Objective To investigate the causes and management strategies for lower limb ischemic necrosis following xenogeneic heterotopic heart transplantation from a multigene-edited pig to a rhesus monkey. Methods A xenogeneic heterotopic heart transplantation was performed on December 16, 2023, at the Institute of Experimental Animals of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, using a quintuple-gene-edited pig as the donor and a rhesus monkey as the recipient. On postoperative day (POD) 9, the recipient monkey underwent left lower limb amputation due to ischemic necrosis. Blood samples were collected at various time points after transplantation for analysis of hematologic parameters, liver and renal function, myocardial enzymes, and coagulation profiles. Ultrasound and computed tomography (CT) were used to evaluate anastomotic patency and cardiac structure. Immunological assays, including complement-dependent cytotoxicity (CDC) and IgG/IgM antibody detection, combined with clinical observations, were employed to assess rejection type and therapeutic response. Results The recipient monkey survived for 46 days after transplantation. Echocardiography demonstrated preserved biventricular systolic function in the recipient’s native heart, with left ventricular ejection fraction (LVEF) consistently exceeding 50%. In the donor pig heart, left ventricular endocardial thickening was noted on POD 9, followed by right ventricular endocardial thickening on POD 24, while LVEF remained around 35%. No hyperacute or acute rejection was detected immunologically. CDC positivity ranged between 3.4% and 5.1%, with IgG/IgM antibody binding trends consistent with CDC results. Following amputation, the recipient exhibited elevated inflammatory markers, coagulopathy, and reactive thrombocytosis, which later normalized. Immunohistochemical staining of the necrotic limb revealed arterial and venous thrombosis; however, no T-cell or B-cell infiltration was observed in vascular structures, thrombi, nerves, muscles, fascia, or skin tissues, with CD3 and CD20 staining both negative. Conclusion Limb ischemia after xenogeneic heart transplantation may be associated with lower extremity vascular thrombosis triggered by local trauma in the context of transplantation-induced inflammatory activation and coagulation dysfunction. While no clear lymphocyte-mediated rejection was observed, further studies are needed to explore the potential role of non-lymphocyte-mediated immune mechanisms.

Objective:To evaluate the efficacy of intraoperative sliding CT assisted deep brain stimulation of subthalaminal nucleus (STN-DBS) in short-term motor improvement and its influencing factors in patients with Parkinson's disease (PD) under general anesthesia.Methods:The cohort consisted of 48 PD patients accepted STN-DBS in Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University from June 2021 to June 2023, including 21 patients accepted STN-DBS under general anesthesia and 27 patients accepted STN-DBS under local anesthesia. STN-DBS was performed in the CT operating room and intraoperative CT was used to confirm the electrode position. Regular program-controlled follow-up for over one year in Out-patient Clinic was applied after discharge. Operation time, complications, stimulus-related adverse events, unified Parkinson's disease rating scale (UPDRS)-Ⅲ score and UPDRS-Ⅲ improvement rate at medicine-off (Med-off) stage/DBS-on stage 1 year after operation, and UPDRS-Ⅲ score and UPDRS-Ⅲ improvement rate at medicine-on (Med-on) stage/DBS-on stage 1 year after operation, and levodopa equivalent daily dose (LEDD) and LEDD reduction were compared between the two groups. Spearman rank correlation analysis or Pearson correlation analysis were used to investigate the correlation between short-term motor improvement ([UPDRS-Ⅲ score at Med-off stage before operation-UPDRS-Ⅲ score at Med-off stage/DBS-on stage 1 year after operation]/UPDRS-Ⅲ score at Med-off stage before operation×100%) and clinical data in PD after STN-DBS under general anesthesia.Results:The operation time of general anesthesia group was (1.9±0.5) h, and that of local anesthesia group was (2.6±0.8) h, with significant difference ( P<0.05). During the 1-year follow-up, no significant difference in incidence of adverse reactions, UPDRS-Ⅲ score improvement rate at Med-on and Med-off stages, LEDD and LEDD reduction was noted between the two groups ( P>0.05). In the general anesthesia group, the short-term motor improvement after STN-DBS was negatively correlated with age or gender ( P>0.05), but positively correlated with maximum improvement rate of preoperative UPDRS-Ⅲ score ( r=0.840, P<0.001). Conclusion:For patients who cannot tolerate local anesthesia, DBS under general anesthesia is also safe and effective.

