ObjectiveBased on the concept of quality by design（QbD）， the processing process of calcined Pyritum was optimized， and its X-ray diffraction（XRD） fingerprint was established. MethodsThe safety， effectiveness and quality controllability of calcined Pyritum were taken as the quality profile（QTPP）， the color， hardness， metallic luster， phase composition， the contents of heavy metals and hazardous elements were taken as the critical quality attributes（CQAs）， and the calcination temperature， calcination time， paving thickness and particle size were determined as the critical process parameters（CPPs）. Differential thermal analysis， X-ray diffraction（XRD） and inductively coupled plasma mass spectrometry（ICP-MS） were used to analyze the correlation between the calcination temperature and CQAs of calcined Pyritum. Then， based on the criteria importance through intercriteria correlation（CRITIC）-entropy weight method， the optimal processing process of calcined Pyritum was optimized by orthogonal test. Powder XRD was used to analyze the phase of calcined Pyritum samples processed according to the best process， and the mean and median maps of calcined Pyritum were established by the superposition of geometric topological figures， and similarity evaluation and cluster analysis were carried out. ResultsThe results of single factor experiments showed that the physical phase of Pyritum changed from FeS₂ to Fe₇S₈ during the process of temperature increase， the color gradually deepened from dark yellow， and the contents of heavy metals and harmful elements decreased. The optimized processing process of calcined Pyritum was as follows：calcination temperature at 750 ℃， calcination time of 2.5 h， paving thickness of 3 cm， particle size of 0.8-1.2 cm， vinegar quenching 1 time［Pyritum-vinegar（10∶3）］. After calcination， the internal structure of Pyritum was honeycomb-shaped， which was conducive to the dissolution of active ingredients. XRD fingerprints of 13 batches of calcined Pyritum characterized by 10 common peaks were established. The similarities of the relative peak intensities of the XRD fingerprints of the analyzed samples were>0.96， and it could effectively distinguish the raw products and unqualified products. ConclusionTemperature is the main factor affecting the quality of calcined Pyritum. After processing， the dissolution of the effective components in Pyritum increases， and the contents of heavy metals and harmful substances decrease， reflecting the function of processing to increase efficiency and reduce toxicity. The optimized processing process is stable and feasible， and the established XRD fingerprint can be used as one of the quality control standards of calcined Pyritum.

ObjectiveBased on the concept of quality by design（QbD）， the processing process of calcined Pyritum was optimized， and its X-ray diffraction（XRD） fingerprint was established. MethodsThe safety， effectiveness and quality controllability of calcined Pyritum were taken as the quality profile（QTPP）， the color， hardness， metallic luster， phase composition， the contents of heavy metals and hazardous elements were taken as the critical quality attributes（CQAs）， and the calcination temperature， calcination time， paving thickness and particle size were determined as the critical process parameters（CPPs）. Differential thermal analysis， X-ray diffraction（XRD） and inductively coupled plasma mass spectrometry（ICP-MS） were used to analyze the correlation between the calcination temperature and CQAs of calcined Pyritum. Then， based on the criteria importance through intercriteria correlation（CRITIC）-entropy weight method， the optimal processing process of calcined Pyritum was optimized by orthogonal test. Powder XRD was used to analyze the phase of calcined Pyritum samples processed according to the best process， and the mean and median maps of calcined Pyritum were established by the superposition of geometric topological figures， and similarity evaluation and cluster analysis were carried out. ResultsThe results of single factor experiments showed that the physical phase of Pyritum changed from FeS₂ to Fe₇S₈ during the process of temperature increase， the color gradually deepened from dark yellow， and the contents of heavy metals and harmful elements decreased. The optimized processing process of calcined Pyritum was as follows：calcination temperature at 750 ℃， calcination time of 2.5 h， paving thickness of 3 cm， particle size of 0.8-1.2 cm， vinegar quenching 1 time［Pyritum-vinegar（10∶3）］. After calcination， the internal structure of Pyritum was honeycomb-shaped， which was conducive to the dissolution of active ingredients. XRD fingerprints of 13 batches of calcined Pyritum characterized by 10 common peaks were established. The similarities of the relative peak intensities of the XRD fingerprints of the analyzed samples were>0.96， and it could effectively distinguish the raw products and unqualified products. ConclusionTemperature is the main factor affecting the quality of calcined Pyritum. After processing， the dissolution of the effective components in Pyritum increases， and the contents of heavy metals and harmful substances decrease， reflecting the function of processing to increase efficiency and reduce toxicity. The optimized processing process is stable and feasible， and the established XRD fingerprint can be used as one of the quality control standards of calcined Pyritum.

