Objective To explore the effect of 3D printing auxiliary stent on the operation of laryngeal microsurgery instrument.Methods Auxiliary stent of suspension laryngoscope was design and 3D printed.30 standardized training residents as experimental participants were randomly divided into conventional group and auxiliary stent group(15 in each group).The pig's larynx was used as a specimen,and the vocal folds were marked with localized staining.Participants performed operation on the stained areas of the vocal folds under suspension laryngoscope(60 times of grasping in 1 h).The conventional group performed operation unaided;The auxiliary stent group performed operation with the auxiliary stent as a support.Two senior chief physicians scored the participants'stability and accuracy.Results The operational stability scale score of the conventional group and the auxiliary stent group were(5.03±4.33)and(8.99±3.42),respectively;The operation accuracy rates were 58.4%(526/900)and 78.9%(710/900),respectively.The operation accuracy rate,operation stability of the auxiliary stent group were significantly higher than those in the conventional group,and the differences were significant(P<0.01).Conclusion The auxiliary stent can significantly improve the stability and accuracy of operation,which has highly application value.

Objective Summarize the clinical application and elevating the caudal end of suspension laryngoscope to deal with severe glottis exposure difficulties.Method A retrospective analysis was conducted on the clinical data of 25 patients with severe dystotic glottic exposure(Cormack-Lehane grade Ⅲ or Ⅳ)who underwent laryngoscopy support surgery from January 2021 to January 2024,then analyze the intraoperative management and outcomes.Results In all the patients,after the angle of the suspension laryngoscope was adjusted to the maximum and the glottis could not be exposed satisfactorily,the caudal end of the suspension laryngoscope stent was lifted to obtain a larger tilt angle and field of view.After the caudal end of the stent was elevated by(11.50±6.31)cm,the glottis was exposed satisfactorily in 23 cases and the operation was performed successfully;In 2 cases,the laryngeal mask airway was used in conjunction with a fibrolaryngoscope and laryngeal forceps were used to extract the lesion step by step.Pharyngeal mucosal tearing and oozing of blood occurred in 24 cases,and the bleeding stopped after electrocoagulation;one case had loose and dislodged teeth.There were no significant changes in blood pressure and heart rate of patients before and after stent lifting(P＞0.05).Conclusion For the severe difficulty of glottis exposure during suspension laryngoscopic surgery,it can be dealt with by lifting the caudal end of the stent,which is a simple and effective method that does not cause serious complications and is worth clinical application.

Objective: To investigate the impact of endometriosis on pregnancy and delivery outcomes in patients undergoing single euploid frozen_thawed blastocyst transfer cycles following preimplantation genetic testing. Methods : A retrospective analysis was performed on clinical data from patients undergoing frozen_thawed blastocyst transfer after preimplantation genetic testing at the reproductive center of The First Affiliated Hospital of Anhui Medical University. The endometriosis group comprised 84 treatment cycles. After 1 : 3 propensity score matching , 252 treatment cycles from non_endometriosis patients were included as the control group. General characteristics and clinical outcomes were compared between the two groups. Results: There were no statistically significant differences between the two groups in terms of general characteristics , human chorionic gonadotropin ( HCG) positive rate , cycle clinical pregnancy rate per cycle , early miscarriage rate , preterm birth rate , live birth rate per cycle , cesarean section rate , delivery weeks , cumulative clinical pregnancy rate , and cumulative live birth rate (all P > 0. 05) . Conclusion Endometriosis may not reduce the pregnancy rate and live birth rate in single frozen euploid blastocyst transfer cycles .

Objective: To investigate the efficacy，safety and feasibility of regional lymph node dissection in laparoscopic radical surgery for bladder cancer under the guidance of indocyanine green fluorescence imaging. Methods: A total of 30 patients with muscle invasive bladder cancer (T2/T3NxM0) who volunteered to enter the clinical trial were randomly divided into the indocyanine green imaging guided laparoscopic regional lymph node dissection group (n=15) and the standard pelvic lymph node dissection group (n=15).The number of positive lymph nodes，operation time，intraoperative bleeding volume，incidence of lymph leakage，and tumor recurrence and metastasis rate 2-year after surgery were collected. Results: The number of positive lymph nodes was (4.20±1.66) and (4.60±1.72) respectively in the indocyanine green and standard groups，with no statistically significant difference (P>0.05).There were no statistically significant difference in the tumor recurrence and metastasis rates 2-year after surgery between the two groups (P>0.05).However，the indocyanine green group had shorter operation time，less intraoperative bleeding volume，and lower incidence of lymphatic leakage than the standard group (P<0.05). Conclusion: Indocyanine green fluorescence imaging guided laparoscopic lymph node dissection has comparable clinical efficacy to standard lymph node dissection，but with fewer complications.

