We report a 30-year-old woman who presented with intermittent gross hematuria and left flank pain，and CT revealed a left staghorn stones. The initial percutaneous nephrolithotomy（PCNL）left a 6 mm fragment，and both stone and urine cultures yielded extended-spectrum β-lactamase（ESBL）-producing Escherichia coli. Seven months later，the stone increased to 6 cm and urine culture revealed Proteus mirabilis. Endoscopic combined intrarenal surgery（ECIRS）achieved complete clearance. At 6-month follow-up，the patient remained asymptomatic，culture-negative，and stone-free. This case highlights that small residual fragments after PCNL may rapidly enlarge with secondary urease-producing infection，underscoring the need for early re-intervention and standard follow-up.

Objective To develop and validate a prediction model to identify high-risk individuals who are at-risk to develop acute liver injury(ALI)within 180 days in new statin users,and to support early clinical intervention.Methods Data were sourced from the Yinzhou Regional Health Information Platform,covering statin initiators aged 18 years and older from January 1,2010,to October 31,2021.The dataset was divided into a derivation cohort and a temporal validation cohort based on the time of statin initiation.Predictors were selected using LASSO regression,and the model was constructed using the extreme gradient boosting(XGBoost)algorithm combined with cost-sensitive learning.Model performance was evaluated using Brier scores,Harrell's C-index,and calibration curves.Results A total of 126,440 statin initiators were included,with 90,542 in the derivation cohort and 35,898 in the validation cohort.Within 180 days of initial statin use,412(0.33％)patients developed ALI,including 305(0.34％)in the derivation cohort and 107(0.30％)in the validation cohort.The final model incorporated 16 predictors,which included demographic characteristics,lifestyle factors,family history,medical history,statin use,and concomitant medication use.The model demonstrated excellent overall performance[Brier score=0.0043,95％CI(0.0038,0.0049)],discrimination[Harrell's C-index=0.761,95％CI(0.725,0.794)],and calibration in internal validation.In temporal validation,the model also performed well[Brier score=0.0044,95％CI(0.0036,0.0052),Harrell's C-index=0.703,95％CI(0.614,0.781)].Conclusion This study develope and validate a prediction model for ALI in statin users,providing clinicians with a reliable tool for individualized risk assessment.This model can help achieve risk stratification and reduce the occurrence of ALI.

Objective To develop and validate a prediction model to identify high-risk individuals who are at-risk to develop acute liver injury(ALI)within 180 days in new statin users,and to support early clinical intervention.Methods Data were sourced from the Yinzhou Regional Health Information Platform,covering statin initiators aged 18 years and older from January 1,2010,to October 31,2021.The dataset was divided into a derivation cohort and a temporal validation cohort based on the time of statin initiation.Predictors were selected using LASSO regression,and the model was constructed using the extreme gradient boosting(XGBoost)algorithm combined with cost-sensitive learning.Model performance was evaluated using Brier scores,Harrell's C-index,and calibration curves.Results A total of 126,440 statin initiators were included,with 90,542 in the derivation cohort and 35,898 in the validation cohort.Within 180 days of initial statin use,412(0.33％)patients developed ALI,including 305(0.34％)in the derivation cohort and 107(0.30％)in the validation cohort.The final model incorporated 16 predictors,which included demographic characteristics,lifestyle factors,family history,medical history,statin use,and concomitant medication use.The model demonstrated excellent overall performance[Brier score=0.0043,95％CI(0.0038,0.0049)],discrimination[Harrell's C-index=0.761,95％CI(0.725,0.794)],and calibration in internal validation.In temporal validation,the model also performed well[Brier score=0.0044,95％CI(0.0036,0.0052),Harrell's C-index=0.703,95％CI(0.614,0.781)].Conclusion This study develope and validate a prediction model for ALI in statin users,providing clinicians with a reliable tool for individualized risk assessment.This model can help achieve risk stratification and reduce the occurrence of ALI.

We report a 30-year-old woman who presented with intermittent gross hematuria and left flank pain，and CT revealed a left staghorn stones. The initial percutaneous nephrolithotomy（PCNL）left a 6 mm fragment，and both stone and urine cultures yielded extended-spectrum β-lactamase（ESBL）-producing Escherichia coli. Seven months later，the stone increased to 6 cm and urine culture revealed Proteus mirabilis. Endoscopic combined intrarenal surgery（ECIRS）achieved complete clearance. At 6-month follow-up，the patient remained asymptomatic，culture-negative，and stone-free. This case highlights that small residual fragments after PCNL may rapidly enlarge with secondary urease-producing infection，underscoring the need for early re-intervention and standard follow-up.

