BACKGROUND: Death burden of stroke is severe with over one-third rural residents in China, but there is still a lack of specific national and high-quality reports on the urban-rural differences in stroke burden, especially for subtypes. We aimed to update the understanding of urban-rural differences in stroke deaths. METHODS: This is a descriptive observational study. Data from the national mortality surveillance system, which covers 323.8 million with 605 disease surveillance points (DSPs) across all 31 provinces, municipalities, and autonomous regions in China. All deaths from stroke as the underlying cause from 2015 to 2020 according to DSPs. Crude mortality rate and age-standardized mortality rate (ASMR) were estimated through DSPs. Average annual percentage change was used to explain the change in mortality rate. RESULTS: From 2015 to 2020, the majority of deaths from all stroke subtypes occurred in rural areas. There were significant differences between the changes of urban and rural ASMRs. On the whole, the changes in urban areas were evidently better, and the ASMR differences were basically expanding. Stroke ASMR in urban China decreased by 15.5%. The rural ASMR of ischemic stroke increased by 12.9%. The rural and urban ASMRs of intracerebral hemorrhage decreased by 24.9% and 27.4%, and those of subarachnoid hemorrhage decreased by 29.5% and 40.4%, respectively. The highest ASMRs of all stroke subtypes and the increasing trend of ischemic stroke ASMR make rural males the focus of stroke management. CONCLUSIONS The death burden of stroke varies greatly between urban and rural China. Rural residents face unique challenges.
Humans ; China/epidemiology* ; Stroke/mortality* ; Rural Population/statistics & numerical data* ; Male ; Female ; Urban Population/statistics & numerical data* ; Middle Aged ; Aged ; Aged, 80 and over ; Adult

Objective:To explore the safety and short-term efficacy of single-port robotic transanal total mesorectal excision (SPr-taTME).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of six patients who underwent SPr-taTME at Daping Hospital of Army Medical University from October to November 2024 were collected. There were 3 males and 3 females, aged (65±5)years. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represen-ted as Mean± SD, measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Intraoperative situations. All patients successfully underwent SPr-taTME without conversion to laparotomy or blood transfusion. There was no intraoperative complication such as accidental hemorrhage or adjacent organ injury. No intra-operative adverse events or mortality occurred. The operation time of the 6 patients was 286(range, 240?400)minutes. The time of transanal platform setup and robotic docking was (21±10)minutes, transanal dissection time was (97±45)minutes, and transabdominal dissection time was (90±35)minutes. The volume of intraoperative blood loss was (47±14)mL. Among the six patients, 1 case underwent synchronous transanal and transabdominal surgery, while 5 cases underwent non-synchronous procedures. Specimens were extracted transanally in 5 cases and via an auxiliary abdominal incision in 1 case. The single-port robotic platform was utilized for the abdominal surgery in 3 cases, while laparoscopy was used in 3 cases. Splenic flexure mobilization was performed in 3 cases and omitted in the other 3 cases. Three patients underwent hand-sewn sigmoid colon-anal anastomosis, 1 case underwent modified Bacon pull-through anastomosis, 1 case received stapled sigmoidorectal anastomosis, 1 case underwent sigmoid colostomy without anastomosis due to significant bowel edema. Two cases didn′t undergo intestinal stoma, 2 cases underwent virtual ileostomy, 1 case underwent ileostomy, and 1 case underwent sigmoid colostomy. (2) Postoperative situations. All patients started water drinking and out‐of‐bed activities on postoperative day 1 and liquid diet intake on postoperative day 2. The time to postoperative first flatus was 1(range, 1?3)days, and duration of postoperative hospital stay was (8±2)days.The total number of lymph nodes dissected was 13±2, with the number of positive lymph nodes as 0(range, 0?3) and the distance of distal resection margin as (23±8)mm. Pathological examination of 6 patients showed 1 case in stage T1N0, 2 cases in stage ypT0N0, 1 case in ypT1N0, 1 case in ypT3N1, and 1 case in ypT0N1. The degree of mesorectal integrity was complete in 5 patients and nearly complete in 1 patient. The surgical specimens of 6 patients showed negative in distal, proximal and circumferential margin. (3) Follow-up. All 6 patients completed the 30-day postoperative follow-up. None of the patients experienced postoperative complication such as bleeding, intestinal obstruction or anastomotic leakage. There was no readmission within 30 days after surgery. Digital rectal examination or colonoscopy on postoperative 30 day confirmed no anastomosis-related complications, including stenosis, dehiscence or anastomotic leakage. All 6 patients survived.Conclusion:The SPr-taTME is safe and feasible, with satisfactory short-term efficacy.