OBJECTIVE: To analyze the imaging and clinical features of diaphragm dysfunction in patients who underwent selective cardiac sternotomy with diaphragm ultrasound and chest CT. METHODS: A prospective cohort study was conducted. The patients undergoing selective cardiac sternotomy in the cardiac and vascular surgery department of Tianjin Medical University General Hospital from June to September 2023 were enrolled. Bedside ultrasound was performed on the day before surgery, within 24 hours of extubation, and on the 7th day after surgery to measure diaphragm excursion (DE) and diaphragm thickness (DT), and to calculate the diaphragm thickening fraction (DTF). The distance from the diaphragm's apex to the thorax's apex in the chest CT scout view was measured before and after the operation, and the diaphragm elevating fraction (DEF) was calculated. Patients were divided into two groups based on whether diaphragm dysfunction (DE < 1 cm) occurred on the 7th day after surgery. The change patterns of imaging indicators were analyzed in both groups. The clinical data of both groups before, during, and after surgery were compared. RESULTS: In total, 67 patients who underwent cardiac sternotomy were enrolled. Among them, 24 patients developed diaphragm dysfunction within 24 hours after extubation; on the 7th day after surgery, 19 patients (28.4%) still exhibited diaphragm dysfunction, while 48 patients (71.6%) did not. Ultrasonic examination of the diaphragm revealed that, compared with the non-diaphragm dysfunction group, patients in the diaphragm dysfunction group exhibited varying degrees of decrease in DE and DTF before and after surgery, with a more significant decrease on the left side, and the differences were statistically significant on the 7th day after surgery [DE (cm): 1.06±0.77 vs. 1.59±0.63, DTF: 19.3% (14.8%, 21.1%) vs. 21.3% (18.3%, 26.1%), both P < 0.05]. There was no statistically significant difference in DT between the two groups at each time point. Changes in bilateral DE and DTF revealed that the non-diaphragm dysfunction group experienced early transient postoperative weakening of diaphragm function, followed by rapid recovery to the preoperative level on the 7th day after surgery, unlike the diaphragm dysfunction group. There were no significant differences between bilateral DE in the two groups on the day before surgery, and the left DE was significantly lower than the right DE within 24 hours after extubation and on the 7th day after surgery in the diaphragm dysfunction group (cm: 0.93±0.72 vs. 1.45±0.70 within 24 hours after extubation, 1.06±0.77 vs. 1.70±0.92 on the 7th day after surgery, both P < 0.05) but no significant difference was found in bilateral DT or DTF. The chest CT scan showed that, the incidence of postoperative diaphragm elevation was 61.2% (41/67), and 38.8% (26/67) did not, while no statistically significant difference in DEF was found between the two groups, nor within each group on both sides. Analysis of the clinical data showed a higher proportion of atrial fibrillation and pulmonary hypertension before surgery [atrial fibrillation: 36.8% (7/19) vs. 10.4% (5/48), pulmonary hypertension: 15.8% (3/19) vs. 2.1% (1/48), both P < 0.05], a higher incidence of high-flow oxygenation and pneumonia during surgery [high-flow oxygenation: 52.6% (10/19) vs. 25.0% (12/48), pneumonia: 73.7% (14/19) vs. 45.8% (22/48), both P < 0.05], and a longer duration of mechanical ventilation and length of intensive care unit (ICU) stay [duration of mechanical ventilation (hours): 47.0 (38.0, 73.0) vs. 24.5 (20.0, 48.0), length of ICU stay (hours): 69.0 (65.0, 117.5) vs. 60.0 (42.3, 90.6), both P < 0.05] in the diaphragm dysfunction group as compared with those in the non-diaphragm dysfunction group. CONCLUSIONS There was a high incidence of diaphragm dysfunction after cardiac sternotomy, which reflected the early transient postoperative weakening of diaphragm function, followed by rapid recovery to the preoperative level in most patients, predominantly on the left side. Diaphragm dysfunction, which was associated with atrial fibrillation and pulmonary hypertension significantly increased the incidence of postoperative pneumonia and prolonged the duration of mechanical ventilation and length of ICU stay.
Humans ; Diaphragm/physiopathology* ; Prospective Studies ; Sternotomy/adverse effects* ; Ultrasonography ; Postoperative Complications/diagnostic imaging* ; Tomography, X-Ray Computed ; Male ; Female ; Middle Aged ; Aged ; Cardiac Surgical Procedures/adverse effects*

