, 225 cases), medium adiponectin subgroup (6.7 to 9.1 mg/L, 227 cases) and high adiponectin subgroup (9.2 to 19.8 mg/L, 220 cases). The basic demographic information, past history and serological indexes were recorded. Univariate and multivariate binary Logistic regression analyses were used to analyze the risk factors for EVA, and multivariate Logistic regression was used to analyze the effect of adiponectin on EVA.Results:The male proportion, age, body mass index (BMI), systolic blood pressure, diastolic blood pressure, triglycerides (TG), fasting blood glucose (FBG), uric acid, glycated hemoglobin (HbA 1c), homocysteine, baPWV and alcohol history proportion in EVA group were significantly higher than those in control group: 64.98% (154/237) vs. 53.33% (232/435), 53 (47, 57) years old vs. 46 (39, 52) years old, (26.34 ± 3.37) kg/m 2 vs. (25.16 ± 3.91) kg/m 2, (132.27 ± 15.48) mmHg (1 mmHg = 0.133 kPa) vs. (117.30 ± 13.04) mmHg, (81.79 ± 11.04) mmHg vs. (71.93 ± 10.10) mmHg, 1.45 (1.03, 2.03) mmol/L vs. 1.08 (0.76, 1.65) mmol/L, 5.52 (5.03, 6.21) mmol/L vs. 5.14 (4.77, 5.56) mmol/L, (380.04 ± 96.43) μmol/L vs. (362.18 ± 94.94) μmol/L, 5.80 (5.50, 5.90)% vs. 5.70 (5.40, 5.82)%, 10.70 (9.01, 12.90) μmol/L vs. 9.96 (8.30, 12.20) μmol/L, 1 586 (1 511, 1 719) cm/s vs. 1 299 (1 215, 1 367) cm/s and 19.41% (46/237) vs. 13.56% (59/435), the adiponectin was significantly lower than that in control group: 7.00 (5.70, 8.75) mg/L vs. 8.40 (6.40, 10.60) mg/L, and there were statistical differences ( P<0.01 or <0.05). There were no statistical differences in total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), creatinine and smoking history proportion between two groups ( P>0.05). The male proportion, BMI, systolic blood pressure, diastolic blood pressure, TG, FBG, uric acid, creatinine, HbA 1c, homocysteine, EVA incidence, baPWV, smoking history proportion and alcohol history proportion in low adiponectin subgroup and medium adiponectin subgroup were significantly higher than those in high adiponectin subgroup, furthermore, the indexes except HbA 1c in low adiponectin subgroup were significantly higher than those in medium adiponectin subgroup, and there were statistical differences ( P<0.05); the HDL-C in low adiponectin subgroup and medium adiponectin subgroup was significantly lower than that in high adiponectin subgroup, furthermore, that in low adiponectin subgroup was significantly lower than that in medium adiponectin subgroup, and there were statistical differences ( P<0.05); there were no statistical differences in age, TC and LDL-C among the three subgroups ( P>0.05). Univariate binary Logistic regression analysis result showed that age, male, BMI, alcohol history, systolic blood pressure, diastolic blood pressure, TG, FBG, uric acid and HbA 1c were the risk factors for EVA ( P<0.01 or <0.05), while the adiponectin was a protective factor for EVA ( P<0.01). Multivariate binary Logistic regression analysis result showed that age, systolic blood pressure, TG and FBG were risk factors for EVA ( OR = 1.098, 1.066, 1.209 and 1.268; 95% CI 1.069 to 1.127, 1.050 to 1.082, 1.007 to 1.451 and 1.069 to 1.502; P<0.01 or <0.05), while adiponectin was a protective factor ( OR = 0.892, 95% CI 0.828 to 0.962, P<0.01). Multivariable Logistic regression analysis result showed that adiponectin consistently remained a protective factor for EVA across unadjusted, preliminary adjusted and fully adjusted covariate models ( OR = 0.553, 0.580 and 0.576; 95% CI 0.451 to 0.678, 0.440 to 0.764 and 0.435 to 0.763; P<0.01). Conclusions:The serum APN level is negatively correlated with the risk of EVA, which may be an independent protective factor for the EVA.