Objective:To analyze the changes and significance in clinical cardiac indicators of early cardiac myocardial dysfunction and cardiac substructure dose during conventional radiotherapy for N 2-N 3 non-small cell lung cancer (NSCLC) with mediastinal lymph node metastases. Methods:The data of 34 NSCLC patients with lymph node metastases in regions 4-8 admitted to the Affiliated Cancer Hospital of Guizhou Medical University from June 2022 to August 2023 were observed and analyzed. All patients were treated with volumetric modulated arc therapy with a prescribed dose of 60-70 Gy. Cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) were measured at 6 time points: within 1 week before radiotherapy ( t0); when the cumulative radiotherapy dose reaches 20 Gy ( t20), 40 Gy ( t40), 60 Gy ( t60) during radiotherapy; within 1 week after radiotherapy ( tp); 1 month after radiotherapy( tp1). Left ventricular global longitudinal strain (LVGLS) and left atrial global longitudinal strain (LAGLS) were assessed at 4 time points: t0, t40, tp and tp1, respectively. The changes in cardiac indicators at different time points during radiotherapy and their correlation with substructure doses were analyzed using analysis of variance, linear regression analysis, and Pearson correlation. Results:The correlation between cardiac substructure dose and mean heart dose (MHD) in the study cohort in the descending order was as follows: left ventricle ( B=0.43, P<0.001), right ventricle ( B=0.37, P=0.002), left atrium ( B=0.16, P<0.001), and right atrium ( B=0.15, P=0.001). There were significant differences in the changes of LVGLS and LAGLS across different time points ( F=3.13, P=0.029; F=17.18, P<0.001). At 1 month after radiation, LAGLS was significantly decreased compared to pre-radiation levels ( P=0.009), whereas no significant difference was observed in LVGLS ( P=1.000). No significant differences were observed in the changes of cTnT and NT-proBNP across different time points (all P>0.05). Significant correlations were identified between cTnT and right ventricle mean dose at t40 ( r=0.38, P=0.025), as well as between NT-proBNP and right atrium mean dose at t60 and tp ( r=0.54, P=0.001; r=0.41, P=0.016). Conclusions:At present, there is no significant difference between the sensitive serum markers of myocardial injury and LVGLS in detecting early myocardial injury. LAGLS may hold substantial clinical value. There is uncertainty about radiation injury and repair of various cardiac substructures.

This study evaluates the safety and early clinical outcomes of a novel 3D-printed titanium alloy "sleeve" component for revising fractured femoral stem prostheses in distal femoral megaprostheses without removing the fractured stem. The six patients included 2 males and 4 females, with an age range of 8-57 years. They were treated at Peking University People's Hospital between August 2020 and December 2023 and underwent revision surgery using the customized sleeve. A self-designed 3D-printed titanium alloy "sleeve" component was used for revision without removing the fractured stem, in the form of an external sleeve around the stem. Postoperative imaging was performed every three months to assess implant stability and bone integration. Functional outcomes were evaluated using the Musculoskeletal Tumor Society (MSTS)-93 score. All six patients successfully completed the surgery and follow-up, with surgical durations ranging from 120 to 230 minutes and intraoperative blood loss ranging from 150 to 800 ml. The follow-up period ranged from 6 to 46 months. At three months postoperatively, X-ray and CT imaging showed cortical bridging between the host bone and the "sleeve" component. By six months, full integration of the host cortical bone with the metal trabecular interface of the "sleeve" was observed. At the final follow-up, MSTS-93 scores ranged from 26 to 29 points, with no complications such as wound healing issues, implant loosening, fracture, infection, or degenerative arthritis. These findings suggest that 3D-printed titanium "sleeve" provide an effective, bone-preserving solution for femoral stem revision in oncologic megaprostheses, leading to favorable early stability and functional recovery.

