Objective: To compare the clinical efficacy of visual dilated sheath combined with needle nephroscope percutaneous nephrolithotomy (PCNL) with traditional PCNL for renal calculi，so as to enhance the intraoperative safety and puncture accuracy. Methods: A retrospective analysis was conducted on 100 patients with renal calculi treated on hospital during Sep.2022 to Sep.2023.Based on the surgical approaches，patients were divided into the needle nephroscope group (PCNL with visual dilator sheath and needle nephroscope，n=52) and traditional group (traditional PCNL，n=48).Clinical characteristics，surgical parameters，and outcomes were compared between the two groups. Results: There were no significant differences between the two groups in baseline data，total operation time and hospital stay (P>0.05).The needle nephroscope group had a longer channel establishment time compared to the traditional group [20.0(17.0-22.0) min vs.16.0 (15.0-21.0) min，P=0.002]，but significantly shorter puncture time [2.0 (1.0-2.6) min vs. 2.8(2.0-3.5) min，P<0.001]，and fewer adjustments of the puncture needle (9.6% vs. 64.6%，P<0.001).The channel was successfully established on the first attempt in all patients in the needle nephroscope group，while only 41 of patients in the traditional group achieved success on the first attempt，6 cases needed 2 attempts，and 1 case needed 3 attempts.Postoperative complications were absent in the needle nephroscope group，whereas postoperative bleeding requiring interventional treatment occurred in 1 case in the traditional group.There was no significant difference in the first-stage stone-clearance rate between the two groups (88.4%vs. 85.4%，P=0.872). Conclusion: PCNL using a visual dilator sheath combined with a needle nephroscope achieves a comparable first-stage stone-clearance rate to traditional PCNL.However，it offers significant advantages in terms of shorter puncture time，fewer adjustments of the puncture needle，and lower postoperative complication rate.These findings suggest superior safety and precision，making it a valuable technique for clinical application.

Glioblastoma (GBM) is one of the common malignant tumors in central nervous system, characterized by excessive angiogenesis. Anti-angiogenic therapeutic drug can improve the therapeutic effect on GBM by inhibiting angiogenesis. However, the mechanisms of angiogenesis in recurrent GBM differ from those in primary GBM, potentially bypassing the vascular endothelial growth factor (VEGF) pathway and forming new blood vessels through alternative routes, thereby the efficacy of anti-angiogenic drug is often poor in recurrent GBM. This review focuses on research progress in angiogenesis mechanism before and after GBM recurrence and provides references for GBM treatment.

Glioblastoma (GBM) is one of the common malignant tumors in central nervous system, characterized by excessive angiogenesis. Anti-angiogenic therapeutic drug can improve the therapeutic effect on GBM by inhibiting angiogenesis. However, the mechanisms of angiogenesis in recurrent GBM differ from those in primary GBM, potentially bypassing the vascular endothelial growth factor (VEGF) pathway and forming new blood vessels through alternative routes, thereby the efficacy of anti-angiogenic drug is often poor in recurrent GBM. This review focuses on research progress in angiogenesis mechanism before and after GBM recurrence and provides references for GBM treatment.

Patients with decompensated cirrhosis often have a reduction in renal function due to severe hepatic insufficiency which results in reduced inactivation of vasodilators, hemodynamic disorders, immune disorders, and infections, and without timely intervention, patients may gradually develop from early prerenal injury to late renal failure. Patients tend to have a low survival rate and great difficulties in treatment. With the gradual clarification of the classification and diagnostic criteria for kidney injury and the discovery of an increasing number of markers for kidney injury, early diagnosis and localization of kidney injury are of great importance for improving the prognosis of patients. This article analyzes the new advances in the pathogenesis, diagnostic criteria, and treatment of renal injury in cirrhotic patients in recent years, so as to provide help for the clinical diagnosis and treatment of cirrhotic patients with renal injury.