OBJECTIVE: To investigate the effectiveness of Youngswick-Akin osteotomy in the treatment of moderate hallux valgus combined with mild to moderate hallux rigidus. METHODS: The clinical data of 43 patients with moderate hallux valgus combined with mild to moderate hallux rigidus who were admitted between August 2019 and August 2022 and met the selection criteria were retrospectively analyzed. There were 8 males and 35 females. The age ranged from 28 to 77 years, with an average age of 59.0 years. The disease duration ranged from 10 to 35 months, with an average of 20 months. The degree of hallux rigidus included 2 cases of CoughlinⅠ degree, 29 cases of Ⅱ degree, 12 cases of Ⅲ degree. The preoperative hallux valgus angle ranged from 25° to 40°, with an average of 32°. All patients were treated with Youngswick-Akin osteotomy. The first metatarsophalangeal joint space was compared before operation and at 6 months after operation. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue scale (VAS) score were used to evaluate the functional recovery and pain relief of the patients before operation and at 6 and 24 months after operation. According to the severity of hallux rigidus, the patients were divided into mild group (Ⅰ, Ⅱ degree) and moderate group (Ⅲ degree) to compare the prognosis, including the changes of AOFAS score, VAS score, and the first metatarsophalangeal joint space. RESULTS: The operation time was 60-75 minutes (mean, 65 minutes). The intraoperative blood loss was 10-30 mL (mean, 20 mL). Two cases had superficial infection of the incision margin after operation, and healed well after dressing change and antibiotic treatment. The incisions of the other patients healed by first intention, and no medial cutaneous nerve injury of the great toe occurred. All patients were followed up 24-31 months, with an average of 25.8 months. The patient's hallux valgus deformity was corrected without recurrence; no complication such as osteomyelitis and hallux varus occurred. The AOFAS score, VAS score, and the first metatarsophalangeal joint space after operation significantly improved when compared with those before operation, the AOFAS score and VAS score at 24 months after operation further improved when compared with those at 6 months after operation, and the differences were significant ( P<0.05). The change of VAS score in mild group was significantly better than that in moderate group ( P<0.05); but there was no significant difference in the changes of AOFAS score and the first metatarsophalangeal joint space between the two groups ( P>0.05). CONCLUSION Youngswick-Akin osteotomy for moderate valgus deformity with mild to moderate hallux rigidus can achieve good functional recovery, pain relief, and joint space improvement.
Humans ; Osteotomy/methods* ; Hallux Valgus/diagnostic imaging* ; Male ; Female ; Middle Aged ; Hallux Rigidus/diagnostic imaging* ; Retrospective Studies ; Adult ; Aged ; Treatment Outcome ; Metatarsophalangeal Joint/surgery*

Renal autotransplantation (RA) offers significant technical advantages for the management of certain complex renal vascular diseases, such as complex renal aneurysms and renal artery malformations. This report describes a case of a 5-year-old child with a complex left renal artery aneurysm combined with multiple aneurysms. The child was admitted to Peking University People's Hospital in December 2023 due to a one-year history of intermittent abdominal pain, with an abdominal mass detected in the past month. Computed tomography angiography(CTA) revealed multiple vascular anomalies, including: (1) a left renal artery aneurysm, (2) an abdominal aortic aneurysm, and (3) a right iliac artery aneurysm. After a comprehensive evaluation of these findings, the surgical team developed a treatment plan that involved the excision of the left renal artery aneurysm, autotransplantation of the left kidney, and resection of the abdominal aortic aneurysm with an artificial vascular catheterization. During surgery, it was discovered that the left renal artery anatomy was highly complex. The artery had two primary branches, along with an additional polar artery located at the lower pole. The aneurysm was identified at the distal end of the renal artery trunk, with a pronounced bulging at the intersection between the main renal artery trunk and its secondary branches. Due to these structural complexities, the team decided to use an ex vivo surgical approach to repair the aneurysm. Ex vivo repair involves temporarily removing the kidney from the body to repair the renal artery aneurysm with enhanced precision, enabling the surgical team to meticulously reconstruct the complex vascular architecture without the constraints of in vivo manipulation. The ex vivo repair of the renal artery aneurysm was successful, allowing for accurate vascular reconstruction and avoiding potential intraoperative complications. Following the reconstruction, the kidney was autotransplanted back into the child's body, and blood flow was effectively restored to the organ. The therapeutic outcome was excellent, with the child experiencing no postoperative complications. The patient recovered well and was discharged from the hospital in stable condition. This case underscores the value of renal autotransplantation combined with ex vivo repair for pediatric patients with complicated renal artery aneurysms. Through this report, we aim to provide insights and considerations for the surgical treatment of similar cases in children with complex renal vascular anatomy.
