1.Effects of Huanglian Jiedutang on Neutrophil Infiltration in Brain of MCAO Mice via Regulation of Chemokine Expression in Exosomes
Haojia ZHANG ; Kai WANG ; Zijin SUN ; Chunyu WANG ; Wei SHAO ; Kunjing LIU ; Liyang DONG ; Dan CHEN ; Wenxiu XU ; Chuanzun WANG ; Wen WANG ; Changxiang LI ; Xueqian WANG ; Fafeng CHENG ; Qingguo WANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(8):42-53
ObjectiveTo investigate whether Huanglian Jiedutang can inhibit neutrophil infiltration in the brains of middle cerebral artery occlusion (MCAO) mice by regulating the expression of neutrophil-related chemokines in exosomes, thereby achieving therapeutic effects. MethodsA total of 130 male specific pathogen-free (SPF) C57BL/6J mice were randomly divided into four groups: Sham-operated group, MCAO model group, Huanglian Jiedutang group (6 g·kg-1), and Ginaton group (21.6 mg·kg-1), with 10 mice in the Ginaton group and 40 mice in each of the remaining three groups. Mice in the Huanglian Jiedutang group and the Ginaton group were administered the corresponding drugs by oral gavage once daily at a volume of 0.15 mL·(10 g)-1 for 7 consecutive days, while the sham-operated and model groups received an equal volume of saline via the same route. After 7 days, MCAO surgery was performed. The distal and proximal ends of the right common carotid artery (CCA) were ligated, a small incision was made between the two ligatures, and a silicone rubber-coated monofilament with a rounded tip was inserted into the lumen to occlude the CCA. The filament was left in place for 1 h to establish a focal cerebral ischemia model. At 24 h after modeling, mice were evaluated. Neurological function was assessed using the Longa score. Cerebral infarct volume was measured by 2,3,5-triphenyltetrazolium chloride (TTC) staining. Cerebral blood flow was observed by laser speckle imaging. Hematoxylin and eosin (HE) staining and Nissl staining were used to observe pathological changes in brain tissues. Exosomes were isolated from mouse plasma and brain tissues by ultracentrifugation and molecular size exclusion and identified by electron microscopy, particle size analysis, and protein blotting. Long-chain RNA libraries of exosomes were constructed and sequenced. Real-time quantitative reverse transcription polymerase chain reaction (Real-time PCR) was used to detect the mRNA expression of inflammatory factors and neutrophil-related chemokines in exosomes from plasma and brain tissues of each group. Enzyme-linked immunosorbent assay (ELISA) was used to detect the protein expression of inflammatory factors and neutrophil-related chemokines in exosomes from brain tissues of each group. Immunohistochemistry was used to detect the expression of the neutrophil-specific protein myeloperoxidase (MPO) in the brains of mice in each group. ResultsCompared with the sham-operated group, the model group showed decreased neurological function scores (P<0.01), obvious cerebral infarction (P<0.01), reduced cerebral blood flow (P<0.01), neuronal necrosis in the brain, and decreased numbers of Nissl bodies (P<0.01). The mRNA expression levels of IL-1β, MPO, CXCL1, CXCL2, CXCL3, CXCL10, CCL2, and CCL3 in exosomes from plasma and brain tissues were significantly increased (P<0.05, P<0.01). The protein expression levels of IL-1β, MPO, CXCL2, and CXCL10 in exosomes from brain tissues were increased (P<0.05, P<0.01), and MPO-positive rates and mean optical density values in brain tissues were elevated (P<0.01). Compared with the model group, the Huanglian Jiedutang group and the Ginaton group showed increased neurological function scores (P<0.05), reduced cerebral infarct volume (P<0.01), restored cerebral blood flow (P<0.01), reduced necrotic cells in the brain, and increased numbers of Nissl bodies (P<0.01). In the Huanglian Jiedutang group, the mRNA expression levels of IL-1β, MPO, CXCL1, CXCL2, CXCL3, CXCL10, CCL2, and CCL3 in exosomes from plasma and brain tissues were decreased (P<0.05, P<0.01). The protein expression levels of IL-1β, MPO, CXCL2, and CXCL10 in exosomes from brain tissues were reduced (P<0.05, P<0.01), and MPO-positive rates and mean optical density values in brain tissues were decreased (P<0.01). ConclusionHuanglian Jiedutang can effectively regulate the expression of neutrophil-related chemokines in exosomes from plasma and brain tissues of MCAO mice, thereby reducing neutrophil infiltration in the brain and achieving therapeutic effects.