ObjectiveTo investigate the influence of sarcopenia on bone mass loss， the risk factors for bone mass loss in liver cirrhosis， and the correlation between body composition and bone mineral density （BMD） by comparing the clinical features of bone mass loss in patients with liver cirrhosis. MethodsA total of 92 patients who were hospitalized and diagnosed with liver cirrhosis in Department of Gastroenterology， The Second Affiliated Hospital of Kunming Medical University， from April to December of 2022 were enrolled， and based on the results of dual-energy X-ray absorptiometry， they were divided into bone mass loss group （osteopenia/osteoporosis） with 57 patients and normal bone mass group with 35 patients. The two groups were compared in terms of general data， laboratory examination， imaging data， and body composition analysis. The independent samples t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups， and the chi-square test or the continuity correction chi-square test was used for comparison of categorical data between two groups； Pearson correlation analysis and Spearman correlation analysis were used to investigate correlation； a binary logistic regression analysis was used to investigate the risk factors for bone mass loss in liver cirrhosis. ResultsCompared with the normal bone mass group， the bone mass loss group had significantly higher age （t=-3.597， P<0.05）， proportion of female patients （χ²=8.393， P<0.05）， N-terminal middle molecular fragment of osteocalcin （N-MID） （Z=-3.068， P<0.05）， β isomer of C-terminal telopeptide of type I collagen （β-CTX） （t=-2.784， P<0.05）， and proportion of patients with sarcopenia （χ²=13.884， P<0.05） and significantly lower calcitonin （CT） （Z=-2.340， P<0.05） and L3 skeletal muscle index （L3-SMI） （t=4.621， P<0.05）. Compared with the normal bone mass group， the bone mass loss group had significantly lower total muscle mass （Z=-2.952， P<0.05）， right upper limb muscle mass （Z=-2.929， P<0.05）， left upper limb muscle mass （Z=-2.680， P<0.05）， right lower limb muscle mass （Z=-3.366， P<0.05）， left lower limb muscle mass （Z=-3.374， P<0.05）， presumed bone mass （t=2.842， P<0.05）， body water mass （Z=-2.779， P<0.05）， basal metabolic rate （BMR） （Z=-3.153， P<0.05）， and BMD of L1— L4 and femoral neck （t=9.789， t=10.280， t=10.832， Z=-7.298， t=8.945， all P<0.05）. Total muscle mass， muscle mass of trunk and limbs， presumed bone mass， BMR， and body water mass in body component analysis were positively correlated with L1 — L4 BMD and femoral neck BMD （all P<0.05）， and fat mass was positively correlated with L1 — L4 BMD （all P<0.05）. Sarcopenia （odds ratio ［OR］=8.737， 95% confidence interval ［CI］： 2.237 — 34.129， P=0.002）， age （OR=1.094， 95%CI： 1.019 — 1.175， P=0.013）， and N-MID （OR=1.095， 95%CI： 1.019 — 1.176， P=0.014） were independent risk factors for bone mass loss in patients with liver cirrhosis. ConclusionOld age， female sex， sarcopenia， elevated N-MID， elevated β-CTX， reduction in CT， low muscle mass， low presumed bone mass， low BMR， and low body water mass are the features of bone mass loss in patients with liver cirrhosis， and sarcopenia， age， and N-MID are independent risk factors for bone mass loss in patients with liver cirrhosis. Detailed assessment of body composition changes can help to identify abnormal BMD in patients with liver cirrhosis.

Osteoporosis is a common extrahepatic complication of liver cirrhosis, and it not only increases the economic burden of patients, but also brings adverse effects on their quality of life and prognosis. Recent studies have shown that sarcopenia, adiponectin, leptin, irisin, and inflammatory factors are involved in the development of osteoporosis in patients with liver cirrhosis, and commonly used anti-osteoporosis drugs include calcium supplement, vitamin D, and bisphosphonates. This article reviews the advances in the risk factors, pathogenesis, and treatment of liver cirrhosis with osteoporosis and points out that there are still controversies over the influence of some factors on osteoporosis, and further studies are needed to explore related pathogeneses and safe and effective treatment regimens.