Child, Preschool ; Humans ; Aneurysm/surgery* ; Aortic Aneurysm, Abdominal/diagnostic imaging* ; Computed Tomography Angiography ; Iliac Aneurysm/surgery* ; Kidney Transplantation/methods* ; Renal Artery/abnormalities* ; Transplantation, Autologous

BACKGROUND:Osteoarthritis is a common degenerative joint disease,and the etiology and development of its pathogenesis are still unclear.Timely diagnosis and treatment of early osteoarthritis are crucial,and there is currently no definite and effective method.Extracellular vesicles come from a wide range of sources,including non-coding RNAs such as small RNAs,circular RNAs,and long chain non-coding RNAs.Extracellular vesicles non-coding RNAs can be directly delivered from primitive cells to neighboring or remote cells,regulating cell activity through intercellular communication and playing an important regulatory role in reshaping the bone and joint microenvironment.OBJECTIVE:To summarize the intervention effects of exosome-derived non-coding RNAs on the joint microenvironment of osteoarthritis and the progress made in clinical application,and to clarify the potential of exosome-derived non-coding RNAs in the diagnosis and treatment of osteoarthritis.METHODS:Search terms "exosomes,non-coding RNA,osteoarthritis,application,signal pathway,synovial fluid,cartilage cells,cartilage matrix,subchondral,mechanism" were used for the search on PubMed database.Finally,66 related articles were included for review analysis.RESULTS AND CONCLUSION:(1) Exosome-derived non-coding RNAs play an important regulatory role in the joint microenvironment during the pathogenesis of osteoarthritis,mainly reflected in:exosome non-coding RNAs regulating the inflammatory response in the joint,degeneration of chondrocytes and cartilage matrix,subchondral bone remodeling,and intercellular communication.(2) The non-coding RNAs in exosomes can serve as biomarkers for osteoarthritis,aiding in the early diagnosis and monitoring of disease progression and prognosis.(3) Exosome non-coding RNAs serve as therapeutic targets for osteoarthritis.Exosomes carry miRNAs to the articular chondrocytes and cartilage matrix to play a regulatory role.(4) Exosomes non-coding RNAs can improve the effect of cartilage tissue engineering by regulating gene expression and promoting intercellular communication to repair or regenerate damaged cartilage.(5) In future research,researchers should continue to explore the intervention mechanism of non-coding RNAs derived from exosomes on osteoarthritis,and apply them to clinical practice in combination with the latest research outcomes in cartilage tissue engineering,which will effectively help solve the pain of osteoarthritis patients.

BACKGROUND:Osteoarthritis is a common degenerative joint disease,and the etiology and development of its pathogenesis are still unclear.Timely diagnosis and treatment of early osteoarthritis are crucial,and there is currently no definite and effective method.Extracellular vesicles come from a wide range of sources,including non-coding RNAs such as small RNAs,circular RNAs,and long chain non-coding RNAs.Extracellular vesicles non-coding RNAs can be directly delivered from primitive cells to neighboring or remote cells,regulating cell activity through intercellular communication and playing an important regulatory role in reshaping the bone and joint microenvironment.OBJECTIVE:To summarize the intervention effects of exosome-derived non-coding RNAs on the joint microenvironment of osteoarthritis and the progress made in clinical application,and to clarify the potential of exosome-derived non-coding RNAs in the diagnosis and treatment of osteoarthritis.METHODS:Search terms "exosomes,non-coding RNA,osteoarthritis,application,signal pathway,synovial fluid,cartilage cells,cartilage matrix,subchondral,mechanism" were used for the search on PubMed database.Finally,66 related articles were included for review analysis.RESULTS AND CONCLUSION:(1) Exosome-derived non-coding RNAs play an important regulatory role in the joint microenvironment during the pathogenesis of osteoarthritis,mainly reflected in:exosome non-coding RNAs regulating the inflammatory response in the joint,degeneration of chondrocytes and cartilage matrix,subchondral bone remodeling,and intercellular communication.(2) The non-coding RNAs in exosomes can serve as biomarkers for osteoarthritis,aiding in the early diagnosis and monitoring of disease progression and prognosis.(3) Exosome non-coding RNAs serve as therapeutic targets for osteoarthritis.Exosomes carry miRNAs to the articular chondrocytes and cartilage matrix to play a regulatory role.(4) Exosomes non-coding RNAs can improve the effect of cartilage tissue engineering by regulating gene expression and promoting intercellular communication to repair or regenerate damaged cartilage.(5) In future research,researchers should continue to explore the intervention mechanism of non-coding RNAs derived from exosomes on osteoarthritis,and apply them to clinical practice in combination with the latest research outcomes in cartilage tissue engineering,which will effectively help solve the pain of osteoarthritis patients.