2.Effects of Huanglian Jiedutang on Neutrophil Infiltration in Brain of MCAO Mice via Regulation of Chemokine Expression in Exosomes
Haojia ZHANG ; Kai WANG ; Zijin SUN ; Chunyu WANG ; Wei SHAO ; Kunjing LIU ; Liyang DONG ; Dan CHEN ; Wenxiu XU ; Chuanzun WANG ; Wen WANG ; Changxiang LI ; Xueqian WANG ; Fafeng CHENG ; Qingguo WANG
Chinese Journal of Experimental Traditional Medical Formulae 2026;32(8):42-53
ObjectiveTo investigate whether Huanglian Jiedutang can inhibit neutrophil infiltration in the brains of middle cerebral artery occlusion (MCAO) mice by regulating the expression of neutrophil-related chemokines in exosomes, thereby achieving therapeutic effects. MethodsA total of 130 male specific pathogen-free (SPF) C57BL/6J mice were randomly divided into four groups: Sham-operated group, MCAO model group, Huanglian Jiedutang group (6 g·kg-1), and Ginaton group (21.6 mg·kg-1), with 10 mice in the Ginaton group and 40 mice in each of the remaining three groups. Mice in the Huanglian Jiedutang group and the Ginaton group were administered the corresponding drugs by oral gavage once daily at a volume of 0.15 mL·(10 g)-1 for 7 consecutive days, while the sham-operated and model groups received an equal volume of saline via the same route. After 7 days, MCAO surgery was performed. The distal and proximal ends of the right common carotid artery (CCA) were ligated, a small incision was made between the two ligatures, and a silicone rubber-coated monofilament with a rounded tip was inserted into the lumen to occlude the CCA. The filament was left in place for 1 h to establish a focal cerebral ischemia model. At 24 h after modeling, mice were evaluated. Neurological function was assessed using the Longa score. Cerebral infarct volume was measured by 2,3,5-triphenyltetrazolium chloride (TTC) staining. Cerebral blood flow was observed by laser speckle imaging. Hematoxylin and eosin (HE) staining and Nissl staining were used to observe pathological changes in brain tissues. Exosomes were isolated from mouse plasma and brain tissues by ultracentrifugation and molecular size exclusion and identified by electron microscopy, particle size analysis, and protein blotting. Long-chain RNA libraries of exosomes were constructed and sequenced. Real-time quantitative reverse transcription polymerase chain reaction (Real-time PCR) was used to detect the mRNA expression of inflammatory factors and neutrophil-related chemokines in exosomes from plasma and brain tissues of each group. Enzyme-linked immunosorbent assay (ELISA) was used to detect the protein expression of inflammatory factors and neutrophil-related chemokines in exosomes from brain tissues of each group. Immunohistochemistry was used to detect the expression of the neutrophil-specific protein myeloperoxidase (MPO) in the brains of mice in each group. ResultsCompared with the sham-operated group, the model group showed decreased neurological function scores (P<0.01), obvious cerebral infarction (P<0.01), reduced cerebral blood flow (P<0.01), neuronal necrosis in the brain, and decreased numbers of Nissl bodies (P<0.01). The mRNA expression levels of IL-1β, MPO, CXCL1, CXCL2, CXCL3, CXCL10, CCL2, and CCL3 in exosomes from plasma and brain tissues were significantly increased (P<0.05, P<0.01). The protein expression levels of IL-1β, MPO, CXCL2, and CXCL10 in exosomes from brain tissues were increased (P<0.05, P<0.01), and MPO-positive rates and mean optical density values in brain tissues were elevated (P<0.01). Compared with the model group, the Huanglian Jiedutang group and the Ginaton group showed increased neurological function scores (P<0.05), reduced cerebral infarct volume (P<0.01), restored cerebral blood flow (P<0.01), reduced necrotic cells in the brain, and increased numbers of Nissl bodies (P<0.01). In the Huanglian Jiedutang group, the mRNA expression levels of IL-1β, MPO, CXCL1, CXCL2, CXCL3, CXCL10, CCL2, and CCL3 in exosomes from plasma and brain tissues were decreased (P<0.05, P<0.01). The protein expression levels of IL-1β, MPO, CXCL2, and CXCL10 in exosomes from brain tissues were reduced (P<0.05, P<0.01), and MPO-positive rates and mean optical density values in brain tissues were decreased (P<0.01). ConclusionHuanglian Jiedutang can effectively regulate the expression of neutrophil-related chemokines in exosomes from plasma and brain tissues of MCAO mice, thereby reducing neutrophil infiltration in the brain and achieving therapeutic effects.
