Objective:To investigate the clinicopathological characteristics and diagnostic criteria of cutaneous melanocytic tumor with CRTC1::TRIM11 fusion (CMTCT), and to improve understanding of this entity.Methods:The clinical features, histology, immunohistochemistry (IHC) and molecular characteristics of 3 CMTCT cases were analyzed, supplemented by a literature review.Results:All patients were female, aged 53, 46 and 46 years, respectively. Grossly, the lesions presented as dermal/subcutaneous nodules protruding from the skin surface. Histologically, tumor cells were arranged in nested and fascicular patterns separated by delicate fibrous septa. Tumor cell infiltration was observed in the epidermis of case 1, but not in that of cases 2 and 3. Tumor cells exhibited epithelioid, spindle-shaped, or oval morphology, with eosinophilic or pale cytoplasm and mild to moderate nuclear atypia. Tumor mitotic figure was <5/10 HPF. Scant melanin pigment was observed in case 2. IHC demonstrated diffuse and strong positivity for SOX-10, S-100 protein and MITF. HMB45 was negative in two cases (case 1 and case 3) and focally positive in case 2; Melan A was negative in two cases (case 1 and case 3) and partially positive in case 2. The Ki-67 proliferation index was approximately 5%-8%. Molecular analysis revealed CRTC1::TRIM11 fusion in three cases via RNA sequencing, and CRTC1 rearrangement in two cases (case 1 and case 3) via fluorescence in situ hybridization.Conclusions:CMTCT shares histological and immunophenotypic features with melanoma and clear cell sarcoma but is defined by the presence of CRTC1::TRIM11 fusion, necessitating molecular confirmation for definitive diagnosis. Complete excision with clear margins is recommended. While most of the CMTCTs exhibit indolent biological behaviors, rare cases may recur locally or metastasize, warranting close follow-up.

Objective:To investigate the clinicopathological characteristics and diagnostic criteria of cutaneous melanocytic tumor with CRTC1::TRIM11 fusion (CMTCT), and to improve understanding of this entity.Methods:The clinical features, histology, immunohistochemistry (IHC) and molecular characteristics of 3 CMTCT cases were analyzed, supplemented by a literature review.Results:All patients were female, aged 53, 46 and 46 years, respectively. Grossly, the lesions presented as dermal/subcutaneous nodules protruding from the skin surface. Histologically, tumor cells were arranged in nested and fascicular patterns separated by delicate fibrous septa. Tumor cell infiltration was observed in the epidermis of case 1, but not in that of cases 2 and 3. Tumor cells exhibited epithelioid, spindle-shaped, or oval morphology, with eosinophilic or pale cytoplasm and mild to moderate nuclear atypia. Tumor mitotic figure was <5/10 HPF. Scant melanin pigment was observed in case 2. IHC demonstrated diffuse and strong positivity for SOX-10, S-100 protein and MITF. HMB45 was negative in two cases (case 1 and case 3) and focally positive in case 2; Melan A was negative in two cases (case 1 and case 3) and partially positive in case 2. The Ki-67 proliferation index was approximately 5%-8%. Molecular analysis revealed CRTC1::TRIM11 fusion in three cases via RNA sequencing, and CRTC1 rearrangement in two cases (case 1 and case 3) via fluorescence in situ hybridization.Conclusions:CMTCT shares histological and immunophenotypic features with melanoma and clear cell sarcoma but is defined by the presence of CRTC1::TRIM11 fusion, necessitating molecular confirmation for definitive diagnosis. Complete excision with clear margins is recommended. While most of the CMTCTs exhibit indolent biological behaviors, rare cases may recur locally or metastasize, warranting close follow-up.