Objective To construct a discharge preparation plan for patients with head and neck cancer undergo-ing tracheotomy and explore its application effect to provide a reference for improving the at-home self-care ability of tracheostomy patients with head and neck cancer.Methods The discharge preparation plan for patients with head and neck cancer undergoing tracheotomy was constructed through literature analysis and expert consultation.A total of 160 patients with tracheotomy for head and neck cancer who were hospitalized in the Department of Oto-laryngology and Head and Neck Surgery of a tertiary A general hospital in Jinan City,Shandong Province from May 2023 to February 2025 were selected by convenience sampling method as the study subjects,and were divided into an experimental group and a control group by block randomization method,with 80 cases in each group.The ex-perimental group received a discharge preparation plan for patients undergoing tracheotomy for head and neck can-cer,while the control group received routine nursing and health education.Data from admission to 1 month after discharge were collected.The levels of mindfulness awareness,self-care ability,and discharge readiness were compared between 2 groups of patients before and after intervention.Results The constructed discharge preparation plan in-cludes 5 stages(pre-contemplation,contemplation,preparation,action,and maintenance).There were no sample dropouts in either group of patients.The experimental group had higher levels of mindfulness awareness,self-care ability and discharge readiness scores than the control group,and the differences were statistically significant(P＜0.001).Conclusion The discharge preparation plan for patients with head and neck cancer undergoing tra-cheotomy is scientifically reasonable,safe,and feasible,which can effectively improve patients' discharge preparation and mindfulness level,and enhance their self-care ability.

Objective To investigate the causal relationship between circadian rhythm disruption and inflammatory bowel disease(IBD)and the mediating effect of gut microbiota based on Mendelian randomization(MR).Methods Summary statistics of Genome-wide Association Study(GWAS)for circadian rhythm disruption(n=205 527)and IBD(n=214 053)were obtained from IEU OpenGWAS database.Summary statistics of GWAS for the gut microbiota were obtained from the MiBioGen database(n=18 340).Two-sample MR analysis was used to estimate the genetic correlation and causality between circadian rhythm disruption and IBD,and the mediating effect of the gut microbiota was analyzed by two-step MR analysis.Results There was a suggestive causal relationship between circadian rhythm disruption and IBD(odds ratio=1.255,P＜0.05).Rikenellaceae id.967 played a mediating role in the causal chain between them(the mediating effect was-0.028 740).Sensitivity analysis confirmed that the results were not interfered by level pleiotropy and heterogeneity.Conclusion There is a genetic correlation between circadian rhythm disruption and IBD,and gut microbiota may play a mediating role between them.

Objective To construct a discharge preparation plan for patients with head and neck cancer undergo-ing tracheotomy and explore its application effect to provide a reference for improving the at-home self-care ability of tracheostomy patients with head and neck cancer.Methods The discharge preparation plan for patients with head and neck cancer undergoing tracheotomy was constructed through literature analysis and expert consultation.A total of 160 patients with tracheotomy for head and neck cancer who were hospitalized in the Department of Oto-laryngology and Head and Neck Surgery of a tertiary A general hospital in Jinan City,Shandong Province from May 2023 to February 2025 were selected by convenience sampling method as the study subjects,and were divided into an experimental group and a control group by block randomization method,with 80 cases in each group.The ex-perimental group received a discharge preparation plan for patients undergoing tracheotomy for head and neck can-cer,while the control group received routine nursing and health education.Data from admission to 1 month after discharge were collected.The levels of mindfulness awareness,self-care ability,and discharge readiness were compared between 2 groups of patients before and after intervention.Results The constructed discharge preparation plan in-cludes 5 stages(pre-contemplation,contemplation,preparation,action,and maintenance).There were no sample dropouts in either group of patients.The experimental group had higher levels of mindfulness awareness,self-care ability and discharge readiness scores than the control group,and the differences were statistically significant(P＜0.001).Conclusion The discharge preparation plan for patients with head and neck cancer undergoing tra-cheotomy is scientifically reasonable,safe,and feasible,which can effectively improve patients' discharge preparation and mindfulness level,and enhance their self-care ability.

