Objective To investigate the application value of bedside ultrasound monitoring of quadriceps muscle changes in mechanically ventilated children in the early treatment of ICU-acquired muscle weakness (ICU-AW). Methods Eighty-two pediatric ICU patients with mechanical ventilation for>48 hours were selected. On the day of admission (D₀) and on day 7 (D₇), bedside ultrasound was performed to measure the thickness and cross-sectional area of the rectus femoris and vastus intermedius muscles. Patients were classified using Medical Research Council scores into control group (n = 63) and muscle weakness group (n = 19). Muscle parameters and atrophy rates were compared between groups. Diagnostic performance was assessed using receiver operating characteristic curves. Results The incidence of ICU-AW was 23.17%. At both D₀ and D₇, the average thickness of the rectus femoris, the average thickness of the vastus intermedius, the average area of the rectus femoris, and the average area of the vastus intermedius were significantly different between the two groups (P<0.05). The atrophy rates of the thickness of the rectus femoris and the area of the vastus intermedius were lower in the control group than in the muscle weakness group at both D₀ and D₇ (P<0.05). The area under the receiver operating characteristic curve for quadriceps parameters in diagnosing ICU-AW was 0.871, with a sensitivity of 89.47% and a specificity of 79.37%. Conclusion Bedside ultrasound dynamic monitoring of quadriceps changes enables early identification of ICU-AW and provides a basis for clinical intervention.

To investigate the clinical outcomes of endoscopic diagnosis and treatment in patients with duodenal variceal bleeding, a retrospective analysis was conducted on clinical data of patients with ectopic duodenal variceal bleeding diagnosed and treated endoscopically at the Digestive Endoscopy Center of Beijing Friendship Hospital, Capital Medical University, from August 2011 to December 2024. Five male patients (mean age 50.4 years) were included. Etiologies included alcohol-related cirrhosis (1 case), hepatitis B virus-related cirrhosis (2 cases), autoimmune disease-associated portal hypertension (1 case), and thrombophilia-related portal hypertension (1 case). Immediate hemostasis was achieved endoscopically in all cases. Two patients (1 alcohol-related and 1 hepatitis B virus-related cirrhosis) exhibited persistent decline in hemoglobin levels post-procedure and received sequential interventional therapy before discharge. The remaining 3 patients recovered uneventfully. Duodenal variceal bleeding, though rare and life-threatening, can be effectively managed through multidisciplinary collaboration. Endoscopic hemostasis should be prioritized when technically feasible.

To investigate the clinical outcomes of endoscopic diagnosis and treatment in patients with duodenal variceal bleeding, a retrospective analysis was conducted on clinical data of patients with ectopic duodenal variceal bleeding diagnosed and treated endoscopically at the Digestive Endoscopy Center of Beijing Friendship Hospital, Capital Medical University, from August 2011 to December 2024. Five male patients (mean age 50.4 years) were included. Etiologies included alcohol-related cirrhosis (1 case), hepatitis B virus-related cirrhosis (2 cases), autoimmune disease-associated portal hypertension (1 case), and thrombophilia-related portal hypertension (1 case). Immediate hemostasis was achieved endoscopically in all cases. Two patients (1 alcohol-related and 1 hepatitis B virus-related cirrhosis) exhibited persistent decline in hemoglobin levels post-procedure and received sequential interventional therapy before discharge. The remaining 3 patients recovered uneventfully. Duodenal variceal bleeding, though rare and life-threatening, can be effectively managed through multidisciplinary collaboration. Endoscopic hemostasis should be prioritized when technically feasible.

To investigate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) combined with single peroral choledochoscopy (SpyGlass) system for transpapillary gallbladder-preserving cholecystolithotomy, and to assess the feasibility of negative pressure suction for complete removal of gallbladder stones and prevention of recurrence, data of 4 patients with gallbladder stones, who received transpapillary gallbladder-preserving cholecystolithotomy through ERCP combined with SpyGlass with method of negative pressure suction at Endoscopy Center of Beijing Friendship Hospital from August 2022 to August 2023 were retrospectively reviewed. The procedure success rate, stone removal rate, the time of cystic duct cannulation, the time of stone removal and incidence of postoperative complication were recorded. The technique success rate of ERCP combined with SpyGlass was 100%, and the stone removal rate was also 100%. The time of cystic duct cannulation was 6-30 min, 2 patients were cannulated via X ray, and the time of cystic duct cannulation was 20 min and 30 min respectively; the other 2 patients were cannulated via SpyGlass, and the time of cystic duct cannulation was 6 min and 8 min respectively. The time of stone removal was 8-20 min, stones of 1 patient were crashed by laser lithotrisy followed by extraction basket due to diameter larger than 1 cm. Stones of all patients were completely removed by using extraction basket and the method of negative pressure suction. No severe adverse event occurred. There was no recurrence of gallbladder stone during the follow-up of 8.5-24.0 months. It is preliminarily believed that endoscopic transpapillary gallbladder-preserving cholecystolithotomy is safe and effective due to its super minimally invasive advantages, which is worth of further clinical application.

