Objective To explore the effects of sacral neuromodulation (SNM) on urodynamic parameters during the storage phase in patients with neurogenic bladder (NB), so as to provide reference for evaluating the efficacy of SNM. Methods A total 49 NB patients undergoing SNM at our hospital during Oct.2012 and May 2025 were enrolled. Baseline data and video-urodynamic parameters were collected. Changes in maximum cystometric capacity, maximum detrusor pressure during storage phase, and bladder compliance before and after treatment were assessed. Improvements in detrusor overactivity (DO) and vesicoureteral reflux (VUR) were also analyzed. Results Among the 49 patients,27 were male and 22 were female, with a mean age of (37.41±15.15) years, a median disease duration of 5.0 (2.0,15.5) years, and a median follow-up of 11 (1,32) months. Up to 37 patients (75.5%) received permanent sacral nerve pulse generator implantation (permanent implant group), while the remaining 12 were classified as the non-permanent implant group. Before and after the test period, all patients showed a significant increase in maximum cystometric capacity [ (218.0 (93.0,358.5) mL vs.300.0 (238.5, 400.0) mL, P<0.001], a decrease in maximum detrusor pressure during the filling phase [32.0 (13.5,71.0) cmH_2 O vs. 20.0 (9.0,50.0) cmH_2 O, P<0.001], and an improvement in bladder compliance [11.8 (8.3,25.6) mL/cmH_2 O vs.26.7 (8.6,44.1) mL/cmH_2O, P<0.001]. In the permanent implant group, comparisons before and after the test period showed an increase in maximum bladder capacity [ (239.16±147.23) mL vs. (312.24±121.83) mL, P<0.001], a decrease in maximum detrusor pressure during filling[32.0 (15.0,58.0) cmH_2 O vs.15.0 (9.0,41.0) cmH_2 O, P<0.05], and improved bladder compliance [10.8 (8.3,23.6) mL/cmH_2 O vs.28.6 (8.6,41.4) mL/cmH_2 O, P<0.001]. No statistically significant differences in these parameters before and after the test period were observed in the non-permanent implant group (P>0.05). A total of 17 patients in the permanent implant group underwent follow-up video urodynamics. Compared to pre-test values, significant improvements were observed in maximum detrusor pressure during filling, and bladder compliance both at the end of the test period and at the last follow-up (P<0.05). However, no statistically significant differences were found in maximum cystometric capacity, maximum detrusor pressure during filling, and bladder compliance between the end of the test period and the last follow-up (P>0.05). Among the 49 patients,21 had DO and 20 had VUR. Both DO and VUR showed improvement after the test period and at the last follow-up. Conclusion SNM can effectively improve storage function in NB patients, ameliorate detrusor overactivity and bladder compliance, and relieve or eliminate VUR in some patients. Long-term follow-up confirms that SNM provides stable therapeutic effects, demonstrating significant clinical value.

Objective To explore the related factors between Helicobacter pylori(Hp)infection and upper gastrointestinal bleeding in the patients with acute myocardial infarction.Methods A total of 180 pa-tients with acute myocardial infarction hospitalized in the department of cardiovascular medicine of Shaanxi Provincial People's Hospital from May 2021 to May 2023 were selected as the study subjects.The general condition of the patients was recorded,the relevant blood biochemical indexes of the patient were recorded,the 3C urea breath test was used to detect Hp,and the expression levels of VEGF,VCAM-1 and CTRP9 were de-termined by ELISA.All study subjects were followed up in 3 months after discharge,and the major adverse cardiac events(MACE)and upper gastrointestinal bleeding events during the follow-up period were recorded.Results Among the 180 study subjects,78 cases(43.33％)were Hp-negative and 102 cases(56.67％)were Hp-positive.The Hb level in Hp-positive patients was lower than that in Hp-negative patients,the levels of IL-6,IL-8,TNF-α,and C-reactive protein were higher than those in Hp-negative patients,and the differences were statistically significant(P＜0.05).The levels of VEGF and VCAM-1 in Hp-positive patients were high-er than those in Hp-negative patients,the level of CTRP9 was lower than that in Hp-negative patients,and the differences were statistically significant(P＜0.05).The results of logistic regression analysis showed that Hb,IL-6,IL-8,TNF-α and C-reactive proteins were the independent influencing factors in predicting Hp infec-tion(P＜0.05).The incidence rate of upper gastrointestinal bleeding events in Hp-positive patients was high-er than that in Hp-negative patients,and the difference was statistically significant(P＜0.05).Hp positivity,Hb and C-reactive protein were the independent influencing factors in predicting the occurrence of upper gas-trointestinal bleeding(P＜0.05).Conclusion The incidence rate of Hp infection in the patients with acute myocardial infarction is high,and the Hp positivity could promote the changes in the levels of various cyto-kines and further aggravate coronary artery injury.Hp infection may increase the incidence rate of upper gas-trointestinal bleeding in the patients with acute myocardial infarction.

Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

Objective To analyze the impact factors on the occurrence of in-hospital adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in elderly patients with coronary heart disease(CHD),and to construct a prediction model in the form of a column-line diagram and to evaluate the effectiveness of the model.Methods The clinical data of 304 elderly coronary heart disease patients who underwent PCI from February 2021 to March 2024 in our hospital were collected.Patients were divided into MACE group(n=81)and non-MACE group(n=223)based on the occurrence of in-hospital MACE.The optimal cutoff values of each fac-tor were obtained by receiver operating characteristic(ROC)curve analysis.Logistic multiple regression modeling was used to investigate the risk factors of in-hospital MACE after PCI in elderly patients with CHD and a predictive model with columnar graphs was constructed.The correction curve was used for the internal validation of the column chart model and the decision curve was used for evaluating the pre-diction efficacy of the column chart model.Results The proportion of angina pectoris,Gensini score,the proportion of the implanted stent number＞2,and the levels of PAG,Scr,hs-CRP,Lp-PLA2 and Lp(a)were higher in the MACE group than in the non MACE group,and the difference was statistically significant(P＜0.05).The results of ROC curve analysis showed that the optimal cut-off val-ues for Gensini integral,PAG,Scr,hs-CRP,Lp-PLA2 and Lp(a)were 21 points,38.64％,96.92μmol/L,8.56mg/L,247.67μg/L and 475.14mg/L,respectively.The results of Logistic multiple regression modeling showed that the number of implanted stents,Gensi-ni score,PAG,Scr,hs-CRP,Lp-PLA2 and Lp(a)were risk factors for the occurrence of in-hospital MACE after PCI in elderly pa-tients with CHD.Internal validation shows that the C-index of the column-line graph model constructed in this study was 0.991(0.982-0.999).The observed values aligned well with the predicted values.The column-line diagram model with a threshold＞0.08 provided net clinical benefits above the number of implanted stent,Gensini score,PAG,Scr,hs-CRP,Lp-PLA2 and Lp(a).Conclu-sion In this study,the column-line graph prediction model constructed based on the number of implantated stent,Gensini score,PAG,Scr,hs-CRP,Lp-PLA2 and Lp(a)had good predictive value for the occurrence of in-hospital MACE after PCI in elderly patients with CHD,which may provide a basis for targeted clinical interventions to reduce the occurrence of in-hospital MACE.

Patients with metastatic castration-resistant prostate cancer (mCRPC) face poor prognoses due to tumor heterogeneity and drug resistance. Antibody-drug conjugates (ADCs) have been under development for over two decades for mCRPC treatment. Several clinical trials have demonstrated promising antitumor activity and acceptable safety profiles for ADCs in this setting. Among prostate-specific membrane antigen (PSMA)-targeted ADCs, ARX517 demonstrates superior safety and more significant prostate-specific antigen (PSA) reductions compared to earlier agents such as MLN2704, PSMA-ADC, and MEDI3726. ADCs targeting B7-H3, such as MGC018 and DB-1311, have also shown antitumor activity. ADCs targeting other antigens, including six-transmembrane epithelial antigen of the prostate (STEAP)1 (DSTP3086S), trophoblast cell surface antigen (TROP)2 (sacituzumab govitecan), and solute carrier (SLC) 44A4 (ASG-5ME), have shown preliminary antitumor activity in early trials but face challenges with insufficient efficacy or toxicity. Tisotumab vedotin (targeting tissue factor) has shown no significant therapeutic response in mCRPC. Meanwhile, disitamab vedotin (HER2-targeted), ABBV-969 and DXC008 (both dual PSMA/STEAP1-targeted) are currently under evaluation. Notably, an international multicenter phase Ⅲ clinical trial (NCT06925737) for mCRPC has been initiated in May 2025 for evaluating B7-H3-targeted ADC ifinatamab deruxtecan. This review summarizes recent advances in ADCs targeting key antigens in mCRPC (including PSMA, B7-H3, STEAP1, TROP2, SLC44A4, and others) and explores combination strategies, offering insights to inform the clinical management of mCRPC.
Humans ; Prostatic Neoplasms, Castration-Resistant/pathology* ; Male ; Immunoconjugates/therapeutic use* ; Glutamate Carboxypeptidase II/immunology* ; Antibodies, Monoclonal, Humanized/therapeutic use* ; B7 Antigens/immunology* ; Neoplasm Metastasis ; Prostate-Specific Antigen ; Antigens, Neoplasm/immunology* ; Antigens, Surface ; Camptothecin/analogs & derivatives* ; Oxidoreductases