3.Analysis of Mechanism of Exosomes of BMSC Modified with Bushen Yisui Capsules on Promoting Differentiation and Maturation of OLN-93 Oligodendrocytes via Regulating miR-15b/Wnt Signaling Pathway
Sisi LIU ; Chunyu LI ; Chen LI ; Haixin LI ; Lei WANG
Chinese Journal of Experimental Traditional Medical Formulae 2025;31(20):115-125
ObjectiveTo investigate the effect and molecular mechanism of exosomes derived from bone marrow mesenchymal stem cells(BMSC-exos) modified with Bushen Yisui capsule(BSYS)-containing serum on promoting the differentiation and maturation of OLN-93 oligodendrocytes by regulating miR-15b/Wnt signaling pathway. MethodsOLN-93 cells were divided into 5 groups, including the normal(NC) group, BMSC-exos group, BSYS-BMSC-exos group, BSYS-BMSC+LV-miR-15b-5p inhibitor-exos group, and BSYS-BMSC+LV-miR-15b-5p NC-exos group. DiR staining was used to observe the uptake of Exos by OLN-93 cells. The effective dosage of BSYS-BMSC-exos on OLN-93 cells was assessed by cell proliferation and activity assay(CCK-8). Stable BMSCs lentiviral transfection strains were established to inhibit miR-15b-5p expression in both BMSCs and their exos, and transfection efficiency was verified by real-time fluorescent quantitative polymerase chain reaction(Real-time PCR) detection of miR-15b-5p. The expressions of 2′,3′-cyclic nucleotide 3′-phosphodiesterase(CNPase) and myelin proteolipid protein(PLP) in OLN-93 cells were detected by immunocytochemistry(ICC) and Western blot. The mRNA expressions of miR-15b-5p and Wnt3a in OLN-93 cells were detected by Real-time PCR, and the protein expression of Wnt3a was measured by Western blot. The expression levels of key molecules in the Wnt/β-catenin signaling pathway of OLN-93 cells, including glycogen synthase kinase(GSK)-3β, β-catenin, and T-cell specific transcription factor 4/transcription factor 7-like 2(TCF4/TCF7L2), were measured by Real-time PCR and Western blot. ResultsDiR-labeled Exos were efficiently taken up by OLN-93 cells. The CCK-8 assay results indicated that 20 mg·L-1 of BSYS-BMSC-exos exhibited the most significant effect in enhancing OLN-93 cell viability(P<0.01) and this dosage was selected for subsequent experiments. Following lentiviral transfection of BMSCs, Real-time PCR results revealed that miR-15b-5p was significantly suppressed in BMSCs(P<0.01), and miR-15b-5p was also notably inhibited in BSYS-BMSC-exos(P<0.01). ICC analysis further revealed an increase in the number of differentiated, mature CNPase and PLP-positive cells following BSYS-BMSC-exos treatment(P<0.01). Western blot results demonstrated that the protein expression of CNPase and PLP was significantly enhanced with BSYS-BMSC-exos treatment(P<0.01). Additionally, BSYS-BMSC-exos also increased the expression levels of miR-15b-5p and p-β-catenin proteins in OLN-93 cells, while decreased the mRNA and protein expressions of Wnt3a, as well as the mRNA expressions of β-catenin and TCF4/TCF7L2, and the protein expression level of p-GSK-3β(Ser9) was significantly reduced(P<0.05, P<0.01). After the transfection of miR-15b-5p inhibitor into BSYS-BMSC-exos, the above effects were significantly diminished(P<0.05, P<0.01). ConclusionBSYS-BMSC-exos facilitate the differentiation and maturation of OLN-93 cells, and its mechanism is related to the upregulation of miR-15b-5p in OLN-93 cells, which inhibits the expression of Wnt3a and thereby suppresses the Wnt signaling pathway.