Background::Although overnight fasting is recommended prior to endoscopic retrograde cholangiopancreatography (ERCP), the benefits and safety of high-carbohydrate fluid diet (CFD) intake 2 h before ERCP remain unclear. This study aimed to analyze whether high-CFD intake 2 h before ERCP can be safe and accelerate patients’ recovery.Methods::This prospective, multicenter, randomized controlled trial involved 15 tertiary ERCP centers. A total of 1330 patients were randomized into CFD group ( n = 665) and fasting group ( n = 665). The CFD group received 400 mL of maltodextrin orally 2 h before ERCP, while the control group abstained from food/water overnight (>6 h) before ERCP. All ERCP procedures were performed using deep sedation with intravenous propofol. The investigators were blinded but not the patients. The primary outcomes included postoperative fatigue and abdominal pain score, and the secondary outcomes included complications and changes in metabolic indicators. The outcomes were analyzed according to a modified intention-to-treat principle. Results::The post-ERCP fatigue scores were significantly lower at 4 h (4.1 ± 2.6 vs. 4.8 ± 2.8, t = 4.23, P <0.001) and 20 h (2.4 ± 2.1 vs. 3.4 ± 2.4, t= 7.94, P <0.001) in the CFD group, with least-squares mean differences of 0.48 (95% confidence interval [CI]: 0.26–0.71, P <0.001) and 0.76 (95% CI: 0.57–0.95, P <0.001), respectively. The 4-h pain scores (2.1 ± 1.7 vs. 2.2 ± 1.7, t = 2.60, P = 0.009, with a least-squares mean difference of 0.21 [95% CI: 0.05–0.37]) and positive urine ketone levels (7.7% [39/509] vs. 15.4% [82/533], χ2 = 15.13, P <0.001) were lower in the CFD group. The CFD group had significantly less cholangitis (2.1% [13/634] vs. 4.0% [26/658], χ2 = 3.99, P = 0.046) but not pancreatitis (5.5% [35/634] vs. 6.5% [43/658], χ2 = 0.59, P = 0.444). Subgroup analysis revealed that CFD reduced the incidence of complications in patients with native papilla (odds ratio [OR]: 0.61, 95% CI: 0.39–0.95, P = 0.028) in the multivariable models. Conclusion::Ingesting 400 mL of CFD 2 h before ERCP is safe, with a reduction in post-ERCP fatigue, abdominal pain, and cholangitis during recovery.Trail Registration::ClinicalTrials.gov, No. NCT03075280.