Objective:To explore the safety and efficacy of intraosseous regional administration (IORA) of vancomycin for preventing infection in primary total knee arthroplasty (TKA).Methods:A total of 124 patients with knee osteoarthritis undergoing TKA between February 2024 and May 2024 at nine hospitals were enrolled. Preoperative infection prophylaxis involved either IORA (0.5 g vancomycin administered via intraosseous regional infusion before incision) or intravenous infusion (1 g vancomycin via peripheral vein). The IORA group included 15 males and 47 females with a median age of 66.5 years (range, 60.0-70.0 years), while the intravenous group included 14 males and 48 females with a median age of 66.0 years (range, 61.8-70.3 years) years. Intraoperative samples were collected including fat and synovium tissues after incision, before prosthesis placement, and after tourniquet release; distal femoral cancellous bone during femoral osteotomy; proximal tibial cancellous bone during tibial osteotomy; proximal intercondylar cancellous bone before prosthesis placement; and peripheral blood from non-infused arms at surgery initiation and after tourniquet release. Vancomycin concentrations were measured using liquid chromatography-tandem mass spectrometry. Vital sign changes were recorded from admission to 5~10 minutes post-IORA (IORA group) or post-incision (intravenous group). Follow-ups were conducted on postoperative day 1 and 3, and at 1 and 3 months, to document complications including IORA-related adverse events, periprosthetic joint infections, surgical site infections, red man syndrome, acute kidney injury, deep vein thrombosis and so on.Results:Vancomycin concentrations in bone, fat, and synovial tissue samples were significantly higher in the IORA group than in the intravenous group ( P<0.05), while vancomycin concentrations in blood samples were significantly lower in the IORA group than in the intravenous group ( P<0.05). Only 7.3%(41/558) of tissue samples in the IORA group had vancomycin concentrations below 2.0 μg/g (the minimum inhibitory concentration of vancomycin against coagulase-negative staphylococcus), compared to 59.3%(331/558) in the intravenous group (χ 2=11.285, P<0.001). In the intravenous group, 16.9%(21/124) of blood samples had vancomycin concentrations exceeding 15.0 mg/L (the threshold associated with a significantly increased risk of nephrotoxicity), while all concentrations in the IORA group were below this threshold, the difference was statistically significant (χ 2=22.943, P<0.001). There were no statistically significant difference ( P>0.05) in vital signs changes before and after vancomycin administration between the two groups. Two patients in the intravenous group experienced incision exudate, while no other related complications occurred in either group. Conclusions:Compared to the traditional intravenous infusion of 1 g vancomycin, intraosseous injection of a low dose (0.5 g) of vancomycin achieves higher local tissue concentrations in the knee joint with a lower incidence of adverse reactions and is safe for infection prophylaxis. Despite guidelines not recommending the routine use of vancomycin for preventing infection after primary TKA, intraosseous injection of 0.5 g vancomycin may be considered intraoperatively for primary TKA in the following scenarios: patients in medical institutions with a high prevalence of methicillin-resistant staphylococcus aureus (MRSA) infections, patients with potential preoperative MRSA colonization, or patients with cephalosporin allergy.