4.Correlation Between Neutrophil to Lymphocyte Ratio and eGFR in Diabetic Patients: A Cross-sectional Analysis Based on NHANES Data
Chunyu JIA ; Gangan WANG ; Jiahui WANG ; Gang CHEN ; Ke ZHENG ; Xuemei LI
Medical Journal of Peking Union Medical College Hospital 2025;16(2):379-385
To investigate the association between neutrophil to lymphocyte ratio (NLR) andestimated glomerular filtration rate (eGFR) in patients with diabetes using large-scale data. Across-sectional analysis was conducted using data from diabetic patients in the National Health and Nutrition Examination Survey database from 2009 to 2014. Differences in NLR between patients with and without chronickidney disease (CKD) were compared. Pearson correlation analysis and multiple linear regression models wereapplied to assess the relationship between NLR and eGFR. A total of 857 diabetic patients were included, with 190 (22.2%) having CKD and 667 (77.8%) without CKD. NLR was significantly higher in patients with CKD compared to those without CKD (2.94±1.69 vs.2.36±1.98, NLR is independently negatively associatedwith eGFR in diabetic patients, demonstrating potential clinical value as an indicator of kidney function declineand CKD risk in this population.
5.Exploiting targeted degradation of cyclins and cyclin-dependent kinases for cancer therapeutics: a review.
Suya ZHENG ; Ye CHEN ; Zhipeng ZHU ; Nan LI ; Chunyu HE ; H Phillip KOEFFLER ; Xin HAN ; Qichun WEI ; Liang XU
Journal of Zhejiang University. Science. B 2025;26(8):713-739
Cancer is characterized by abnormal cell proliferation. Cyclins and cyclin-dependent kinases (CDKs) have been recognized as essential regulators of the intricate cell cycle, orchestrating DNA replication and transcription, RNA splicing, and protein synthesis. Dysregulation of the CDK pathway is prevalent in the development and progression of human cancers, rendering cyclins and CDKs attractive therapeutic targets. Several CDK4/6 inhibitors have demonstrated promising anti-cancer efficacy and have been successfully translated into clinical use, fueling the development of CDK-targeted therapies. With this enthusiasm for finding novel CDK-targeting anti-cancer agents, there have also been exciting advances in the field of targeted protein degradation through innovative strategies, such as using proteolysis-targeting chimera, heat shock protein 90 (HSP90)-mediated targeting chimera, hydrophobic tag-based protein degradation, and molecular glue. With a focus on the translational potential of cyclin- and CDK-targeting strategies in cancer, this review presents the fundamental roles of cyclins and CDKs in cancer. Furthermore, it summarizes current strategies for the proteasome-dependent targeted degradation of cyclins and CDKs, detailing the underlying mechanisms of action for each approach. A comprehensive overview of the structure and activity of existing CDK degraders is also provided. By examining the structure‒activity relationships, target profiles, and biological effects of reported cyclin/CDK degraders, this review provides a valuable reference for both CDK pathway-targeted biomedical research and cancer therapeutics.
Humans
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Neoplasms/metabolism*
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Cyclin-Dependent Kinases/antagonists & inhibitors*
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Cyclins/metabolism*
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Proteolysis
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Antineoplastic Agents/pharmacology*
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Molecular Targeted Therapy
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Proteasome Endopeptidase Complex/metabolism*
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Animals
6.Imaging poly(ADP-ribose) polymerase-1 (PARP1) in vivo with 18F-labeled brain penetrant positron emission tomography (PET) ligand.