Objective:To investigate the correlation between bladder mucosal smoothness (BMS) and early urinary continence recovery following laparoscopic radical prostatectomy (LRP).Methods:A retrospective analysis was conducted on the clinical data of 192 prostate cancer patients who underwent LRP at Peking University Third Hospital between January 2016 and March 2020. The patients' average age was (69.1±8.0) years old, and the median pre-biopsy PSA level was 12.23 (7.45, 20.36) ng/ml. There were 69 patients (35.9%) with a Gleason score <7 and 123 patients (64.1%) with a Gleason score ≥7. Clinical staging showed that 92 patients (47.9%) were in stage T 1/T 2, and 100 patients (52.1%) were in stage T 3. All patients underwent MRI before prostate biopsy. The preoperative MRI measured the prostate volume (PV) as 35.4 (26.3, 51.1) ml, and membranous urethral length (MUL) as (13.9±3.5) mm. The intravesical prostatic protrusion length (IPPL) was <5 mm in 128 patients (66.7%) and ≥5 mm in 64 patients (33.3%). All patients completed MRI examination before biopsy, BMS was defined into four grades according to MRI: grade 0, the bladder mucosa is completely smooth; grade 1, a small amount of unevenness and bumps can be seen in the bladder mucosa; grade 2, fissures can be seen in the bladder mucosa, less than half of the bladder wall, or bladder diverticulum; grade 3, the bladder fissure exceeds half of the bladder wall, or fissure progresses to a small loss of muscularis. In this study, there were 63 patients (32.8%) with grade 0, 95 patients (49.5%) with grade 1, and 34 patients (17.7%) with grade 2-3. Postoperatively, patients were followed up monthly from the first month onwards to assess urinary continence recovery, defined as not requiring pads throughout the day. Logistic multivariate regression analysis was used to identify risk factors affecting early postoperative urinary continence recovery, and log-rank test was used to compare postoperative urinary continence recovery curves among different groups. Results:All surgeries were successfully completed. The complete urinary continence rates at 1, 3, 6, and 12 months postoperatively were 40.1% (77/192), 57.8% (111/192), 71.9% (138/192), and 90.1% (173/192), respectively.In the univariate analysis of urinary incontinence, the proportion of urinary incontinence was lower in patients with PV <40 ml than that in patients with PV ≥40 ml [33.0% (38/115) vs. 55.8% (43/77), P<0.05]. The proportion of urinary incontinence in patients with maximum urethral length (MUL) <14 mm was higher than that in patients with MUL ≥14 mm [75.7% (56/74) vs. 21.2% (25/118), P<0.05]. The proportion of urinary incontinence in patients with the interpubic prostate length (IPPL) <5 mm was lower than that in patients with IPPL ≥5 mm [26.6% (34/128) vs. 73.4% (47/64), P<0.05]. The proportion of urinary incontinence was lower in the group with a BMS of 0 compared to those with BMS of 1 and BMS of 2-3 [23.8% (15/63) vs. 47.4% (45/95) vs. 61.8% (21/34), P<0.05]. These results indicated that the differences in urinary incontinence proportions across these indicators are statistically significant. Multivariate analysis indicated that MUL, IPPL, and BMS were independent risk factors for early postoperative urinary incontinence(all P<0.05). The log-rank test demonstrated that differences in postoperative urinary continence recovery among groups with different PV ( P<0.05), MUL, IPPL, and BMS were all statistically significant(all P<0.05). Conclusions:Higher BMS grades are an independent risk factor for early postoperative urinary incontinence. Preoperative MUL, IPPL, PV, and BMS are correlated with urinary continence recovery after LRP. These findings require further validation in larger clinical studies.