Objective:To evaluate the effect of esketamine on caspase-11-mediated non-canonical pathway pyroptosis in sepsis-induced acute lung injury in rats.Methods:Eighteen SPF healthy Sprague-Dawley rats, aged 8-12 weeks, weighing 280-320 g, were divided into 3 groups ( n=6 each) using a random number table method: sham operation group (Sham group), cecal ligation and puncture (CLP) group and CLP+ esketamine group (CLP+ ES group). Sepsis was induced by CLP in anesthetized animals. Esketamine 10 mg/kg was injected via the tail vein immediately after development of the model, and the equal volume of normal saline was injected via the tail vein in the other two groups. At 24 h after development of the model, the rats were sacrificed under anesthesia, and the lung tissues and blood samples were taken. The wet to dry lung weight ratio (W/D ratio) was calculated, and the pathological changes were observed and the lung injury was scored. The expression of caspase-11, gasdermin D-N (GSDMD-N), phosphorylated phosphatidylinositol 3-kinase (p-PI3K) and phosphorylated protein kinase B (p-AKT) was detected by Western blot. The expression of caspase-11 and GSDMD-N mRNA was detected by quantitative real-time polymerase chain reaction. The serum concentration of interleukin-1β (IL-1β) was determined by enzyme-linked immunosorbent assay. Results:Compared with Sham group, the lung injury score and W/D ratio were significantly increased, the expression of caspase-11 and GSDMD-N protein and mRNA was up-regulated, the expression of p-PI3K and p-AKT was down-regulated, and the concentration of IL-1β was increased in CLP group ( P<0.05). Compared with CLP group, the lung injury score and W/D ratio were significantly decreased, the expression of caspase-11 and GSDMD-N protein and mRNA was down-regulated, the expression of p-PI3K and p-AKT was up-regulated, and the concentration of IL-1β was decreased in CLP+ ES group ( P<0.05). Conclusions:The mechanism by which esketamine alleviates sepsis-induced acute lung injury may be related to the inhibition of caspase-11-mediated non-canonical pathway pyroptosis in rats.

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.

This study evaluates the safety and early clinical outcomes of a novel 3D-printed titanium alloy "sleeve" component for revising fractured femoral stem prostheses in distal femoral megaprostheses without removing the fractured stem. The six patients included 2 males and 4 females, with an age range of 8-57 years. They were treated at Peking University People's Hospital between August 2020 and December 2023 and underwent revision surgery using the customized sleeve. A self-designed 3D-printed titanium alloy "sleeve" component was used for revision without removing the fractured stem, in the form of an external sleeve around the stem. Postoperative imaging was performed every three months to assess implant stability and bone integration. Functional outcomes were evaluated using the Musculoskeletal Tumor Society (MSTS)-93 score. All six patients successfully completed the surgery and follow-up, with surgical durations ranging from 120 to 230 minutes and intraoperative blood loss ranging from 150 to 800 ml. The follow-up period ranged from 6 to 46 months. At three months postoperatively, X-ray and CT imaging showed cortical bridging between the host bone and the "sleeve" component. By six months, full integration of the host cortical bone with the metal trabecular interface of the "sleeve" was observed. At the final follow-up, MSTS-93 scores ranged from 26 to 29 points, with no complications such as wound healing issues, implant loosening, fracture, infection, or degenerative arthritis. These findings suggest that 3D-printed titanium "sleeve" provide an effective, bone-preserving solution for femoral stem revision in oncologic megaprostheses, leading to favorable early stability and functional recovery.