Xin ZHOU ; Jiahui CHEN ; Jimmy S PATEL ; Wenqing RAN ; Yinlong LI ; Richard S VAN ; Mostafa M H IBRAHIM ; Chunyu ZHAO ; Yabiao GAO ; Jian RONG ; Ahmad F CHAUDHARY ; Guocong LI ; Junqi HU ; April T DAVENPORT ; James B DAUNAIS ; Yihan SHAO ; Chongzhao RAN ; Thomas L COLLIER ; Achi HAIDER ; David M SCHUSTER ; Allan I LEVEY ; Lu WANG ; Gabriel CORFAS ; Steven H LIANG
Acta Pharmaceutica Sinica B 2025;15(10):5036-5049
Poly(ADP-ribose) polymerase 1 (PARP1) is a multifunctional protein involved in diverse cellular functions, notably DNA damage repair. Pharmacological inhibition of PARP1 has therapeutic benefits for various pathologies. Despite the increased use of PARP inhibitors, challenges persist in achieving PARP1 selectivity and effective blood-brain barrier (BBB) penetration. The development of a PARP1-specific positron emission tomography (PET) radioligand is crucial for understanding disease biology and performing target occupancy studies, which may aid in the development of PARP1-specific inhibitors. In this study, we leverage the recently identified PARP1 inhibitor, AZD9574, to introduce the design and development of its 18F-isotopologue ([18F]AZD9574). Our comprehensive approach, encompassing pharmacological, cellular, autoradiographic, and in vivo PET imaging evaluations in non-human primates, demonstrates the capacity of [18F]AZD9574 to specifically bind to PARP1 and to successfully penetrate the BBB. These findings position [18F]AZD9574 as a viable molecular imaging tool, poised to facilitate the exploration of pathophysiological changes in PARP1 tissue abundance across various diseases.
7.Factors affecting the prevalence of hyperuricemia in an island troop
Yongguang FANG ; Shujun SUN ; Chong TANG ; Chunyu LIU ; Qian XU ; Ying LIANG ; Huihui GUO ; Peng YANG ; Nannan CHEN
Journal of Navy Medicine 2025;46(6):574-578
Objective To analyze the factors affecting the prevalence of hyperuricemia(HUA)in an island troop.Methods A total of 1 113 soldiers stationed on an island from December 2021 to December 2022 were selected as research objects by cluster sampling.Their lifestyle and health information were collected.Physical examination and laboratory detection were conducted.Multivariate logistic regression was used to analyze the influencing factors of HUA.Results The prevalence rate of HUA was 21.02%(234/1 113).There were significant differences in the body mass index(BMI),waist-to-hip ratio,triglyceride,alanine aminotransferase,and creatinine between the soldiers with hyperuricemia and the soldiers with normal blood uric acid(P<0.05).Multivariate logistic regression analysis showed that BMI≥24(OR=1.49,95%CI:1.09-2.05),abnormal liver function(OR=2.26,95%CI:1.31-3.92),and dyslipidemia(OR=1.46,95%CI:1.01-2.12)were positively correlated with hyperuricemia;age>30 years old(OR=0.59,95%CI:0.37-0.93)and exercise time>1 h per week(OR=0.46,95%CI:0.22-0.97)were negatively correlated with HUA.Conclusion The prevalence rate of hyperuricemia is at a high level in an island troop.BMI≥24,age≤30 years old,exercise time≤1 h per week,abnormal liver function,and dyslipidemia are the risk factors for HUA.Prevention and control measures should be taken as early as possible for the soldiers with these risk factors.
8.Disrupted aperiodic neural activity and differential cognitive correlates in patients with schizophrenia
Kexin ZHANG ; Yilin YUAN ; Tianhang ZHOU ; Tingfang WU ; Chunyu DU ; Chenmei XIE ; Weiran CHEN ; Jing WANG ; Xin YU
Chinese Mental Health Journal 2025;39(6):477-482
Objective:To explore the aperiodic components(1/f slopes)and their associations with cognitive impairment in patients with schizophrenia.Methods:Nineteen patients with schizophrenia according to the Interna-tional Statistical Classification of Diseases and Related Health Problem,Tenth Revision(ICD-10)and 21 normal controls were administrated the total Brief Assessment of Cognition in Schizophrenia(BACS)to measure the cogni-tive performance.The 5-minute eyes-closed and eyes-open resting EEG signals were collected and parameterized in-to aperiodic components(1/f slope).Finally,Pearson correlation was used to examine the relationships between the 1/f slope and cognition assessment scores.Results:The patients with schizophrenia had higher 1/f slope compared to HC on central location of scalp(P<0.05).The vocal memory scores showed a significantly positive relation with 1/f slopes in patients with schizophrenia(anterior location:r=-0.68,P<0.05;central location:r=-0.44,P<0.05),but a significantly negative relation in normal controls(anterior location:r=0.57,P<0.05;posterior lo-cation:r=0.54,P<0.05).Conclusion:The 1/f slopes of EEG in schizophrenia were steeper than normal control,suggesting its strong cognitive functional significance and complex mechanisms in schizophrenia.