Objective To investigate the best scoring systems for predicting the severity and prognosis of hyperlipidemic acute pancreatitis (HLAP) by comparing APACHEII, BISAP, MCTSI, MEWS, POP, SPS, and PANC3 scores. Methods A retrospective analysis was performed for the data of 123 patients with HLAP who were hospitalized and treated in The Second Affiliated Hospital of Kunming Medical University from October 2017 to January 2022. The patients were divided into mild acute pancreatitis (MAP) group with 24 patients, moderate- severe acute pancreatitis (MSAP) group with 56 patients, and severe acute pancreatitis (SAP) group with 43 patients, and the three groups were compared in terms of basic data and scores of the above scoring systems. The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups; the chi-square test was used for comparison of categorical data between groups. MedCalc software was used to plot the receiver operating characteristic (ROC) curve, and the area under the ROC curve (AUC) was used to compare the value of these scoring systems in predicting disease severity and local and systemic complications in HLAP patients. Results There were significant differences between the three groups in diabetes mellitus ( χ 2 =6.880, P < 0.05), length of hospital stay ( H =26.494, P < 0.001), local complications ( χ 2 =52.211, P < 0.001), acute kidney injury (AKI) ( χ 2 =38.247, P < 0.001), acute respiratory distress syndrome (ARDS) ( χ 2 =79.201, P < 0.001), and multiple organ dysfunction syndrome (MODS) ( χ 2 =45.032, P < 0.001). As for the scores of the above scoring systems, there were significant differences between the three groups in APACHE Ⅱ, BISAP, MCTSI, MEWS, POP, SPS, and PANC3 ( H =47.525, 42.662, 53.545, 31.664, 49.233, 48.543, and 9.443, all P < 0.05). APACHE Ⅱ score had a significantly higher value than MEWS score in predicting SAP ( Z =2.090, P < 0.05), and the other scores had a similar value, among which POP score had the largest AUC of 0.883. MCTSI score had the highest value in predicting local complications (AUC=0.886), with a sensitivity of 84.7% and a specificity of 74.5% at the cut-off value of 5. APACHE Ⅱ and POP scores had an AUC of 0.911 (95% confidence interval [ CI ]: 0.835-0.986, P < 0.001) and 0.920 (95% CI : 0.866-0.974, P < 0.001), respectively, in predicting AKI; APACHE Ⅱ score had a higher predictive value than MCTSI and MEWS scores, POP score had a higher predictive value than MCTSI, MEWS, and BISAP scores, and SPS score had a higher predictive value than MCTSI score. APACHE Ⅱ score had an AUC of 0.914 (95% CI : 0.854-0.973, P < 0.001) in predicting ARDS and had a higher predictive value than BISAP and MEWS ( Z =2.152 and 3.015, both P < 0.05). APACHE Ⅱ and POP scores had an AUC of 0.969 (95% CI : 0.941-0.996, P < 0.001) and 0.932 (95% CI : 0.880-0.984, P < 0.001), respectively, in predicting MODS, and APACHE Ⅱ score had a higher predictive value than SPS, BISAP, MEWS, and MCTSI. Conclusion POP score has the highest value in predicting SAP, with a comparable predictive ability to all the other scoring systems except MEWS. APACHEII and POP scores have a good value in predicting systemic complications and show a high accuracy in predicting AKI and MODS, and APACHEII score is highly accurate in predicting ARDS.

Acute pancreatitis (AP) is a common acute abdominal disease in gastroenterology. Severe patients tend to have high mortality and poor prognosis, and early evaluation of disease conditions and prediction of clinical outcome is of particular importance to improve the prognosis of patients. In recent years, great progress has been made in related markers for predicting the severity stratification and prognosis of patients with AP. This article reviews the value of immune indices, cytokines, genes, biochemical indices, imaging findings, and other related indicators in predicting the severity, mortality, and complications of AP.