Objective: To compare the effects of 12week maximum fat oxidation (FATmax) intensity exercise combined with dietary restriction and FATmax intensity exercise alone on body composition, blood lipid metabolism and ferroptosis in obese college students with nonalcoholic fatty liver disease(NAFLD),so as to provide a exercise prescription reference for rehabilitation treatment of obese NAFLD college students. Methods: In August 2023,a total of 45 obese NAFLD college students were divided into maximum fat oxidation intensity exercise combined with dietary restriction group (FATmax+DR, n=22) and FATmax group (n=23) by random number table method,who were recruited through online notifications and physical examinations at the Physical Examination Center of Fenyang College of Shanxi Medical University. FATmax group received FATmax intensity exercise with 3 times a week for 12 weeks (FATmax:0.51 g/min, exercise intensity:50.14% VO2max and the heart rate:136.78 times/min). FATmax+DR group underwent 12 weeks of FATmax intensity exercise combined with dietary restriction, and daily dietary energy intake was determined according to resting energy consumption. Body composition, four items of blood lipids and the indicators of oxidative stress and ferroptosis were measured before and after the intervention.The differences of indicators among each group were analyzed by using independent sample t test and paired sample t test. Results: Before the intervention, there were no significant differences in body composition,four items of blood lipid, oxidative stress and iron death between FATmax+DR group and FATmax group (P>0.05). After 12 weeks of intervention, body weight , body mass index(BMI), body fat mass, trunk fat mass, visceral fat area and serum low density lipoprotein(LDL) and malondialdehyde(MDA) levels in FATmax+DR group were significantly lower than those in FATmax group, while serum high density lipoprotein(HDL) and glutathione(GSH) levels were higher than those in FATmax group (t=-2.30，-3.23,-3.97,-5.85,-3.44,-3.06,-2.03,-2.09; 2.73, 2.42, P<0.05). There were no significant differences in serum levels of total cholesterol(TC), triglyceride(TG), superoxide dismutase(SOD) and glutathion peroxidase 4(GPX4) between the two groups (t=1.49, 1.00, -0.01, 0.59, P>0.05). Conclusion Twelveweek FATmax intensity exercise combined with dietary restriction could significantly improve body composition and dyslipidemia, prevent the occurrence of ferroptosis and liver oxidative damage in obese NAFLD college students,which could serve as a timely promotion and application of intervention for obese college students with NAFLD.

Objective To explore the experience of robot-assisted laparoscopic surgery in the treatment of residual malformation of urachus with children.Methods The clinical date of 10 children with urachal remnants malformation treated by Da Vinci Robot Assisted Laparoscopic Surgery in Wuhan Children's Hospital from July 2021 to July 2023 were retrospectively analyzed.Robot-assisted laparoscopic surgery was used to analyze the intraoperative situation,postoperative complications,surgical effect and pathological results.Results All 10 cases were treated by Da Vinci Robot Assisted Laparoscopic Surgery without Laparotomy and complete excision,while maintain the umbilical integrality,8 cases with symptoms were resected after preoperative imaging diagnosis,1 case was asymptomatic and resected due to continuous enlargement of the cyst,and 1 case was found to be resected during other operations.The average operation time was(140.70±17.66)min,the median blood loss was 7.5(4.5,27.5)ml,the postoperative urethral catheterization was(6.2±1.26)d,the hospital stay was(9.9±0.94)d and the average cost was(46378.92±2777.13)yuan.All the urachal remnants were confirmed by Pathology as 9 cases of urachal cysts and 1 case of urachal fistula.Conclusion Robot-assisted laparoscopic surgery is safe and effective in the treatment of urachal remnants malformation in children,the surgical procedure for resected repair of the anterior abdominal wall has unique advantages.