Objective To explore the risk factors of asymptomatic gallbladder stones secondary to common bile duct stones.Methods A retrospective analysis was conducted on the data of asymptomatic gallstone patients diagnosed by the physical examination center of our hospital from January 2019 to October 2021,as well as asymptomatic gallstone patients with secondary common bile duct stones admitted to the hospital.According to whether secondary common bile duct stones occurred,the patients were divided into two groups.Among them,134 patients with asymptomatic gallbladder stones were the control group.There were 150 cases of common bile duct stones secondary to asymptomatic gallbladder stones,which were the observation group.The differences in baseline data between the two studies were balanced by propensity match scoring.The relevant data were compared and analyzed.Statistical analysis of the data was performed using SPSS 26.0 software and R software.Results There was no statistical significance in the distribution of age,gender,BMI index,smoking,drinking,exercise,hypertension and diabetes between the two groups(P＞0.05).The comparison of clinical indicators between groups showed that the number of gallbladder stones(multiple),the maximum diameter of stones(≥ 10 mum),and the diameter of the common bile duct may be related to asymptomatic gallbladder stones secondary to common bile duct stones,with p-values all less than 0.05 and statistically significant differences.There were statistically significant differences in the number of gallbladder stones(multiple),the maximum diameter of the stones(≥10 mum),and the diameter of the common bile duct(P＜0.05).Youdaoplaceholder0 Logistic Multivariate regression analysis showed that OR of the maximum diameter of the stone was 0.362(0.181-0.725),which was a protective factor for common bile duct stones secondary to asymptomatic gallbladder stones,and OR of the common bile duct diameter was 2.076(1.571-2.743),which was a risk factor for common bile duct stones secondary to asymptomatic gallbladder stones.Conclusion Asymptomatic gallbladder stones secondary to common bile duct stones are the result of multiple factors working together.

Objective To explore the risk factors of asymptomatic gallbladder stones secondary to common bile duct stones.Methods A retrospective analysis was conducted on the data of asymptomatic gallstone patients diagnosed by the physical examination center of our hospital from January 2019 to October 2021,as well as asymptomatic gallstone patients with secondary common bile duct stones admitted to the hospital.According to whether secondary common bile duct stones occurred,the patients were divided into two groups.Among them,134 patients with asymptomatic gallbladder stones were the control group.There were 150 cases of common bile duct stones secondary to asymptomatic gallbladder stones,which were the observation group.The differences in baseline data between the two studies were balanced by propensity match scoring.The relevant data were compared and analyzed.Statistical analysis of the data was performed using SPSS 26.0 software and R software.Results There was no statistical significance in the distribution of age,gender,BMI index,smoking,drinking,exercise,hypertension and diabetes between the two groups(P＞0.05).The comparison of clinical indicators between groups showed that the number of gallbladder stones(multiple),the maximum diameter of stones(≥ 10 mum),and the diameter of the common bile duct may be related to asymptomatic gallbladder stones secondary to common bile duct stones,with p-values all less than 0.05 and statistically significant differences.There were statistically significant differences in the number of gallbladder stones(multiple),the maximum diameter of the stones(≥10 mum),and the diameter of the common bile duct(P＜0.05).Youdaoplaceholder0 Logistic Multivariate regression analysis showed that OR of the maximum diameter of the stone was 0.362(0.181-0.725),which was a protective factor for common bile duct stones secondary to asymptomatic gallbladder stones,and OR of the common bile duct diameter was 2.076(1.571-2.743),which was a risk factor for common bile duct stones secondary to asymptomatic gallbladder stones.Conclusion Asymptomatic gallbladder stones secondary to common bile duct stones are the result of multiple factors working together.

Objective:To evaluate the efficacy of intraoperative sliding CT assisted deep brain stimulation of subthalaminal nucleus (STN-DBS) in short-term motor improvement and its influencing factors in patients with Parkinson's disease (PD) under general anesthesia.Methods:The cohort consisted of 48 PD patients accepted STN-DBS in Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University from June 2021 to June 2023, including 21 patients accepted STN-DBS under general anesthesia and 27 patients accepted STN-DBS under local anesthesia. STN-DBS was performed in the CT operating room and intraoperative CT was used to confirm the electrode position. Regular program-controlled follow-up for over one year in Out-patient Clinic was applied after discharge. Operation time, complications, stimulus-related adverse events, unified Parkinson's disease rating scale (UPDRS)-Ⅲ score and UPDRS-Ⅲ improvement rate at medicine-off (Med-off) stage/DBS-on stage 1 year after operation, and UPDRS-Ⅲ score and UPDRS-Ⅲ improvement rate at medicine-on (Med-on) stage/DBS-on stage 1 year after operation, and levodopa equivalent daily dose (LEDD) and LEDD reduction were compared between the two groups. Spearman rank correlation analysis or Pearson correlation analysis were used to investigate the correlation between short-term motor improvement ([UPDRS-Ⅲ score at Med-off stage before operation-UPDRS-Ⅲ score at Med-off stage/DBS-on stage 1 year after operation]/UPDRS-Ⅲ score at Med-off stage before operation×100%) and clinical data in PD after STN-DBS under general anesthesia.Results:The operation time of general anesthesia group was (1.9±0.5) h, and that of local anesthesia group was (2.6±0.8) h, with significant difference ( P<0.05). During the 1-year follow-up, no significant difference in incidence of adverse reactions, UPDRS-Ⅲ score improvement rate at Med-on and Med-off stages, LEDD and LEDD reduction was noted between the two groups ( P>0.05). In the general anesthesia group, the short-term motor improvement after STN-DBS was negatively correlated with age or gender ( P>0.05), but positively correlated with maximum improvement rate of preoperative UPDRS-Ⅲ score ( r=0.840, P<0.001). Conclusion:For patients who cannot tolerate local anesthesia, DBS under general anesthesia is also safe and effective.

