ObjectiveTo observe the clinical efficacy of tonifying kidney and replenishing essence on asthenozoospermia patients with the syndrome of kidney essence deficiency and the effects of this method on the adenosine 5′-monophosphate-activated protein kinase （AMPK）/mammalian target of rapamycin complex 1 （mTORC1） signaling pathway. MethodsSeventy-two eligible asthenozoospermia patients with the syndrome of kidney essence deficiency treated in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from February 2023 to January 2024 were selected and randomly assigned into an observation group and a control group， with 36 patients in each group. The observation group received oral administration of Guilu Tianjing capsules， while the control group received oral administration of L-carnitine oral solution. The treatment course lasted for 4 weeks in both groups. The observed indicators included sperm progressive motility rate （PR）， total sperm motility （PR+NP）， percentage of normal mitochondrial membrane potential （MMP）， and traditional Chinese medicine （TCM） symptom scores before and after treatment in both groups. A three-month follow-up was instituted to record the conception status of the patients’ spouses. Additionally， eight patients were randomly selected from the eligible patients in the observation group， and four healthy males with normal semen routine examination results were included as the control group for the determination of protein expression. Western blotting was conducted to assess the expression of AMPK， phosphorylated （p）-AMPK， regulatory-associated protein of mTOR （RAPTOR） and p-RAPTOR， and PTEN-induced putative kinase 1 （PINK1） in sperms from the observation group before and after treatment， as well as in the sperms of the control group. ResultsThe pregnancy rate of spouses in the observation group was 9.09% （3/33）， which was higher than that （3.33%， 1/30） in the control group. The total response rate was 84.8% （28/33） in the observation group and 66.7% （20/30） in the control group， with no statistically significant difference. After treatment， both groups were improved considering PR， PR+NP， MMP， and TCM symptom scores （P<0.01）. Moreover， the observation group exhibited more pronounced decreases in TCM symptom scores than the control group （P<0.05）， while the changes in PR， PR+NP， and MMP showed no statistical significance between groups. Compared with the control group， the asthenozoospermia group exhibited upregulations in phosphorylation levels of AMPK and RAPTOR and protein level of PINK （P<0.01）. The administration of Guilu Tianjing Capsules led to downregulations in the phosphorylation levels of AMPK and RAPTOR and protein level of PINK1 （P<0.01）. However， the protein levels of AMPK and RAPTOR demonstrated no significant difference between before and after treatment. During the study period， neither group of patients exhibited any notable adverse reactions. ConclusionGuilu Tianjing capsules can enhance the sperm motility and percentage of normal mitochondrial membrane potential in asthenozoospermia patients with the syndrome of kidney essence deficiency by downregulating the AMPK/mTORC1 signaling pathway， lowering the protein level of PINK1， and inhibiting excessive activation of mitophagy.

ObjectiveTo observe the clinical efficacy of tonifying kidney and replenishing essence on asthenozoospermia patients with the syndrome of kidney essence deficiency and the effects of this method on the adenosine 5′-monophosphate-activated protein kinase （AMPK）/mammalian target of rapamycin complex 1 （mTORC1） signaling pathway. MethodsSeventy-two eligible asthenozoospermia patients with the syndrome of kidney essence deficiency treated in the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from February 2023 to January 2024 were selected and randomly assigned into an observation group and a control group， with 36 patients in each group. The observation group received oral administration of Guilu Tianjing capsules， while the control group received oral administration of L-carnitine oral solution. The treatment course lasted for 4 weeks in both groups. The observed indicators included sperm progressive motility rate （PR）， total sperm motility （PR+NP）， percentage of normal mitochondrial membrane potential （MMP）， and traditional Chinese medicine （TCM） symptom scores before and after treatment in both groups. A three-month follow-up was instituted to record the conception status of the patients’ spouses. Additionally， eight patients were randomly selected from the eligible patients in the observation group， and four healthy males with normal semen routine examination results were included as the control group for the determination of protein expression. Western blotting was conducted to assess the expression of AMPK， phosphorylated （p）-AMPK， regulatory-associated protein of mTOR （RAPTOR） and p-RAPTOR， and PTEN-induced putative kinase 1 （PINK1） in sperms from the observation group before and after treatment， as well as in the sperms of the control group. ResultsThe pregnancy rate of spouses in the observation group was 9.09% （3/33）， which was higher than that （3.33%， 1/30） in the control group. The total response rate was 84.8% （28/33） in the observation group and 66.7% （20/30） in the control group， with no statistically significant difference. After treatment， both groups were improved considering PR， PR+NP， MMP， and TCM symptom scores （P<0.01）. Moreover， the observation group exhibited more pronounced decreases in TCM symptom scores than the control group （P<0.05）， while the changes in PR， PR+NP， and MMP showed no statistical significance between groups. Compared with the control group， the asthenozoospermia group exhibited upregulations in phosphorylation levels of AMPK and RAPTOR and protein level of PINK （P<0.01）. The administration of Guilu Tianjing Capsules led to downregulations in the phosphorylation levels of AMPK and RAPTOR and protein level of PINK1 （P<0.01）. However， the protein levels of AMPK and RAPTOR demonstrated no significant difference between before and after treatment. During the study period， neither group of patients exhibited any notable adverse reactions. ConclusionGuilu Tianjing capsules can enhance the sperm motility and percentage of normal mitochondrial membrane potential in asthenozoospermia patients with the syndrome of kidney essence deficiency by downregulating the AMPK/mTORC1 signaling pathway， lowering the protein level of PINK1， and inhibiting excessive activation of mitophagy.