Objective:To translate the Clinical Leadership Needs Analysis Instrument (CLeeNA) into Chinese and to test its reliability and validity.Methods:The source scale was translated based on the Beaton translation model, and cultural debugging was completed through expert consultation and pre-surveys to form the Chinese version of CLeeNA. Convenience sampling was used to select 536 nurses from three Class Ⅲ Grade A hospitals in Anhui Province from August to December 2023 to conduct the survey and to verify the reliability and validity of the scale. A total of 536 questionnaires were distributed and 495 valid questionnaires were recovered, with an effective recovery rate of 92.351% (495/536) .Results:The Chinese version of CLeeNA contained 43 entries in 7 dimensions of self and team development, staff and care delivery, technology and care initiatives, financial and service management, leadership and clinical practice, patient safety and risk management, and standards of care. The content validity index at the item level ranged from 0.800 to 1.000, and the content validity index at the scale level was 0.953. Exploratory factor analysis extracted 7 common factors with a cumulative variance contribution rate of 82.098%. Confirmatory factor analysis showed that the model fit was acceptable. The total Cronbach's ɑ coefficient for the scale was 0.958, the folding coefficient was 0.898, and the retest reliability coefficient was 0.928.Conclusions:The Chinese version of CLeeNA has good reliability and validity, and can be used for measuring the clinical leadership needs of nurses.

Objective:To investigate the level of rehabilitation exercise adherence in patients undergoing anterior cruciate ligament (ACL) reconstruction within 6 months post-surgery, analyze its trajectory, and provide a reference for clinical nursing interventions.Methods:Using a convenience sampling method, 150 patients who underwent arthroscopic ACL reconstruction at the First Affiliated Hospital of Zhengzhou University from June 2022 to August 2023 were selected. Rehabilitation exercise adherence was assessed monthly from postoperative 1 month (M 1) to 6 months (M 6) using the Orthopedic Functional Exercise Adherence Scale. A latent class growth model was employed to analyze adherence trajectory categories, and Logistic regression was used to identify influencing factors for different adherence trajectories. Results:A total of 144 patients completed follow-up (follow-up rate was 96.00%). Exercise adherence scores gradually declined over the 6 months post-surgery, with scores of (50.30±5.39), (45.92±3.85), (39.48±5.27), (35.83±6.19), (31.85±7.59), and (29.88±7.88) from M 1 to M 6, respectively. The difference in scores across time points was statistically significant ( F=85.467, P<0.01). Three potential categories were identified through the latent class growth model: the moderate-high level rapid decline group ( n=65, 45.14%), the moderate-low level stable group ( n=32, 22.22%), and the moderate-low level slow decline group ( n=47, 32.64%). Logistic regression analysis revealed that gender and age were significant factors influencing adherence trajectory categories ( P<0.05) . Conclusions:Dynamic declines in rehabilitation exercise adherence are common among ACL reconstruction patients, with varying degrees of decline. Gender and age may influence adherence trajectories, suggesting that targeted management strategies could be implemented in clinical practice.

Objective To investigate the effects of simulated-microgravity on the osteogenic differentiation,primary cilia status,cytoskeleton structure,and the YAP(Yes-associated protein)expression in primary osteoblasts.Methods Primary osteoblasts were isolated from the skull bones of neonatal Wistar rats and cultured in random positioning machine system to simulate the cellular effects of microgravity.The calcified nodules were stained with Arlizarin to assess the cellular mineralization ability,the primary cilia and cytoskeleton were detected by immunofluorescence staining of Arl13b/γ-Tubulin and α-Tubulin,respectively,and the expression of YAP was measured by western blot.Results The cellular osteogenic differentiation were markedly suppressed after treated with simulated microgravity for 24 h,and the ciliated cells decreased from(58.44±3.65)%to(15.76±1.84)%in parallel with a decline of average cilium length from(3.19±0.51)μm to(1.59±0.46)μm.In addition,simulated microgravity induced disassembly of microtubules.Notably,simulated microgravity interfered YAP expression and the inhibition of YAP into nucleus.Furthermore,knockdown of YAP expression in osteoblasts notably reduced primary cilia expression and inhibited osteogenic differentiation.Conclusion Primary cilia is a key organelle of osteoblasts in sensing microgravity and regulating osteogenic differentiation.Interference with YAP expression and inhibition of nuclear YAP entry may play an important role in the deaggregation of primary cilia induced by microgravity.