9.Progress in the treatment of Alzheimer′s disease by Chinese medicine extracts based on C . elegans model
Yuqing Pei ; Chunyu Xu ; Xindi Shao ; Yujie Zhu ; Siyue Zhou ; Zhiyi Zheng ; Fei Cheng ; Xuan Shi ; Zhangyue Chen
Acta Universitatis Medicinalis Anhui 2025;60(4):760-765
Abstract
Alzheimer′s disease(AD) is a common neurodegenerative disease. It has been found that AD is related to various pathogenic factors such as genetics, cardiovascular and cerebrovascular disease, and excessive phosphorylation of tau protein. However, no definitive conclusions on its pathogenesis have been reached. In this paper, the research progress on the pathogenesis of AD inC.elegansmodel and the therapeutic effects of traditional Chinese medicine extracts on AD are reviewed, providing a basis for further research on the alleviating effects of Chinese medicine extracts on AD.
10.The efficacy and safety of the ballistic-ultrasonic-negative pressure three-in-one energy platform in mini-percutaneous nephrolithotomy
Haijie XIE ; Junkai HUANG ; Linguo XIE ; Shiyong QI ; Yue CHEN ; Chunyu LIU
Chinese Journal of Urology 2025;46(4):280-286
Objective:To explore the efficacy and safety of the ballistic-ultrasound-negative pressure three-in-one energy platform (Trilogy) for micro-channel percutaneous nephrolithotomy (mini-PCNL).Methods:A retrospective analysis was conducted on the clinical data of 140 patients with upper urinary tract stones treated at Tianjin Medical University Second Hospital from February to October 2024. All patients underwent mini-PCNL and were divided into the holmium laser group and the Trilogy group based on the stone fragmentation equipment used during the procedure. There were 69 patients in the holmium laser group and 71 in the Trilogy group. The two groups had similar mean ages (55.1±10.2 years vs. 53.4±10.8 years), male patient proportions (50 cases, 72.5% vs. 50 cases, 70.4%), body mass indices (25.2±3.6 kg/m 2 vs. 25.3±4.0 kg/m 2), incidence rates of hypertension (29 cases, 42.0% vs. 31 cases, 43.7%), diabetes (15 cases, 21.7% vs. 12 cases, 16.9%), mean cumulative stone lengths (39.2±12.6 mm vs. 35.9±14.8 mm), total stone volumes preoperatively (6 184.3±3 653.5 mm 3 vs. 5 644.9±4 173.8 mm 3), mean CT values for stones (1 138.2±264.3 HU vs. 1 151.3±208.0 HU), stone locations (ureter 14 cases, 20.3% vs. 22 cases, 31.0%; kidney 48 cases, 69.6% vs. 39 cases, 54.9%; both ureter and kidney 7 cases, 10.1% vs. 10 cases, 14.1%), preoperative mean urinary white blood cell counts [9.6(3.6, 31.2) cells/HPF vs. 11.9(3.8, 34.5) cells/HPF], proportions of patients with preoperative urinary white blood cells (+ + + ; 23 cases, 33.3% vs. 25 cases, 35.2%), nitrite positivity rates (4 cases, 5.8% vs. 3 cases, 4.2%), and urine culture positivity rates (12 cases, 17.4% vs. 18 cases, 25.4%) showed no statistically significant differences. The proportion of patients with moderate or higher hydronephrosis in the holmium laser group was lower than that in the Trilogy group (32 cases, 46.4% vs. 47 cases, 66.2%, P=0.018). The holmium laser group utilized holmium laser lithotripsy, where stone fragments were either flushed out with a vortex or retrieved with a stone basket. The Trilogy group employed a three-in-one energy platform to break the stones. This device incorporated pneumatic ballistic, ultrasound, and negative pressure suction capabilities within the same metallic probe, allowing the stone to be fragmented into small pieces while simultaneously performing ultrasonic negative pressure stone clearance. The parameters for the three-in-one energy platform were adjusted based on intraoperative conditions, typically setting negative pressure at 30%-50%, ultrasound power at 