Objective To study the effects of photodynamic therapy (PDT) combined with torasemide on rat glioma by detecting the protein expression of matrix metalloproteinase 2 (MMP2),matrix metalloproteinase 9 (MMP9),sodium-potassium-chloride co-transporter 1 (NKCC1) and vascular endothelial growth factor (VEGF).Methods Male Wistar rats with glioma were randomly divided into four groups,includes control group (sham group,n=15),photodynamic therapy group (PDT group,n=15),torasemide group (T group,n=15) and PDT+T group (n=15).The rats were normally fed in the sham group,were received PDT (80 J/cm2) for 10 min in the PDT group,were received intraperitoneal torasemide 5 mg/kg for 3 days in the T group,and received PDT and torasemide treatment in the PDT+T group.After 2 weeks,5 rats were sacrificed from each group.Peritumoral edema tissues were harvested for the detection of wet-dry-weight ratio (W/D),and the protein expression of MMP2,MMP9,NKCC 1 and VEGF by Western Blot,immunohistochemistry and qRT-PCR.The remaining rats were used for survival time assessment.Results Compared with the sham group,the PDT group showed an increase in W/D (5.17±0.42 vs 4.83±0.38),the expression of NKCC1 (0.54±0.21 vs 0.35±0.12) and VEGF (0.68±0.20 vs 0.42±0.15),and survival time ((32.2±2.9) d vs (25.3±2.6) d) (all P＜0.05),and showed an decrease in the expression of MMP2 (2.76±0.42 vs 1.88±0.17) and MMP9 (2.55±0.38 vs 1.46±0.21) (all P＜0.05).Compared with the PDT group,the T group showed decrease in W/D (3.68±1.04),the expression of NKCC1 (0.22±0.10) and VEGF (0.33±0.14),and survival time ((28.7±2.2) d) (all P＜0.05),and showed increase in the expression of MMP2 (2.71 ±0.35) and MMP9 (2.42±0.36) (all P＜0.05).Compared with the PDT group,the PDT+T group showed decrease in W/D (4.52±0.46),and the expression of NKCC1 (0.30±0.16),VEGF (0.44±0.21),MMP2 (1.84±0.23) and MMP9 (1.53±0.24) (all P＜0.05),and showed increase in survival time ((44.5±2.8) d)(P＜0.05).Conclusion PDT combined with torasemide can reduce PDT induced edema,reduce tumor invasiveness,and prolonged the average survival time of rats.

Aim To investigate the protective effects of beraprost sodium on cerebral cortical neuron injury in chronic aluminum-overload rats and its effects on PGIS-IP signaling pathway. Methods 75 SD rats were randomized into five groups: normal control group, chronic aluminum-overload group ( model group) and beraprost sodium groups-low dose (6 μg· kg-1 ), medium dose ( 12 μg · kg-1 ) and high dose (24 μg·kg-1). Aluminum gluconate (Al3+ 200 mg ·kg-1 d-1, once a day, 5d a week, for 20 weeks, p. o. ) was administered to rats of cerebral damage model. The rats of experimental groups were concomi-tantly treated with beraprost sodium ( p. o. ) daily for 20 weeks. After the model was built successfully, the spatial learning and memory( SLM) function was done by Morris water maze. The cortical neurons damage was detected by HE staining, SOD activities and MDA contents. The 6-k-PGF1α levels in cortex were meas-ured by ELISA. The expressions of PGIS, IP mRNA and IP protein were also studied. Results Compared with the rats of normal control group, the SLM function was significantly impaired ( P<0. 01 ) and considera-ble karyopycnosis was observed in model group rats. The SOD activities were weakened ( P <0. 01 ), the MDA contents increased ( P<0. 05 ) and the levels of 6-k-PGF1α raised significantly ( P <0. 01). The ex-pressions of PGIS and IP mRNA in the rats cortex obvi-ously increased ( P<0. 01 ), so did the expression of IP protein(P<0. 05). Compared with the rats of mod-el group, the SLM function of rats in experimental groups decreased significantly ( P<0. 01 ) and damage of cortical neurons reduced remarkably. The SOD ac-tivities increased ( P <0. 01 ) and the MDA contents decreased ( P <0. 01). Besides, the content of 6-k-PGF1α, the expressions of PGIS mRNA and IP protein in the rats cortex decreased significantly ( P<0. 05 ) as well as IP mRNA ( P<0. 01). Conclusion Our re-sults demonstrate that in cerebral cortical neuron of chronic aluminum-overload rats, beraprost sodium has notably protective effects and the mechanism might be related to PGIS-IP signaling pathway.