Objective:To investigate the correlation between bladder mucosal smoothness (BMS) and early urinary continence recovery following laparoscopic radical prostatectomy (LRP).Methods:A retrospective analysis was conducted on the clinical data of 192 prostate cancer patients who underwent LRP at Peking University Third Hospital between January 2016 and March 2020. The patients' average age was (69.1±8.0) years old, and the median pre-biopsy PSA level was 12.23 (7.45, 20.36) ng/ml. There were 69 patients (35.9%) with a Gleason score <7 and 123 patients (64.1%) with a Gleason score ≥7. Clinical staging showed that 92 patients (47.9%) were in stage T 1/T 2, and 100 patients (52.1%) were in stage T 3. All patients underwent MRI before prostate biopsy. The preoperative MRI measured the prostate volume (PV) as 35.4 (26.3, 51.1) ml, and membranous urethral length (MUL) as (13.9±3.5) mm. The intravesical prostatic protrusion length (IPPL) was <5 mm in 128 patients (66.7%) and ≥5 mm in 64 patients (33.3%). All patients completed MRI examination before biopsy, BMS was defined into four grades according to MRI: grade 0, the bladder mucosa is completely smooth; grade 1, a small amount of unevenness and bumps can be seen in the bladder mucosa; grade 2, fissures can be seen in the bladder mucosa, less than half of the bladder wall, or bladder diverticulum; grade 3, the bladder fissure exceeds half of the bladder wall, or fissure progresses to a small loss of muscularis. In this study, there were 63 patients (32.8%) with grade 0, 95 patients (49.5%) with grade 1, and 34 patients (17.7%) with grade 2-3. Postoperatively, patients were followed up monthly from the first month onwards to assess urinary continence recovery, defined as not requiring pads throughout the day. Logistic multivariate regression analysis was used to identify risk factors affecting early postoperative urinary continence recovery, and log-rank test was used to compare postoperative urinary continence recovery curves among different groups. Results:All surgeries were successfully completed. The complete urinary continence rates at 1, 3, 6, and 12 months postoperatively were 40.1% (77/192), 57.8% (111/192), 71.9% (138/192), and 90.1% (173/192), respectively.In the univariate analysis of urinary incontinence, the proportion of urinary incontinence was lower in patients with PV <40 ml than that in patients with PV ≥40 ml [33.0% (38/115) vs. 55.8% (43/77), P<0.05]. The proportion of urinary incontinence in patients with maximum urethral length (MUL) <14 mm was higher than that in patients with MUL ≥14 mm [75.7% (56/74) vs. 21.2% (25/118), P<0.05]. The proportion of urinary incontinence in patients with the interpubic prostate length (IPPL) <5 mm was lower than that in patients with IPPL ≥5 mm [26.6% (34/128) vs. 73.4% (47/64), P<0.05]. The proportion of urinary incontinence was lower in the group with a BMS of 0 compared to those with BMS of 1 and BMS of 2-3 [23.8% (15/63) vs. 47.4% (45/95) vs. 61.8% (21/34), P<0.05]. These results indicated that the differences in urinary incontinence proportions across these indicators are statistically significant. Multivariate analysis indicated that MUL, IPPL, and BMS were independent risk factors for early postoperative urinary incontinence(all P<0.05). The log-rank test demonstrated that differences in postoperative urinary continence recovery among groups with different PV ( P<0.05), MUL, IPPL, and BMS were all statistically significant(all P<0.05). Conclusions:Higher BMS grades are an independent risk factor for early postoperative urinary incontinence. Preoperative MUL, IPPL, PV, and BMS are correlated with urinary continence recovery after LRP. These findings require further validation in larger clinical studies.

Objective:To conduct a meta-analysis to analyze the efficacy and adverse reactions of fractionated high dose rate brachytherapy (HDR-BT) as monotherapy for localized prostate cancer.Methods:Relevant databases were searched to collect the clinical trials on HDR-BT as monotherapy in patients with localized prostate cancer. Included studies were limited to full-text publications of fractionated HDR-BT as monotherapy with a median follow-up of at least 5 years, and adequate reporting of treatment outcomes and adverse reactions data. Stata 12.0 was used for data analysis.Results:According to the inclusion and exclusion criteria, a total of 11 clinical trials involving 2 683 patients with prostate cancer were included in this meta-analysis. The results of the meta-analysis showed that 5-year biochemical recurrence-free survival (bRFS) rate and overall survival (OS) rate were 94% (95% CI: 93% - 96%) and 96% (95% CI: 94% - 98%), respectively. Long-term (≥5 years) cancer-specific survival (CSS) rate and distant metastasis-free survival (DMFS) rate were 99% (95% CI: 98% - 100%) and 98% (95% CI: 98% - 99%), respectively. Long-term (≥5 years) late grade ≥3 grade gastrointestinal and genitourinary adverse reactions rates were 2% (95% CI: 1% - 3%) and 9% (95% CI: 6% - 13%), respectively. Conclusions:Fractionated HDR-BT as monotherapy is an effective treatment for patients with localized prostate cancer. Its long-term efficacy is encouraging, and the treatment is well tolerated and safe.

Endoscopic retrograde cholangio-pancreatography (ERCP) is one of the primary procedural techniques used for diagnosing biliary and pancreatic diseases. Post-ERCP pancreatitis (PEP) is the most common complication of ERCP, which resulted in prolonged hospitalization and potential risk of patients' lives, especially in severe cases. Understanding the risk factors associated with PEP is of paramount importance for its prevention. Currently, recognized risk factors for PEP encompass both patient-related factors and ERCP procedure-related factors. By considering these risk factors, implementing appropriate preoperative, intraoperative, and postoperative interventions could effectively reduce the incidence of PEP. In this article, we concisely summarized the common risk factors and preventive methods for PEP, offering valuable insights for healthcare professionals in clinical practice.