Objective To preliminarily investigate the safety and efficacy of percutaneous microwave ab-lation(MWA)in patients with advanced breast cancer involving the skin or nipple-areola complex(NAC).Methods This study included breast cancer patients with skin or NAC involvement treated at the Fifth Medical Center of the Chinese PLA General Hospital from January 2011 to August 2024.Patients underwent percutaneous MWA with water isolation technique to protect surrounding tissues.Clinical data were retrospectively collected,and the technical success rate,complications,prognosis,patient satisfaction with breast aesthetics,and quality of life improvement were analyzed.Results A total of 19 patients(24 lesions)meeting the inclusion and ex-clusion criteria were analyzed.The cases included 4 with T4N0M0,2 with T4N1M0,3 with T4N2M0,1 with T4N3M0,1 with T4N2M1,and 8 with T4N3M1.The average diameter of the 24 lesions was(4.9±3.4)cm,with an average of(1.6±0.6)ablation sessions per lesion.The median ablation time was 36.9(26.1,61.7)minutes,and the median ablation energy was 84.2(45.6,149.2)kJ.The technical success rate was 100%.Postoperatively,7 patients(7/19,36.8%)experienced skin burns around the lesion or nipple shedding,all of which healed naturally.The median overall survival was 35.0(17.0,45.5)months,and the median recur-rence-free survival was 17.0(11.0,38.5)months.Patient satisfaction with post-treatment breast aesthetics was 89.5%,and all patients reported significant improvement in their quality of life.Conclusions Percutane-ous microwave ablation for breast cancer involving the skin or NAC was preliminary demonstrates to be safe and effective,suggesting its potential as a viable treatment option for patients with inoperable breast cancer.

Objective:Analyze the clinicopatholocical and imaging characteristics of hepatic epithelioid hemangioendothelioma (HEHE) and the related factors of survival prognosis.Methods:Clinical data of 32 patients diagnosed with HEHE at the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2023 retrospectively analyzed, including 11 males and 21 females, aged (46.8±3.6) years. The clinical manifestations, pathological findings, CT and MRI features of the patients were analyzed and the living conditions of the patients were followed up. Kaplan-Meier method was used for survival analysis, and log-rank test was used for survival rate comparison.Results:Among the 32 patients, 17 (53.1%) had no obvious symptoms, 10 (31.3%) had abdominal pain, 6 (18.8%) had abdominal distension, and 4 (12.5%) had lost weight. Under the microscope, HEHE was composed of mucous matrix and epithelioid endothelial cells, with dense surrounding cells and relatively sparse center. Small blood vessels can be seen invading the junction with normal liver tissue. The positive rates of endothelial marker CD34 in immunohistochemically staining was 100%(32/32), the positive rates of CD31 were 100% (32/32). The positive rates of erythroblast transformation specific related gene were 100% (28/28), and the positive rates of Friend leukemia virus integration protein 1 (22/22) were 100%. CT and MRI scan showed that the lesion were mainly multiple nodules and in diffuse formality. In arterial phase, the lesion showed slight homogeneous or ring-like enhancement, while in portal phase, the lesion showed progressive enhancement. Some lesions may exhibit more specific "lollipop sign" ( n=9) and "target ring sign" ( n=15). The median overall survival time of the 32 patients was 47 months, and the cumulative 1-, 3-, and 5-year survival were 100%, 95.0% and 72.7%, respectively. The cumulative survival rate of patients with "target ring sign" ( n=15), extrahepatic organ involvement or metastasis ( n=8) and Ki-67 positive rate >5% ( n=10) were lower than those without the above characteristics (all P<0.05). Conclusion:The clinical manifestations of HEHE were not typical, and the tumor was rich in mucus matrix and epithelioid endothelial cells, expressing endothelial markers. CT and MRI scan mainly showed multiple nodules or diffused lesion, and the "lollipop sign" and "target ring sign" were helpful for diagnosis. HEHE patients with Ki-67 positivity rate >5%, "target ring sign", and extrahepatic organs involvement or metastasis had a poor prognosis.