Objective To explore the experience of robot-assisted laparoscopic surgery in the treatment of residual malformation of urachus with children.Methods The clinical date of 10 children with urachal remnants malformation treated by Da Vinci Robot Assisted Laparoscopic Surgery in Wuhan Children's Hospital from July 2021 to July 2023 were retrospectively analyzed.Robot-assisted laparoscopic surgery was used to analyze the intraoperative situation,postoperative complications,surgical effect and pathological results.Results All 10 cases were treated by Da Vinci Robot Assisted Laparoscopic Surgery without Laparotomy and complete excision,while maintain the umbilical integrality,8 cases with symptoms were resected after preoperative imaging diagnosis,1 case was asymptomatic and resected due to continuous enlargement of the cyst,and 1 case was found to be resected during other operations.The average operation time was(140.70±17.66)min,the median blood loss was 7.5(4.5,27.5)ml,the postoperative urethral catheterization was(6.2±1.26)d,the hospital stay was(9.9±0.94)d and the average cost was(46378.92±2777.13)yuan.All the urachal remnants were confirmed by Pathology as 9 cases of urachal cysts and 1 case of urachal fistula.Conclusion Robot-assisted laparoscopic surgery is safe and effective in the treatment of urachal remnants malformation in children,the surgical procedure for resected repair of the anterior abdominal wall has unique advantages.

Objective:To report the sampling study design and radiography protocol of a large-sample investigation on skeletal maturation of 3 to 18-year-old children in China.Methods:Multi-stage stratified random sampling was employed in this study. Two provinces, municipalities, or autonomous regions were randomly selected from each of the seven regions of China, including Northeast China, Northwest China, North China, Central China, East China, Southwest China, and South China. Then one rural and one urban investigation site were randomly selected from each province, municipality, or autonomous region. In total 28 sites were included. Among those sites, four residential districts were randomly selected from each urban site, and four townships from each rural site. For each residential district or township, 1-4 kindergartens, primary schools, and middle schools were chosen. Random cluster sampling was used to extract 3-<6-year-old children in kindergartens, and 6-18-year-old children in primary schools and middle schools. The investigation on skeletal maturation was sampled proportionate to the sampling of the whole study. The estimated simple size was 780 for each site, and 21 840 for all 28 sites in total. There were six groups of 3-<6-year-old children classified at 0.5-year intervals, and 12 groups of 6-18-year-old children classified at 1-year intervals. Posteroanterior position radiography of the left hand and wrist was achieved for all subjects.Results:The study was performed from August 26, 2019 to October 16, 2021. In total, 20 444 children received posteroanterior position radiography of the left hand and wrist, including 10 196 males and 10 248 females, 9 711 urban and 10 733 rural, respectively. The 3-<6-year-old group included 1 611 (male 819, female 792) subjects, and the 6 to 18-year-old group included 18 833 (male 9 377, female 9 456) subjects.Conclusion:This nationwide investigation on skeletal maturation of 3 to 18-year-old children in seven regions of China was successfully preformed. The results of this study can provide an important reference for establishing the current evaluation criteria of bone age in Chinese children and adolescents.

Non-small cell lung cancer （NSCLC） is a malignant tumor of the respiratory system with a high incidence. The early symptoms are not typical， and most patients are diagnosed at an advanced stage， which seriously threatens the lives and health of people. Surgery， chemotherapy， and targeted therapy are the main means of treatment at present， but the consequent drug resistance and adverse reactions restrict these treatment methods with certain limitations. In recent years， with the development of traditional Chinese medicine （TCM） in tumor resistance， TCM has attracted extensive attention for its obvious therapeutic effect and fewer adverse reactions. Numerous signaling pathways are involved in the formation and development of NSCLC， where phosphatidylinositol 3 kinase （PI3K）/protein kinase B （Akt）/mammalian target of rapamycin （mTOR） signaling pathway is one of the key regulatory pathways. The PI3K/Akt/mTOR signaling pathway affects the proliferation， invasion， and metastasis of NSCLC cells by affecting the cycle， inhibiting the apoptosis， inhibiting the autophagy of tumor cells， and promoting tumor neovascularization. As revealed by the recent literature， Chinese medicine plays an indispensable role in NSCLC cell autophagy， cell cycle， apoptosis， invasion and metastasis， neovascularization， and reversal of drug resistance by regulating the PI3K/Akt/mTOR signaling pathway. Although some Chinese medicinal extracts or compounds have made great breakthroughs in some mechanisms of action in the treatment of NSCLC， these studies only remain at the level of in vitro cell experiments and animal studies in vivo. Researchers are faced with the great challenge of "transforming the research results of Chinese medicines into clinical applications". Based on the current research status in China and abroad， this paper reviewed Chinese medicine in the intervention in NSCLC through the regulation of PI3K/Akt/mTOR signaling pathway in recent years， in order to open up new ideas for NSCLC drug therapy research and also provide a useful reference for further mechanism research.