Objective:To explore the clinical safety and effectiveness of self-draining ureteral stent with thread in kidney transplant recipients in renal transplantation.Methods:This study is a prospective cohort clinical study in the Department of Urology of Peking University People's Hospital from November 2022 to January 2024.The ureteral stent with thread group,in which a 2-0 Mersilene suture of 20-30 cm was used at the bladder end of the ureteral stent during the operation.On the 9th day after the opera-tion,the suture attached to the end of the ureteral stent was expelled out of the urethral orifice with the urine when the catheter was removed.The ureteral stent could be removed along with the suture.As to the cystoscope group,a ureteral stent was routinely placed during kidney transplantation,and the ureteral stent was removed under local infiltration anesthesia through cystoscopy after the operation.The pain scores[numerical rating scale(NRS)-11]during catheter removal and the incidence of urinary tract in-fections were observed and compared between the two groups.t test was used to compare the pain scores of indwelling ureteral stents and ureteral stents removal between the two groups,and Chi-square test was used to compare the occurrence of urinary system complications within 3 months after operation between the two groups.P＜0.05 was considered statistically significant.Results:As of March 2024,all the re-cipients were followed up for an average of 6 months(3 to 12 months)postoperatively.A total of 46 kid-ney transplantation patients were included,with 21 in the ureteral stent with thread group and 25 in the cystoscope group.There were no statistically significant differences between the two groups in age distri-bution,male-to-female ratio,and deceased versus live donor grafts.Three months after renal transplanta-tion,there were 15 cases of urinary tract infection in the cystoscope group and 4 cases in the ureteral stent with thread group(P=0.007).No significant urinary fistula,wound infection,or ureteral stenosis occurred in either group.No stent-related complications,stent migration,or stone formation were ob-served.The postoperative bladder spasm symptom scores for indwelling ureteral stents in the cystoscope group and the ureteral stent with thread group were 4.4±2.5 and 4.6±2.4,respectively,with no sta-tistically significant difference(t=0.29,P=0.773).However,the pain scores during ureteral stent re-moval were 4.9±1.6 and 3.0±1.0 in the two groups,respectively,with a statistically significant diffe-rence(t=5.017,P＜0.001).The total costs of indwelling and removing ureteral stents in the cystosco-py group and the ureteral stent with thread group were 6 452.0(5 539.5,6 452.0)yuan and 3 225.0(3 225.0,3 225.0)yuan,respectively,and the difference was statistically significant(P＜0.001).Conclusion:Compared with the conventional transplanted kidney ureteral stent,the self-discharge ure-teral stent technique with sutures is simpler,has a shorter ureteral stent inlay time,reduces the symptoms of bladder spasms,significantly reduces the cost of catheterization,and has fewer postoperative urinary system complications.It is a worthy improved surgical method to be promoted.

Objective To observe the application effect of different doses of dexmedetomidine in thyroid surgery under recurrent laryngeal nerve monitoring.Methods A total of 60 patients with thyroid surgery un-der general anesthesia,moreover adopting recurrent laryngeal nerve monitoring during the operation,in this hospital from October 2021 to June 2023 were selected as the study subjects and divided into the control group(group A),low dose group(group B)and high dose group(group C)by the random number table method.The group B and group C respectively used dexmedetomidine 0.3 μg/kg and 0.6 μg/kg as a loading dose be-fore anesthesia induction,0.3 μg·kg-1·h-1 and 0.6 μg·kg-1·h-1 were respectively injected by mi-cropump for anesthesia maintenance,while the group A adopted the same amount of normal saline.The other anesthesia management methods were the same in the three groups.The mean arterial pressure(MAP)and heart rate after entering the room(T0),before anesthesia induction(T1),after anesthesia intubation(T2),at 1 min after anesthesia intubation(T3),immediately after surgical incision(T4),isolation of the thyroid gland(T5)and at 1 min after extubation(T6),incidence rate of adverse reactions,choking reaction score,extubation time after stopping medication and dosage of propofol and remifentanil were recorded.Results The choking reaction score,extubation time after stopping medication and propofol dosage were manifested as the group C＜group B＜group A(P＜0.05).The remifentanil dosage in group C and group B was less than that in group A(P＜0.05).MAP at T1 in the group C was lower than that in the group A and group B(P＜0.05),but there was no statistical difference between the group A and group B(P＞0.05).MAP at T2-T6 in the group B and group C was lower than that in the group A(P＜0.05),but the difference between the group B and group C had no statistical significance(P＞0.05).The heart rate at T1-T6 in the group B and group C was lower than that in the group A(P＜0.05).The heart rate at T1,T2,T4,T5 and T6 in the group C was lower than that in the group B(P＜0.05).Bradycardia during operation did not occur in various groups.The intraoperative recurrent laryngeal nerve monitoring process was smooth without appearing interference.The incidence rate of adverse reactions had no statistical difference in various groups(P＞0.05).Conclusion He-modynamics by using 0.6 μg/kg dexmedetomidine in the patients with thyroid operation under recurrent la-ryngeal nerve monitoring is more smooth and steady,which could reduce the use amounts of anesthetic drugs,decrease the occurrence of choking reaction,shorten the operation extubation time after operation,moreover does not increase the incidence rate of postoperative adverse reactions.