Objective To explore the significance of mitoxantrone hydrochloride injection and carbon nanoparticles suspension injection in endoscopic radical thyroid cancer surgery.Methods A retrospective analysis was carried out on patients who underwent endoscopic radical surgery for unilateral thyroid cancer at the Depart-ment of General Surgery,Gansu Provincial Central Hospital,from December 2022 to February 2024.The patients were classified into two groups according to the intraoperative tracer employed:the mitoxantrone group and the nanocarbon group.After a 6-month postoperative follow-up,the baseline data of the two patient groups were compared.The intraoperative visualization of lymph nodes and parathyroid glands in both groups was observed.Additionally,the hospitalization costs and the incidence of postoperative complications were compared between the two groups.Results In this study,110 cases were included in the Mitoxantrone group and 126 cases in the nanocarbon group.The staining time of the central lymph nodes was significantly shorter in the nanocarbon group compared to the mitoxantrone group(P<0.05).The blue staining rate of MHI reached 97.5%,while the black staining rate of CNSI was 98.3%.The difference between them was not statistically significant(P>0.05).Regarding the number of central lymph nodes dissected,it was 9.34±0.22 in the Mitoxantrone group and 9.88±0.24 in the nanocarbon group,with no statistically significant difference(P>0.05).Similarly,the parathyroid misdissection rates were 1.8%and 0.8%in the two groups respectively,and no significant statistical difference was observed(P>0.05).Postoperative blood calcium and PTH levels measured at 1 day,1 month,and 6 months did not show any statistically significant differences between the two groups(P>0.05).The incidence of transient hypoparathy-roidism and hypocalcemia was comparable in both groups(P>0.05),and no patients developed permanent hypo-parathyroidism or permanent hoarseness.None of the patients in one Mitoxantrone group experienced postoperative hemorrhage,coeliac leakage,or skin staining.In contrast,in the nanocarbon group,there was one case of postop-erative hemorrhage and one case of coeliac leakage,and two case of skin staining.Conclusions In laparoscopic unilateral thyroid cancer radical surgery,when it comes to lymph node tracing and parathyroid gland protection,no significant disparities were detected between MHI and CNSI.Nevertheless,CNSI exhibits a shorter staining time for central lymph nodes.In contrast,MHI is more manageable,features a faster metabolic rate,and has been demonstrated to be more cost-effective.

Objective To preliminarily investigate the safety and efficacy of percutaneous microwave ab-lation(MWA)in patients with advanced breast cancer involving the skin or nipple-areola complex(NAC).Methods This study included breast cancer patients with skin or NAC involvement treated at the Fifth Medical Center of the Chinese PLA General Hospital from January 2011 to August 2024.Patients underwent percutaneous MWA with water isolation technique to protect surrounding tissues.Clinical data were retrospectively collected,and the technical success rate,complications,prognosis,patient satisfaction with breast aesthetics,and quality of life improvement were analyzed.Results A total of 19 patients(24 lesions)meeting the inclusion and ex-clusion criteria were analyzed.The cases included 4 with T4N0M0,2 with T4N1M0,3 with T4N2M0,1 with T4N3M0,1 with T4N2M1,and 8 with T4N3M1.The average diameter of the 24 lesions was(4.9±3.4)cm,with an average of(1.6±0.6)ablation sessions per lesion.The median ablation time was 36.9(26.1,61.7)minutes,and the median ablation energy was 84.2(45.6,149.2)kJ.The technical success rate was 100%.Postoperatively,7 patients(7/19,36.8%)experienced skin burns around the lesion or nipple shedding,all of which healed naturally.The median overall survival was 35.0(17.0,45.5)months,and the median recur-rence-free survival was 17.0(11.0,38.5)months.Patient satisfaction with post-treatment breast aesthetics was 89.5%,and all patients reported significant improvement in their quality of life.Conclusions Percutane-ous microwave ablation for breast cancer involving the skin or NAC was preliminary demonstrates to be safe and effective,suggesting its potential as a viable treatment option for patients with inoperable breast cancer.