Objective:To evaluate the clinical value of intraoperative sliding CT in deep brain stimulation (DBS) for Parkinson's disease (PD).Methods:A total of 117 PD patients accepted DBS in Department of Neurosurgery, First Affiliated Hospital of Zhengzhou University from May 2019 to May 2023 were chosen; 46 patients had local anesthesia and 71 had general anesthesia. Bilateral subthalamic nucleus (STN) DBS was performed in 73 patients, bilateral medial globus pallidus (GPi) DBS was performed in 43 patients, and right GPi and left STN DBS was performed in 1 patient. Preoperative/intraoperative sliding CT images and preoperative MRI images were fused to calculate the spatial distance between the preoperative planned target and actual target (adjusting electrode position timely in case of spatial distance greater than 2 mm [electrode displacement]). Differences of spatial distance between preoperative planned target and actual target in patients accepted different types of anesthesia and surgical modalities were compared.Results:All 117 patients were successfully operated and 234 electrodes were implanted. No patients needed a second operation for misalignment of electrodes or poor efficacy. During CT scan, neither anesthesia extubation or mechanical collision nor intracranial hemorrhage complications occurred. Spatial distance between the preoperative planned target and actual target was (1.35±0.50) mm in 117 patients. Displacement was noted in 4 electrodes and immediately adjusted during the operation; and CT re-examination confirmed good electrode position. No statistical significance in spatial distance between the preoperative planned target and actual target was noted between the general anesthesia group and local anesthesia group, and between the STN group and GPi group ( P>0.05). Conclusion:Intraoperative sliding CT is simple, safe and effective, which helps to timely adjust the electrode position during operation, avoids second operation and complications, and improves the safety and efficacy of DBS.

Literature related to children's adenoid hypertrophy was retrieved to form an expert questionnaire.According to the group standard writing rules of the China Association of Chinese Medicine,the peer consultation,quality evaluation and suitability eval-uation were completed through three rounds of Delphi expert questionnaire surveys and expert discussion meetings,and the Clinical Practice Guidelines for TCM in Children with Adenoidal Hypertrophy was finally formed.The guidelines have been formulated to clarify the scope of application of the guidelines,normative reference documents,terms and definitions,diagnosis,syndrome differentiation,treatment,prevention and care,and to provide an important reference for the clinical practice and diagnosis and treatment norms of tra-ditional Chinese medicine for children with adenoid hypertrophy.

Objective:To explore the feasibility of recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology in the Cyberknife Synchrony-based respiratory tracking.Methods:CT scans of an inflatable pig lung after anti-rot processing were obtained. Then, eight simulated tumor lesion sites were designed in the left and right lung lobes using intelligent navigation software, with four classified as the sputum bronchial environment group and four classified as the wet bronchial environment group. Based on the implantation principle of Cyberknife fiducial markers, 32 recoverable fiducial markers were implanted around various simulated tumor lesions via bronchus under intelligent guidance. Then, the end-expiratory state of the pig lung was simulated, the pig lung was scanned again to obtain CT images of the implanted recoverable fiducial markers, and the number of successfully implanted fiducial markers was recorded. Eight deliverable Synchrony treatment protocols were designed using the Cyberknife planning system (Multiplan v4.6), and then the pig lung with simulated respiratory movements was exposed to radiation. After radiation, the implanted recoverable fiducial markers were retrieved using the bronchoscopy technique, and the number of successfully retrieved fiducial markers was recorded. Moreover, the translational errors, rotational errors, and rigid body errors were extracted from the Cyberknife log file and analyzed.Results:No recoverable fiducial markers slipped or fell during the experiment. Thirty-two recoverable fiducial markers were successfully implanted and recovered under the guidance of intelligent navigation bronchoscopy, with implantation and recovery success rates of both 100%. Moreover, the tracking rate and rigid body errors of the fiducial markers were 100% and less than 5 mm, respectively. The data from the Cyberknife log file indicated that there was no significant difference between the sputum bronchial environment group and the wet bronchial environment group in the translational errors in the left-right direction, the rotational errors in the roll direction, and the rotational errors in the pitch direction ( P>0.05). Compared to the wet bronchial environment group, the sputum bronchial environment group had slightly higher translational errors in front-back ( Z=-3.57, P<0.01) and cranio-caudal ( Z=-2.53, P<0.05) directions, lower rotational errors along the yaw axis ( Z = -3.88, P < 0.01), and lower rigid body error ( Z=-3.32, P<0.01), and the differences were all statistically significant. Conclusions:The recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology is feasible. Recoverable fiducial markers are stable in the bronchus of the phantom, and the Cyberknife tracking precision can meet clinical requirements. Therefore, the recoverable fiducial marker implantation guided using the intelligent navigation bronchoscopy technology has promising prospects in clinical and teaching applications.