Objective To analyze the impact factors on the occurrence of in-hospital adverse cardiovascular events(MACE)after percutaneous coronary intervention(PCI)in elderly patients with coronary heart disease(CHD),and to construct a prediction model in the form of a column-line diagram and to evaluate the effectiveness of the model.Methods The clinical data of 304 elderly coronary heart disease patients who underwent PCI from February 2021 to March 2024 in our hospital were collected.Patients were divided into MACE group(n=81)and non-MACE group(n=223)based on the occurrence of in-hospital MACE.The optimal cutoff values of each fac-tor were obtained by receiver operating characteristic(ROC)curve analysis.Logistic multiple regression modeling was used to investigate the risk factors of in-hospital MACE after PCI in elderly patients with CHD and a predictive model with columnar graphs was constructed.The correction curve was used for the internal validation of the column chart model and the decision curve was used for evaluating the pre-diction efficacy of the column chart model.Results The proportion of angina pectoris,Gensini score,the proportion of the implanted stent number＞2,and the levels of PAG,Scr,hs-CRP,Lp-PLA2 and Lp(a)were higher in the MACE group than in the non MACE group,and the difference was statistically significant(P＜0.05).The results of ROC curve analysis showed that the optimal cut-off val-ues for Gensini integral,PAG,Scr,hs-CRP,Lp-PLA2 and Lp(a)were 21 points,38.64％,96.92μmol/L,8.56mg/L,247.67μg/L and 475.14mg/L,respectively.The results of Logistic multiple regression modeling showed that the number of implanted stents,Gensi-ni score,PAG,Scr,hs-CRP,Lp-PLA2 and Lp(a)were risk factors for the occurrence of in-hospital MACE after PCI in elderly pa-tients with CHD.Internal validation shows that the C-index of the column-line graph model constructed in this study was 0.991(0.982-0.999).The observed values aligned well with the predicted values.The column-line diagram model with a threshold＞0.08 provided net clinical benefits above the number of implanted stent,Gensini score,PAG,Scr,hs-CRP,Lp-PLA2 and Lp(a).Conclu-sion In this study,the column-line graph prediction model constructed based on the number of implantated stent,Gensini score,PAG,Scr,hs-CRP,Lp-PLA2 and Lp(a)had good predictive value for the occurrence of in-hospital MACE after PCI in elderly patients with CHD,which may provide a basis for targeted clinical interventions to reduce the occurrence of in-hospital MACE.

Objective:To investigate the incidence and influencing factors of allergic reactions to cephalosporins.Methods:A cross-sectional study of 29 medical institutions in Zhejiang Province was conducted from April 2021 to June 2021.The incidence of allergic reactions to cephalosporins was investigated,and the influencing factors of cephalosporin-induced allergic reactions were analyzed by Poisson regression.Results:A total of 56 155 patients were included in this study.The total incidence of allergic reactions to cephalosporin was 1.67‰,the highest incidence of anaphylaxis occurred for ceftizoxime(4.27‰),followed by ceftriaxone(3.49‰)and cefotaxime(2.40‰).There was no significant difference in the incidence of allergic reactions between patients with negative skin tests and those without skin tests(1.75％o vs.1.63‰,RR=1.07,95％CI:0.70-1.63,P＞0.05).Poisson regression showed that body mass index(BMI)＜18.5 kg/m2(RR=2.43,95％CI:1.23-4.82,P＜0.05)and history of β-lactam antibiotics allergy(RR=33.88,95％CI:1.47-781.12,P＜0.05)increased cephalosporin-induced anaphylaxis.Compared with cefuroxime,the risk of allergic reactions was increased for ceftriaxone(RR=3.08,95％CI:1.70-5.59,P＜0.01),ceftazidime(RR=1.89,95％CI:1.03-3.47,P＜0.05),and ceftizoxime(RR=3.74,95％CI:1.64-8.50,P＜0.01).Conclusions:Lower BMI and history of β-lactam antibiotics allergy increase the risk of cephalosporin allergic reactions.The routine skin test may not reduce the occurrence of allergic reactions to cephalosporins. This study has been registered at Chinese Clinical Trial Registry(ChiCTR2200064314).