Objective:To evaluate the efficacy and safety of baricitinib combined with ruxolitinib cream in the treatment of progressive nonsegmental vitiligo.Methods:Clinical data were retrospectively collected from patients with progressive nonsegmental vitiligo in Boao Super Hospital. All the patients were treated with oral baricitinib daily (2 mg/day for patients weighing ≤ 50 kg; 4 mg/day for those > 50 kg) in combination with topical application of ruxolitinib cream twice daily for 24 consecutive weeks. Disease severity was assessed using the facial vitiligo area scoring index (F-VASI) and total body VASI (T-VASI) at baseline, week 12, and week 24. Adverse reactions were monitored throughout the treatment course.Results:Six patients with progressive nonsegmental vitiligo were collected, including 3 males and 3 females, aged 26 - 42 years, with the disease duration ranging from 0.5 to 25 years. At week 12, 3 patients achieved a 50% ~ < 75% improvement in facial vitiligo lesions (F-VASI 50), 1 patient achieved F-VASI 75 (75% ~ < 90% improvement), and 1 patient achieved T-VASI 50; at week 24, 4 patients achieved F-VASI 50, 1 patient achieved F-VASI 75, 1 patient achieved F-VASI 90 (≥ 90% improvement), and 3 patients achieved T-VASI 50. During the treatment, upper respiratory infection occurred in 1 patient, acne in 1 patient, pruritus in 2 patients, elevation of total cholesterol levels in 2 patients, and increase of high-density lipoprotein levels in 2 patients. No severe adverse events were observed during the treatment.Conclusion:The combination therapy with baricitinib and ruxolitinib cream may have potential efficacy and safety in the treatment of progressive nonsegmental vitiligo.

Objective:To investigate the clinical diagnosis and treatment of granulomatous prostatitis（GP）in patients with Prostate Imaging Reporting and Data System（PI-RADS）scores ≥ 4 on magnetic resonance imaging（MRI）.Methods:The data of 12 GP patients with PI-RADS score ≥ 4 who were admitted to Beijing Chaoyang Hospital，Capital Medical University，from February 2015 to February 2025，were retrospectively analyzed. The patients were aged 51?73 years（mean 66 years）. Presenting complaints included elevated prostate-specific antigen（PSA）levels in 6 cases，prostatic mass in 2 cases，urinary retention in 3 cases，and gross hematuria in 1 case. All 12 patients had concomitant lower urinary tract symptoms. Medical history revealed pulmonary tuberculosis in 2 cases，testicular tuberculosis in 1 case，close contact with tuberculosis in 1 case（spouse diagnosed with pulmonary tuberculosis 5 years earlier），allergic granulomatous vasculitis in 1 case，and intravesical bacillus Calmette-Guérin（BCG）instillation in 1 case. Digital rectal examination（DRE）showed gradeⅠprostatic hyperplasia in 2 cases，grade Ⅱ in 9 cases，and grade Ⅲ in 1 case. Nodules were palpable in 6 patients. The median PSA was 7.20 ng/ml（ranging 1.11?21.90 ng/ml），with 2 cases < 4 ng/ml. Transrectal ultrasound was performed in 10 patients，and prostate volumes were ranging from 29.48 to 109.78 cm3，with 6 cases > 45 cm3. All 12 patients underwent MRI，and all demonstrated PI-RADS scores ≥ 4，typically presenting as low signal intensity on T2-weighted imaging，high signal on diffusion-weighted imaging（DWI），and low apparent diffusion coefficient（ADC）values. Contrast-enhanced MRI in 8 cases revealed heterogeneous enhancement. One patient underwent 68Ga-prostate-specific membrane antigen positron emission tomography-computed tomography（ 68Ga-PSMA PET-CT），which showed band-like increased uptake in the central zone. All 12 patients were preoperatively suspected of prostate cancer，of whom 10 underwent transrectal biopsy and 2 underwent transperineal biopsy. Pathological characteristics and follow-up results were analyzed. Treatment outcomes were analyzed，The International Prostate Symptom Score（IPSS），quality of life（QOL）score，maximum urinary flow rate（Q max），and post-void residual urine（PVR）volume were compared before and 1 month after treatment. Results:Histopathology confirmed GP in all cases，with chronic inflammation in 11 cases and acute inflammation in 1 case. Immunohistochemistry demonstrated positivity for CD68（macrophage marker），high-molecular weight cytokeratin（HCK），and reticulin staining；periodic acid-Schiff（PAS）and acid-fast staining were positive in 2 cases，corresponding to 1 patient with a prior history of pulmonary tuberculosis and 1 with testicular tuberculosis. Two patients underwent thulium laser enucleation of the prostate，while 10 received conservative treatment，including 2 patients with tuberculosis infection who were referred for anti-tuberculosis therapy and 8 patients treated with oral tamsulosin 0.2 mg once daily. Follow-up was completed in 10 patients：9 were followed for 1 ? 3 months（mean 2.4 months），and 1 patient was followed for 9 years before being diagnosed with prostate cancer. Two additional patients，whose pathological findings suggested a possible diagnosis of tuberculous granulomatous prostatitis，were advised to undergo anti-tuberculosis treatment at another hospital and were subsequently lost to follow-up. Among the 2 patients who underwent thulium laser enucleation，IPSS decreased from 26 and 25 to 6 and 5 respectively，QOL scores decreased from 6 and 5 to 1 and 0 respectively，Q max increased from 4.5 and 4.3 ml/s to 23.0 and 21.9 ml/s respectively. In the 8 patients treated conservatively，IPSS decreased from 18.45±7.17 to 14.45±5.03，and QOL score decreased from 5.09±1.04 to 4.09±0.70 at 1 month after treatment，showing significant improvement（ P < 0.05）. Additionally，one patient initially diagnosed with GP and managed conservatively remained stable for 9 years，but subsequently developed urinary retention and underwent thulium laser enucleation，with postoperative pathology confirming prostate cancer. Conclusions:Clinical manifestations of GP are nonspecific，and the condition can easily be mistaken for prostate cancer due to elevated PSA levels and PI-RADS scores ≥4. Some patients may present with acute urinary retention，but definitive diagnosis still relies on prostate biopsy and immunohistochemistry. Treatment should be individualized according to the underlying etiology，with medication as the mainstay，while transurethral surgical intervention may be considered in cases with obstruction. Although GP is a benign lesion，its potential association with prostate cancer warrants vigilance and emphasizes the importance of long-term follow-up.