Objective:To explore the value of the model based on multi-sequence magnetic resonance imaging (MRI) radiomics and clinical features in predicting molecular subtypes of pediatric medulloblastoma (MB).Methods:MRI imaging data and clinical data of 100 children with primary MB admitted in the First Affiliated Hospital of Zhengzhou University from January 2011 to January 2020 were analyzed retrospectively.Fifty children with primary MB were allocated to training cohort, and those of the other 50 were allocated to testing cohort by using simple random sampling method.In the training cohort, there were 5 cases of WNT-activated MB (Wingless, WNT), 5 cases of SHH-activated MB (Sonic hedgehog, SHH), 28 cases of non-WNT/non-SHH medulloblastoma Group3 (Group3), 12 cases of non-WNT/non-SHH medulloblastoma Group4 (Group4). The testing cohort included 11 cases of WNT, 3 cases of SHH, 24 cases of Group3 and 12 cases of Group4.The robust and non-redundant features were selected from 5 929 three-dimensional radiomic features extracted from the manually delineated tumor area, and Boruta algorithm was used to further select the optimal features.Based on the selected features, a random forest prediction model was constructed using the training cohort (50 cases), which was further used to evaluate the testing cohort (50 cases). Combined with radiomic features and clinical features, a joint random forest prediction, clinical-radiomic model was constructed.Results:A radiomic model containing 13 optimal radiomics features was used to predict molecular subtypes of MB.The area under curve(AUC) of receiver operating characteristic (ROC) curve for WNT, SHH, Group3 and Group4 MB cases in the testing cohort was 0.923 1, 0.673 7, 0.519 2 and 0.705 0, respectively.Incorporating clinical features into the radiomic model improved AUC for WNT and SHH at 0.944 1 and 0.819 1, respectively.Conclusions:The multi-sequence clinical radiomic model has a high predictive value for pediatric MB with the molecular subtypes of WNT and SHH, which provides decision-making supports for individualized diagnosis and treatment of pediatric MB.

Objective:To investigate the effect of peripheral blood neutrophil to lymphocyte ratio (NLR) and platelet distribution width (PDW) on the clinical prognosis of childhood medulloblastomaMethods:Clinical data and survival data of 76 pediatric patients who were diagnosed as medulloblastoma by post-operative pathology in the First Affiliated Hospital of Zhengzhou University from January 2009 to December 2016 were collected. Kaplan- Meier method was used to calculate the overall survival(OS) and progression free survival(EFS) rates, Log- rank test was employed to compare the survival rates of different groups, and Cox proportional hazards regression model was used for multivariate analysis. Results:The log- rank test revealed that 5-year PFS rate and OS rate (22.2%, 22.2%) in the high NLR group (NLR>4.94) were significantly lower than those in the low NLR group (NLR≤4.94) (45.6%, 55.7%), and the differences were statistically significant(PFS: P=0.009, OS: P=0.001), and the 5-year PFS and OS (52.3%, 66.5%) of the high PDW group (PDW>15.90) were significantly higher than those in the low PDW group (PDW ≤ 15.90) (27.1%, 32.5%), and the differences were statistically significant(PFS: P=0.032, OS: P=0.039). Univa-riate analysis showed that the extent of resection (PFS: P=0.006, OS: P=0.009), and postoperative radiotherapy (PFS: P=0.011, OS: P=0.001) and postoperative radiotherapy(PFS: P=0.011, OS: P=0.001) were the factors influencing the prognosis of children with medulloblastoma.Multivariate Cox proportional hazards regression model analysis suggested that no postoperative radiotherapy (PFS: P=0.048, OS: P=0.008), NLR>4.94 (PFS: P=0.023, OS: P=0.003) and PDW≤15.90 (PFS: P=0.028, OS: P=0.006) were the independent risk factors for the prognosis of childhood medulloblastoma. Conclusions:Increased NLR and decreased PDW indicate unfavorable prognosis of the childhood medulloblastoma.Therefore, preoperative NLR and PDW may be the potential prognostic markers for childhood medulloblastoma.