Objective:To evaluate the effect of esketamine on caspase-11-mediated non-canonical pathway pyroptosis in sepsis-induced acute lung injury in rats.Methods:Eighteen SPF healthy Sprague-Dawley rats, aged 8-12 weeks, weighing 280-320 g, were divided into 3 groups ( n=6 each) using a random number table method: sham operation group (Sham group), cecal ligation and puncture (CLP) group and CLP+ esketamine group (CLP+ ES group). Sepsis was induced by CLP in anesthetized animals. Esketamine 10 mg/kg was injected via the tail vein immediately after development of the model, and the equal volume of normal saline was injected via the tail vein in the other two groups. At 24 h after development of the model, the rats were sacrificed under anesthesia, and the lung tissues and blood samples were taken. The wet to dry lung weight ratio (W/D ratio) was calculated, and the pathological changes were observed and the lung injury was scored. The expression of caspase-11, gasdermin D-N (GSDMD-N), phosphorylated phosphatidylinositol 3-kinase (p-PI3K) and phosphorylated protein kinase B (p-AKT) was detected by Western blot. The expression of caspase-11 and GSDMD-N mRNA was detected by quantitative real-time polymerase chain reaction. The serum concentration of interleukin-1β (IL-1β) was determined by enzyme-linked immunosorbent assay. Results:Compared with Sham group, the lung injury score and W/D ratio were significantly increased, the expression of caspase-11 and GSDMD-N protein and mRNA was up-regulated, the expression of p-PI3K and p-AKT was down-regulated, and the concentration of IL-1β was increased in CLP group ( P<0.05). Compared with CLP group, the lung injury score and W/D ratio were significantly decreased, the expression of caspase-11 and GSDMD-N protein and mRNA was down-regulated, the expression of p-PI3K and p-AKT was up-regulated, and the concentration of IL-1β was decreased in CLP+ ES group ( P<0.05). Conclusions:The mechanism by which esketamine alleviates sepsis-induced acute lung injury may be related to the inhibition of caspase-11-mediated non-canonical pathway pyroptosis in rats.

Objective:To explore the safety and short-term efficacy of single-port robotic transanal total mesorectal excision (SPr-taTME).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of six patients who underwent SPr-taTME at Daping Hospital of Army Medical University from October to November 2024 were collected. There were 3 males and 3 females, aged (65±5)years. Observation indicators: (1) intraoperative situations; (2) postoperative situations; (3) follow-up. Measurement data with normal distribution were represen-ted as Mean± SD, measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers. Results:(1) Intraoperative situations. All patients successfully underwent SPr-taTME without conversion to laparotomy or blood transfusion. There was no intraoperative complication such as accidental hemorrhage or adjacent organ injury. No intra-operative adverse events or mortality occurred. The operation time of the 6 patients was 286(range, 240?400)minutes. The time of transanal platform setup and robotic docking was (21±10)minutes, transanal dissection time was (97±45)minutes, and transabdominal dissection time was (90±35)minutes. The volume of intraoperative blood loss was (47±14)mL. Among the six patients, 1 case underwent synchronous transanal and transabdominal surgery, while 5 cases underwent non-synchronous procedures. Specimens were extracted transanally in 5 cases and via an auxiliary abdominal incision in 1 case. The single-port robotic platform was utilized for the abdominal surgery in 3 cases, while laparoscopy was used in 3 cases. Splenic flexure mobilization was performed in 3 cases and omitted in the other 3 cases. Three patients underwent hand-sewn sigmoid colon-anal anastomosis, 1 case underwent modified Bacon pull-through anastomosis, 1 case received stapled sigmoidorectal anastomosis, 1 case underwent sigmoid colostomy without anastomosis due to significant bowel edema. Two cases didn′t undergo intestinal stoma, 2 cases underwent virtual ileostomy, 1 case underwent ileostomy, and 1 case underwent sigmoid colostomy. (2) Postoperative situations. All patients started water drinking and out‐of‐bed activities on postoperative day 1 and liquid diet intake on postoperative day 2. The time to postoperative first flatus was 1(range, 1?3)days, and duration of postoperative hospital stay was (8±2)days.The total number of lymph nodes dissected was 13±2, with the number of positive lymph nodes as 0(range, 0?3) and the distance of distal resection margin as (23±8)mm. Pathological examination of 6 patients showed 1 case in stage T1N0, 2 cases in stage ypT0N0, 1 case in ypT1N0, 1 case in ypT3N1, and 1 case in ypT0N1. The degree of mesorectal integrity was complete in 5 patients and nearly complete in 1 patient. The surgical specimens of 6 patients showed negative in distal, proximal and circumferential margin. (3) Follow-up. All 6 patients completed the 30-day postoperative follow-up. None of the patients experienced postoperative complication such as bleeding, intestinal obstruction or anastomotic leakage. There was no readmission within 30 days after surgery. Digital rectal examination or colonoscopy on postoperative 30 day confirmed no anastomosis-related complications, including stenosis, dehiscence or anastomotic leakage. All 6 patients survived.Conclusion:The SPr-taTME is safe and feasible, with satisfactory short-term efficacy.

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.