Objective:To dynamically assess liver fibrosis using magnetic resonance elastography (MRE) and explore factors associated with fibrosis reversal in patients with metabolic dysfunction-associated steatohepatitis (MASH).Methods:This study included data from patients diagnosed with MASH by liver biopsy who underwent at least two MRE examinations. Patients were divided into a fibrosis reversal group and a non-reversal group according to whether MRE values decreased by 20% during follow-up. Differences in clinical data between the groups were compared using analysis of variance, the Kruskal-Wallis test, and the chi-square test. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for fibrosis reversal in MASH.Results:A total of 46 cases were included in this study (mean age 50.1±12.3 years, BMI 26.1±3.1 kg/m2). Among them, the reversal group accounted for 26.1%. The rate of decrease in MRI proton density fat fraction (PDFF) was significantly higher in the reversal group (-50.0% vs. -8.1%, P=0.001) than in the non-reversal group between the two MRE examinations. The reversal group showed a more significant change rate of decreases in fasting insulin (-37.3% vs. -3.6%, P=0.011), insulin resistance index (-38.6% vs. -6.5%, P=0.044), and ALP (-24.9% vs. 0, P=0.004). Multivariate logistic regression analysis indicated that the rate of change in MRI PDFF was an independent predictor of fibrosis reversal ( OR=0.96, 95% CI: 0.92-1.00, P=0.046). Conclusion:A decrease in MRI proton density fat fraction levels is independently associated with liver fibrosis reversal in MASH, suggesting that intervention targeting liver fat content may be an effective treatment strategy.