Objective:To systematically evaluate of the efficacy and safety of Tip-flexible suction ureteral access sheath and ordinary ureteral access sheath combined with flexible ureteroscopy to treat upper urinary tract stones.Methods:The databases CNKI, Wanfang, VIP, CBM, PubMed, Cochrane, Embase, Web of Science, MEDLINE and Google Scholar were searched from their inception to May 31, 2024 for related studies about Tip-flexible suction ureteral access sheath compared with ordinary ureteral sheath combined with flexible ureteroscopy to treat upper urinary tract stones. Literature screening and data extraction were performed independently by two researchers, the quality assessment of randomized controlled trials was assessed using the Cochrane risk of bias assessment scale, the Newcastle-Ottawa risk of bias assessment scale was used to assess the quality of retrospective studies, and finally Meta-analysis of data was conducted using Review Manager 5.3 software.Results:A total of 14 literatures involving 1947 patients with upper urinary tract stones (1017 in the Tip-flexible suction sheath group and 930 in the ordinary sheath group) were included. Meta-analysis showed that the stone free rate of the Tip-flexible suction sheath group was higher than that of the ordinary sheath group (immediate postoperative stone free rate 80.7% vs. 60.0%, OR = 3.04, 95% CI 2.30-4.03, P<0.05; 1 month after surgery stone free rate 94.4% vs. 79.4%, OR=4.39, 95% CI 3.12-6.19, P<0.05). The total complication rate of the Tip-flexible suction sheath group was lower than that of the ordinary sheath group (5.4% vs. 17.3%, OR=0.29, 95% CI 0.21~0.40, P<0.05). There was no significant difference in the decrease of hemoglobin level between the Tip-flexible suction sheath group and the ordinary sheath group at 1 day after surgery( MD=-0.30, 95% CI -2.61-2.02, P>0.05). The postoperative fever in the Tip-flexible suction sheath group was less than that in the ordinary sheath group (1.9% vs. 7.5%, OR=0.28, 95% CI 0.15-0.54, P<0.05). There was no significant difference in operation time between the Tip-flexible suction sheath group and the ordinary sheath group( MD=-4.93, 95% CI -11.48-1.62, P>0.05). The postoperative hospital stay in the Tip-flexible suction sheath group was shorter than that in the ordinary sheath group ( MD=-0.20, 95% CI -0.25--0.16, P <0.05). Conclusions:Compared with ordinary ureteral access sheath combined with flexible ureteroscope to treat upper urinary tract stones, Tip-flexible suction ureteral access sheath has a higher stone free rate, less postoperative fever, low total complication rate, shorter postoperative hospital stay, which is conducive to postoperative recovery and is safer and more effective.

Objective:To systematically evaluate of the efficacy and safety of Tip-flexible suction ureteral access sheath and ordinary ureteral access sheath combined with flexible ureteroscopy to treat upper urinary tract stones.Methods:The databases CNKI, Wanfang, VIP, CBM, PubMed, Cochrane, Embase, Web of Science, MEDLINE and Google Scholar were searched from their inception to May 31, 2024 for related studies about Tip-flexible suction ureteral access sheath compared with ordinary ureteral sheath combined with flexible ureteroscopy to treat upper urinary tract stones. Literature screening and data extraction were performed independently by two researchers, the quality assessment of randomized controlled trials was assessed using the Cochrane risk of bias assessment scale, the Newcastle-Ottawa risk of bias assessment scale was used to assess the quality of retrospective studies, and finally Meta-analysis of data was conducted using Review Manager 5.3 software.Results:A total of 14 literatures involving 1947 patients with upper urinary tract stones (1017 in the Tip-flexible suction sheath group and 930 in the ordinary sheath group) were included. Meta-analysis showed that the stone free rate of the Tip-flexible suction sheath group was higher than that of the ordinary sheath group (immediate postoperative stone free rate 80.7% vs. 60.0%, OR = 3.04, 95% CI 2.30-4.03, P<0.05; 1 month after surgery stone free rate 94.4% vs. 79.4%, OR=4.39, 95% CI 3.12-6.19, P<0.05). The total complication rate of the Tip-flexible suction sheath group was lower than that of the ordinary sheath group (5.4% vs. 17.3%, OR=0.29, 95% CI 0.21~0.40, P<0.05). There was no significant difference in the decrease of hemoglobin level between the Tip-flexible suction sheath group and the ordinary sheath group at 1 day after surgery( MD=-0.30, 95% CI -2.61-2.02, P>0.05). The postoperative fever in the Tip-flexible suction sheath group was less than that in the ordinary sheath group (1.9% vs. 7.5%, OR=0.28, 95% CI 0.15-0.54, P<0.05). There was no significant difference in operation time between the Tip-flexible suction sheath group and the ordinary sheath group( MD=-4.93, 95% CI -11.48-1.62, P>0.05). The postoperative hospital stay in the Tip-flexible suction sheath group was shorter than that in the ordinary sheath group ( MD=-0.20, 95% CI -0.25--0.16, P <0.05). Conclusions:Compared with ordinary ureteral access sheath combined with flexible ureteroscope to treat upper urinary tract stones, Tip-flexible suction ureteral access sheath has a higher stone free rate, less postoperative fever, low total complication rate, shorter postoperative hospital stay, which is conducive to postoperative recovery and is safer and more effective.