Objective To explore the significance of mitoxantrone hydrochloride injection and carbon nanoparticles suspension injection in endoscopic radical thyroid cancer surgery.Methods A retrospective analysis was carried out on patients who underwent endoscopic radical surgery for unilateral thyroid cancer at the Depart-ment of General Surgery,Gansu Provincial Central Hospital,from December 2022 to February 2024.The patients were classified into two groups according to the intraoperative tracer employed:the mitoxantrone group and the nanocarbon group.After a 6-month postoperative follow-up,the baseline data of the two patient groups were compared.The intraoperative visualization of lymph nodes and parathyroid glands in both groups was observed.Additionally,the hospitalization costs and the incidence of postoperative complications were compared between the two groups.Results In this study,110 cases were included in the Mitoxantrone group and 126 cases in the nanocarbon group.The staining time of the central lymph nodes was significantly shorter in the nanocarbon group compared to the mitoxantrone group(P<0.05).The blue staining rate of MHI reached 97.5%,while the black staining rate of CNSI was 98.3%.The difference between them was not statistically significant(P>0.05).Regarding the number of central lymph nodes dissected,it was 9.34±0.22 in the Mitoxantrone group and 9.88±0.24 in the nanocarbon group,with no statistically significant difference(P>0.05).Similarly,the parathyroid misdissection rates were 1.8%and 0.8%in the two groups respectively,and no significant statistical difference was observed(P>0.05).Postoperative blood calcium and PTH levels measured at 1 day,1 month,and 6 months did not show any statistically significant differences between the two groups(P>0.05).The incidence of transient hypoparathy-roidism and hypocalcemia was comparable in both groups(P>0.05),and no patients developed permanent hypo-parathyroidism or permanent hoarseness.None of the patients in one Mitoxantrone group experienced postoperative hemorrhage,coeliac leakage,or skin staining.In contrast,in the nanocarbon group,there was one case of postop-erative hemorrhage and one case of coeliac leakage,and two case of skin staining.Conclusions In laparoscopic unilateral thyroid cancer radical surgery,when it comes to lymph node tracing and parathyroid gland protection,no significant disparities were detected between MHI and CNSI.Nevertheless,CNSI exhibits a shorter staining time for central lymph nodes.In contrast,MHI is more manageable,features a faster metabolic rate,and has been demonstrated to be more cost-effective.

Objective:Analyze the clinicopatholocical and imaging characteristics of hepatic epithelioid hemangioendothelioma (HEHE) and the related factors of survival prognosis.Methods:Clinical data of 32 patients diagnosed with HEHE at the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2023 retrospectively analyzed, including 11 males and 21 females, aged (46.8±3.6) years. The clinical manifestations, pathological findings, CT and MRI features of the patients were analyzed and the living conditions of the patients were followed up. Kaplan-Meier method was used for survival analysis, and log-rank test was used for survival rate comparison.Results:Among the 32 patients, 17 (53.1%) had no obvious symptoms, 10 (31.3%) had abdominal pain, 6 (18.8%) had abdominal distension, and 4 (12.5%) had lost weight. Under the microscope, HEHE was composed of mucous matrix and epithelioid endothelial cells, with dense surrounding cells and relatively sparse center. Small blood vessels can be seen invading the junction with normal liver tissue. The positive rates of endothelial marker CD34 in immunohistochemically staining was 100%(32/32), the positive rates of CD31 were 100% (32/32). The positive rates of erythroblast transformation specific related gene were 100% (28/28), and the positive rates of Friend leukemia virus integration protein 1 (22/22) were 100%. CT and MRI scan showed that the lesion were mainly multiple nodules and in diffuse formality. In arterial phase, the lesion showed slight homogeneous or ring-like enhancement, while in portal phase, the lesion showed progressive enhancement. Some lesions may exhibit more specific "lollipop sign" ( n=9) and "target ring sign" ( n=15). The median overall survival time of the 32 patients was 47 months, and the cumulative 1-, 3-, and 5-year survival were 100%, 95.0% and 72.7%, respectively. The cumulative survival rate of patients with "target ring sign" ( n=15), extrahepatic organ involvement or metastasis ( n=8) and Ki-67 positive rate >5% ( n=10) were lower than those without the above characteristics (all P<0.05). Conclusion:The clinical manifestations of HEHE were not typical, and the tumor was rich in mucus matrix and epithelioid endothelial cells, expressing endothelial markers. CT and MRI scan mainly showed multiple nodules or diffused lesion, and the "lollipop sign" and "target ring sign" were helpful for diagnosis. HEHE patients with Ki-67 positivity rate >5%, "target ring sign", and extrahepatic organs involvement or metastasis had a poor prognosis.