Purpose To provide technical support for the use of echo-planar imaging(EPI)in the diagnosis of brain diseases,the image quality and diagnostic effect of single-shot echo-planar imaging(ssEPI)diffusion-weighted imaging(DWI)and multi-shot echo-planar imaging(msEPI)DWI sequences in the detection of brain diseases at 5.0T MR are analyzed.Materials and Methods A retrospective analysis was conducted on 42 patients with intracranial diseases who underwent T2-FLAIR,ssEPI DWI and msEPI DWI scans on a 5.0T MR system in the First Affiliated Hospital of USTC from August to September 2023.Two radiologists independently assessed image quality,measured distortion displacement,and compared signal-to-noise ratio,lesion-to-normal tissue contrast,contrast-to-noise ratio and apparent diffusion coefficient.Results msEPI sequence demonstrated significantly superior subjective scores,including geometric distortion,susceptibility artifacts,edge sharpness and overall image quality compared with those of ssEPI sequence(Z=5.728,4.197,5.766,5.777,all P<0.001).Quantitative analysis revealed substantial reduction in distortion displacement in msEPI sequence,including frontal lobe[(5.91±1.41)mm vs.(15.63±2.21)mm,t=34.050,P<0.001],anterior temporal lobe[(4.17±0.78)mm vs.(7.18±1.87)mm,t=12.263,P<0.001],posterior temporal lobe[(4.76±1.36)mm vs.(8.38±2.01)mm,t=21.336,P<0.001],cerebral diameter[(4.37±1.65)mm vs.(12.74±2.84)mm,t=23.255,P<0.001]and brainstem diameter[(0.80±0.63)mm vs.(1.98±1.63)mm,t=7.092,P<0.001],compared with ssEPI sequence.However,no statistically significant differences were observed in signal-to-noise ratio or contrast-to-noise ratio between the two sequences(P=0.848,0.638).Notably,msEPI sequences exhibited significantly enhanced lesion-normal tissue contrast compared with ssEPI sequences[221(131,311)vs.150(90,240),Z=3.89,P<0.001].Conclusion At 5.0T MRI,msEPI demonstrated superior image quality and diagnostic performance for craniocerebral diseases compared to ssEPI DWI sequences.

OBJECTIVE To establish an in vitro simulated one compartment extravascular adminis-tration model with lanthanum nitrate as the test substance,and explore the differences between this model and the classic in vitro administration model in lanthanum nitrate induced HepG2 cell death.METHODS An in vitro administration device was designed based on compartment model theories which consisted of four functional chambers:the liquid storage chamber,mixing chamber,toxicant exposure chamber,and waste liquid receiving chamber.The four chambers were connected by peristaltic pump hoses.The peristaltic pumps were employed to ensure unidirectional and constant speed trans-mission of liquid between these chambers.According to the preset toxicokinetic parameters such as T1/2a and T1/2,an in vitro simulated one compartment extravascular administration model of lanthanum nitrate was constructed using the device.The content of lanthanum nitrate in the toxicant exposure chamber at different time points was measured using inductively coupled plasma mass spectrometry.The concentration-time curves of lanthanum nitrate were analyzed using PKsolver and GraphPad Prism 8.0 software.The constructed in vitro simulated one compartment extravascular administration model was evaluated by comparing the measured and theoretical values of toxicokinetic parameters.HepG2 cells were treated with lanthanum nitrate in the in vitro simulated one compartment extravascular administration model and classic in vitro administration model,respectively,and cell death was measured using the Hoechst 33342/propidium iodide staining method.RESULTS Within the Cmax range of 3.91-1 000.00 μmol·L-1,the measured concentration-time curves of lanthanum nitrate in the toxicant expo-sure chamber almost conformed with the corresponding calculated theoretical curves(the correlation coefficients were all>0.998 0).The measured values of toxicokinetic parameters,including Ke,T1/2,Ka,T1/2a,Tmax,Cmax,CL and AUC0-∞,were close to the corresponding theoretical values.The fitting coeffi-cients(R2)of the concentration-time curves for each experimental group were all>0.990 0,which was consistent with one compartment model for extravascular administration.In the simulated one compart-ment extravascular administration model,no significant death of HepG2 cells was observed in any lanthanum nitrate dose group.In the classic in vitro administration model,the cell death rate of the 0.500 mmol·L-1 lanthanum nitrate group was higher than that of the solvent control group,but no significant cell death was observed in the 0.119 mmol·L-1 group or 0.243 mmol·L-1 group.When Cmax or Cadministration was 0.500 mmol·L-1,classic in vitro administration induced a higher cell death rate than simulated one compart-ment extravascular administration.However,there was no statistically significant difference in lanthanum nitrate induced HepG2 cell death between the two administration models when the AUC was equal.CONCLUSION The device designed in this study can be used to in vitro simulate one compartment extravascular administration,making in vitro toxicity testing more similar to in vivo scenarios,and providing data for optimizing administration methods of in vitro toxicity testing.There are differences in lanthanum nitrate induced HepG2 cell death between simulated one compartment extravascular administration and classic in vitro administration,indicating that different in vitro exposure modes can affect toxicity.