Objective:To explore the feasibility of pressure tolerance threshold (PTO) in evaluating the effect of local anesthesia in patients undergoing transperineal prostate biopsy.Methods:Patients who underwent periprostatic nerve block prostate biopsy in Northern Jiangsu People's Hospital from March 2022 to October 2023 were prospectively enrolled.Inclusion criteria: ① suspicious prostate nodules detected by digital rectal examination, any prostate-specific antigen (PSA) value; ② transrectal prostate ultrasound (TRUS) or magnetic resonance imaging (MRI) showing suspicious lesions, any PSA; ③ the PSA >10 ng/ml; ④PSA 4-10 ng/ml, suspicious free/total PSA or suspicious PSA density. Inclusion was required if one of these criteria was met. Exclusion criteria: ① previous history of prostate biopsy or prostate surgery; ② severe cardiovascular and cerebrovascular diseases or coagulation disorders; ③ severe urinary tract infection; ④ taking analgesics within 24 hours before surgery; ⑤ unable to complete the pain score or refused to cooperate; ⑥ rectal stenosis or other rectal lesions detected by digital rectal examination.The PTO of all patients was measured by the same physician using a tenderness measuring instrument before puncture. Visual analogue scale (VAS) was used to evaluate the pain during the operation. According to the VAS score, the patients were divided into mild pain group (VAS score 0-3 points) and moderate to severe pain group (VAS score 4-10 points). The clinical data of the two groups were compared. The correlation between PTO and VAS score was further analyzed. The receiver operating characteristic (ROC) curve of PTO to predict pain during puncture was drawn, and the optimal cut-off value of PTO was calculated by the maximum Youden index.Results:A total of 304 patients were enrolled in this study, including 184 patients in the mild pain group and 120 patients in the moderate to severe pain group.There were no significant differences in age [69 (63, 73) years old vs. 69 (61, 74) years old], body mass index[24.0(22.9, 25.0)kg/m 2 vs. 23.9(22.8, 24.7)kg/m 2], PSA[14.6(10.5, 25.1)ng/ml vs. 14.0(10.5, 20.7)ng/ml], and hypertension[59.8%(110/184) vs.64.2%(77/120)]between the mild pain group and the moderate to severe pain group ( P> 0.05), while there were significant differences in PTO[(6.69±1.20)kgf/cm 2 vs.(5.13±0.92)kgf/cm 2], number of puncture needles[19(18, 22)needles vs. 22(20, 24)needles], prostate volume[36.5(26.6, 52.5)ml vs. 63.2(47.4, 89.4)ml], diabetes[35.3%(65/184) vs. 23.3%(28/120)], and major trauma experience[37.5%(69/184) vs.15.8%(19/120)] ( P<0.05). There was a high correlation between PTO and VAS score ( r=0.689, P<0.001). ROC curve analysis showed that when PTO was 5.99 kgf/cm 2, the accuracy of predicting moderate to severe pain during prostate biopsy was the highest. The AUC was 0.848, the Youden index was 0.675, the sensitivity and specificity were 89.2% and 78.3%, respectively. Conclusions:PTO can evaluate the effect of local anesthesia in patients undergoing transperineal prostate biopsy.PTO can be measured before surgery in patients undergoing transperineal prostate biopsy. When the patient's PTO is ≥5.99 kgf/cm 2, the patient's pain tolerance is better and the local anesthesia effect is feasible.When the patient's PTO is less than 5.99 kgf/cm 2, the patient's pain tolerance is poor, so the patient could be recommended to undergo spinal anesthesia or general anesthesia to reduce the pain during prostate biopsy.

Objective:To explore the feasibility of pressure tolerance threshold (PTO) in evaluating the effect of local anesthesia in patients undergoing transperineal prostate biopsy.Methods:Patients who underwent periprostatic nerve block prostate biopsy in Northern Jiangsu People's Hospital from March 2022 to October 2023 were prospectively enrolled.Inclusion criteria: ① suspicious prostate nodules detected by digital rectal examination, any prostate-specific antigen (PSA) value; ② transrectal prostate ultrasound (TRUS) or magnetic resonance imaging (MRI) showing suspicious lesions, any PSA; ③ the PSA >10 ng/ml; ④PSA 4-10 ng/ml, suspicious free/total PSA or suspicious PSA density. Inclusion was required if one of these criteria was met. Exclusion criteria: ① previous history of prostate biopsy or prostate surgery; ② severe cardiovascular and cerebrovascular diseases or coagulation disorders; ③ severe urinary tract infection; ④ taking analgesics within 24 hours before surgery; ⑤ unable to complete the pain score or refused to cooperate; ⑥ rectal stenosis or other rectal lesions detected by digital rectal examination.The PTO of all patients was measured by the same physician using a tenderness measuring instrument before puncture. Visual analogue scale (VAS) was used to evaluate the pain during the operation. According to the VAS score, the patients were divided into mild pain group (VAS score 0-3 points) and moderate to severe pain group (VAS score 4-10 points). The clinical data of the two groups were compared. The correlation between PTO and VAS score was further analyzed. The receiver operating characteristic (ROC) curve of PTO to predict pain during puncture was drawn, and the optimal cut-off value of PTO was calculated by the maximum Youden index.Results:A total of 304 patients were enrolled in this study, including 184 patients in the mild pain group and 120 patients in the moderate to severe pain group.There were no significant differences in age [69 (63, 73) years old vs. 69 (61, 74) years old], body mass index[24.0(22.9, 25.0)kg/m 2 vs. 23.9(22.8, 24.7)kg/m 2], PSA[14.6(10.5, 25.1)ng/ml vs. 14.0(10.5, 20.7)ng/ml], and hypertension[59.8%(110/184) vs.64.2%(77/120)]between the mild pain group and the moderate to severe pain group ( P> 0.05), while there were significant differences in PTO[(6.69±1.20)kgf/cm 2 vs.(5.13±0.92)kgf/cm 2], number of puncture needles[19(18, 22)needles vs. 22(20, 24)needles], prostate volume[36.5(26.6, 52.5)ml vs. 63.2(47.4, 89.4)ml], diabetes[35.3%(65/184) vs. 23.3%(28/120)], and major trauma experience[37.5%(69/184) vs.15.8%(19/120)] ( P<0.05). There was a high correlation between PTO and VAS score ( r=0.689, P<0.001). ROC curve analysis showed that when PTO was 5.99 kgf/cm 2, the accuracy of predicting moderate to severe pain during prostate biopsy was the highest. The AUC was 0.848, the Youden index was 0.675, the sensitivity and specificity were 89.2% and 78.3%, respectively. Conclusions:PTO can evaluate the effect of local anesthesia in patients undergoing transperineal prostate biopsy.PTO can be measured before surgery in patients undergoing transperineal prostate biopsy. When the patient's PTO is ≥5.99 kgf/cm 2, the patient's pain tolerance is better and the local anesthesia effect is feasible.When the patient's PTO is less than 5.99 kgf/cm 2, the patient's pain tolerance is poor, so the patient could be recommended to undergo spinal anesthesia or general anesthesia to reduce the pain during prostate biopsy.