Objective:To evaluate the therapeutic effect of ultrasound-guided microwave ablation (MWA) in the treatment of breast cancer liver metastases (BCLM), and to select the beneficiaries.Methods:A retrospective study was performed in 63 patients with BCLM who underwent ultrasound-guided microwave ablation in Department of Interventional Ultrasound, the Fifth Medical Center of Chinese PLA General Hospital, and had detailed follow-up data from February 2010 to October 2022. General patient data and laboratory results were collected. Univariate and multivariate Cox regression analyses were performed to determine the independent influencing factors for prognosis in patients with BCLM. A nomogram model was established to predict the survival rates of patients after operation.Calibration curve and decision curve were plotted to evaluate the calibration degree and the clinical benefit of the model, respectively. Time-dependent ROC curve was plotted to evaluate the predicting ability of the model. All patients were divided into high-risk group and low-risk group according to prognostic index. Survival curves were plotted to compare differences in survival between the two groups.Results:Multivariate Cox regression analysis showed that tumor burden score(TBS) and the presence of extrahepatic metastasis before MWA were independent influencing factors for prognosis of BCLM(all P<0.001). The combined prediction model was established based on TBS, extrahepatic metastasis and axillary nodal metastases. The areas under the 1-year, 2-year and 3-year ROC curves were 0.849, 0.855 and 0.878, respectively, suggesting that the model had good predicting ability. The calibration curve showed that the model had good calibration degree, while the decision curve showed that the model had good clinical practicability. The median survival time between the two groups was statistically significant[13.5 (9, 20) months vs 63.0 (39, 140) months, P<0.001]. Conclusions:Low-risk patients with BCLM gain significant clinical benefits after microwave ablation treatment, while high-risk patients do not exhibit a noticeable survival advantage.

Objective:To explore the effectiveness of applying the ADDIE (analysis, design, develop, implement, evaluate) Model in clinical teaching for nursing interns in spine surgery department.Methods:Using a convenience sampling method, 44 nursing interns in the Department of Orthopedics at Peking Union Medical College Hospital were selected as the control group from July 2021 to May 2022, and were taught using traditional methods. From July 2022 to May 2023, 45 nursing interns were selected as the observation group, and a teaching team was formed to design a training program based on the five stages of the ADDIE instructional design model. This program was tailored to improve the overall clinical competence of the spinal surgery nursing interns. After training, the teaching effects were evaluated based on knowledge test scores, skills test scores, overall clinical competence, and teaching satisfaction.Results:After the training, the skills test scores in specialized nursing for the observation group were (94.87±1.10) points, higher than the control group's (93.98±1.41) points, with a statistically significant difference ( P<0.01). The observation group also scored higher than the control group in clinical judgment, organizational effectiveness, overall performance, and total score in the Mini-Clinical Evaluation Exercise, with statistically significant differences ( P<0.01). Additionally, the observation group reported higher satisfaction with the teaching plan and methods compared to the control group ( P<0.05) . Conclusions:Clinical teaching for spinal surgery nursing interns based on the ADDIE instructional design model can improve their specialized practical skills and overall clinical competence. The interns also expressed a high level of acceptance for this teaching design model.