80%-100%, ballistic power at 80%, and frequency at 8 Hz. During the stone fragmentation process, the ballistic device fragmented the stones while ultrasound further reduced larger fragments and removed them. Some fragments that were difficult to break could also be flushed out or retrieved with a stone basket. The efficiency of stone clearance (volume of stones cleared per unit time) was compared between the two groups, as well as the stone-free rates on postoperative day 1 and day 30. Stone clearance time was defined as the duration from the start of fragmentation to the placement of the nephrostomy tube. Changes in postoperative white blood cells, hemoglobin, and albumin levels compared to preoperative levels, as well as the incidence of Clavien-Dindo complications, were compared between the two groups. Equipment failure incidents were recorded (fiber fracture in the holmium laser group indicating it could not be used; probe fracture in the Trilogy group). Patients were sub-grouped based on stone CT values into CT ≥ 1 000 HU and CT < 1 000 HU categories to compare stone clearance efficiency between the two devices within each sub-group. In the CT≥1 000 HU sub-group, there were 51 cases in the holmium laser group and 54 in the Trilogy group, there were no significant differences in preoperative total stone volume (6 785.0±3 902.3 mm 3 vs. 5 678.1±4 297.7 mm 3). In the CT < 1 000 HU sub-group, there were 18 cases in the holmium laser group and 17 in the Trilogy group. There were no significant differences between the groups in preoperative total stone volume (4 482.2±2 110.6 mm 3 vs. 5 530.9±3 845.3 mm 3). Results:The overall stone clearance efficiency in the Trilogy group was higher than that in the holmium laser group (87.9±35.7 mm 3/min vs. 77.1±24.3 mm 3/min, P=0.038). There were no significant differences in residual stone volume before discharge [5.5(0, 84.0) mm 3 vs. 5.3(0, 175.0) mm 3], stone clearance time (79.4±43.2 min vs. 66.6±49.7 min), or the proportion of patients using stone baskets during the procedure (33 cases, 47.8% vs. 36 cases, 50.7%). Postoperative changes in white blood cells, hemoglobin, and albumin compared to preoperative levels were not significantly different [(4.1±2.9)×10 9/L vs. (3.3±2.2)×10 9/L; (-2.9±10.5) g/L vs. (-1.6±9.3) g/L; (-2.5±3.6) g/L vs. (-1.8±5.0) g/L] Furthermore, there were no statistically significant differences in equipment failure rates (1 case, 1.4% vs. 4 cases, 5.6%), stone-free rates (postoperative day 1: 43 cases, 62.3% vs. 47 cases, 66.2%; postoperative day 30: 50 cases, 72.5% vs. 53 cases, 74.6%), or Clavien-Dindo complication rates (grade Ⅰ: 11 cases, 15.9% vs. 8 cases, 11.3%; grade Ⅱ: 2 cases, 2.8% vs. 0 cases; grade Ⅲ: 1 case, 1.4% vs. 0 cases). In the CT ≥ 1 000 HU sub-group, the clearance time for the holmium laser was longer than that for Trilogy (93.3±41.0 min vs. 74.6±51.9 min, P=0.044), there were no significant differences in residual stone volume before discharge [6.3(1.6, 173.8) mm 3 vs. 4.5(0, 69.0) mm 3] between the two groups. In the CT < 1 000 HU sub-group, the overall stone clearance efficiency of the Trilogy group exceeded that of the holmium laser group (134.2±38.0 mm 3/min vs. 105.5 ± 7.1 mm 3/min, P=0.004), there were no significant differences between the groups in residual stone volume before discharge [0(0, 51.1) mm 3 vs. 16.3(0, 957.2) mm 3], or stone clearance time (40.2±18.1 min vs. 39.1±27.5 min). Conclusions:In mini-PCNL surgery, the stone fragmentation efficiency of the three-in-one lithotripsy energy platform is superior to that of the holmium laser, while the overall complication rate is comparable to that of the holmium laser.


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