ObjectiveThe lung mesenchymal stem cells （LMSCs） induced by D-galactose （D-gal） were intervened by Wenfei Huaxian decoction-containing serum to explore the mechanism of Wenfei Huaxian decoction in delaying the senescence of LMSCs through the nicotinamide phosphoribosyltransferase/silent information regulator 1 （NAMPT/SIRT1） signaling pathway. MethodWenfei Huaxian decoction-containing serum was prepared. LMSCs were isolated by gradient density centrifugation， and they were cultured and identified in vitro. The senescence model in vitro was established by stimulating cells via D-gal for 24 h. LMSCs cells were modeled after being treated with different volume fractions （5%， 10%， 20%， 40%， and 80%） of Wenfei Huaxian decoction-containing serum for 24 h， and the cell proliferation level was detected by methyl thiazolyl tetrazolium （MTT） method. The cells were randomly divided into blank serum group， model group， and high， medium， and low dose groups of Wenfei Huaxian decoction-containing serum. Senescence-associated β-galactosidase （SA-β-gal） staining was used to detect the senescence of LMSCs in each group. The content of NAD + was detected by colorimetry. The levels of senescence-associated factors （p16 and p53）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） in cell culture supernatant were detected by enzyme-linked immunosorbent assay （ELISA）. Western blot was used to detect the relative expression of senescence-associated proteins and NAMPT/SIRT1 signaling pathway-related proteins. ResultCompared with the blank serum group， the proliferation of LMSCs was significantly inhibited after D-gal stimulation for 24 h （P<0.01）. Compared with the model group， the proliferation of LMSCs could be promoted after intervention with the corresponding Wenfei Huaxian decoction-containing serum （P<0.05， P<0.01）. Compared with the blank serum group， the SA-β-gal staining of LMSCs in the model group after D-gal stimulation was enhanced， and the content of NAD⁺ was increased （P<0.01）. The expression levels of senescence factors p16 and p53， as well as SASP pro-inflammatory factors IL-6 and TNF-α in the cell culture supernatant， were significantly increased （P<0.01）. The expression of senescence-associated proteins p16， p21， and p53 increased （P<0.01）， and the protein expression of NAMPT， SIRT1， peroxisome proliferator-activated receptor γ coactivator 1α （PGC-1α）， and forkhead box family transcription factor O1 （FoxO1） decreased （P<0.01）. Compared with the model group， the SA-β-gal staining of LMSCs in each group of Wenfei Huaxian decoction-containing serum was significantly reduced， and the content of NAD⁺ was decreased （P<0.01）. The senescence factors （p16 and p53） and inflammatory factors （IL-6 and TNF-α） in the cell culture supernatant were significantly decreased （P<0.01）. The expression of senescence-associated proteins （P16， P21， and P53） decreased （P<0.05， P<0.01）. The protein expressions of NAMPT， SIRT1， PGC-1α， and FoxO1 were significantly up-regulated （P<0.05， P<0.01）. ConclusionWenfei Huaxian decoction can alleviate senescence and inflammatory response damage of D-gal-induced LMSCs， and its mechanism may be related to the regulation of the NAMPT/SIRT1 signaling pathway.