Objective:To investigate the influencing factors of headache degree in migraine patients with patent foramen ovale (PFO).Methods:The clinical data of 124 migraine patients with PFO from January 2013 to June 2019 in Dalian Central Hospital Affiliated to Dalian Medical University were retrospectively analyzed. The right-to-left shunt of PFO was assessed by contrast-enhanced transcranial Doppler (c-TCD); the diameter of PFO, length of PFO tunnel and the presence of atrial septal aneurysm (ASA) were detected by transesophageal echocardiography (TEE); the degree of migraine was assessed by headache impact test-6 (HIT-6) scale. The relations between right-to-left shunt volume of PFO, diameter of PFO and degree of migraine were analyzed by Goodman-Kruskal γ test; the relations between the length of PFO tunnel, ASA and degree of migraine were analyzed by Spearman rank correlation analysis.Results:Among the 124 migraine patients with PFO, the c-TCD test result showed that small shunt volume was in 20 cases, medium shunt volume in 31 cases, and large shunt volume in 73 cases. The TEE test result showed that small foramen ovale in 76 cases, medium foramen ovale in 47 cases, and large foramen ovale in 1 case; long tunnel in 57 cases, and short tunnel in 67 cases; without ASA in 91 cases, and with ASA in 33 cases. The HIT-6 score result showed that some influence in 9 cases, significantly influence in 22 cases, and serious influence in 93 cases. The Goodman-Kruskal γ test result showed that right-to-left shunt volume of PFO and diameter of PFO were positive correlation with degree of migraine ( γ = 0.66, P<0.01; γ = 0.38, P<0.05). The Spearman rank correlation analysis result showed that ASA was positive correlation with degree of migraine ( r = 0.18, P<0.05), while the length of PFO tunnel was negative correlation with degree of migraine ( r = -0.23, P<0.05). Conclusions:The right to left shunt amount of PFO, diameter of PFO and the presence of ASA are positive correlation with degree of migraine, while the length of PFO tunnel is negative correlation with degree of migraine.

Objective:To evaluate the efficacy and safety of a China-made disposable peroral cholangioscope in animal cholangioscopy.Methods:Six healthy Bama minipigs underwent the domestic disposable peroral cholangioscopy after anesthesia. The operation performance and image quality of the products were evaluated, and intraoperative and postoperative complications were recorded.Results:All 6 animals received the domestic disposable peroral cholangioscopy. The cholangioscope showed good operating performance and could smoothly enter the biliary tract through the duodenoscope. The water injection, suction and instrument channels were unobstructed. The cholangioscopic image was clear, the color resolution was good, and there was no image distortion. The lumen and the mucosal surface could be accurately assessed. During the examination, there was no operative injuries such as bleeding, perforation, or adverse events such as respiratory depression or cardiac arrest. All pigs survived the operation with no adverse reaction.Conclusion:The China-made disposable peroral cholangioscope is safe, with good operability and high-quality image.

Objective:To study the risk factors for complications after endoscopic retrograde cholangiopancreatography (ERCP) in super-aged patients (≥80 years).Methods:Clinical data of 512 super-aged patients with pancreaticobiliary diseases who underwent 638 ERCP procedures at the Digestive Endoscopy Center, Zhongnan Hospital of Wuhan University, from July 2011 to June 2021, were studied retrospectively. Indications and results of the ERCP operations were analyzed. Multivariate logistic regression model was used to analyze the risk factors for ERCP-related complications.Results:The total success rate of ERCP cannulation in super-aged patients was 94.0% (600/638), which showed no difference compared with that of patients of <60 years old (2 433/2 557, 95.2%) or patients of 60~<80 years old (2 815/3 004, 93.7%) ( χ2=5.49, P=0.064). The overall incidence of post-ERCP complications was 15.2% (97/638), and the in-hospital mortality was 2.1% (11/512), which showed significant difference compared with patients of <60 years old (8/1 809, 0.4%) and patients of 60-<80 years old (21/2 127, 1.0%) ( χ2=13.39, P=0.002). Multivariate regression analysis showed that hypertension ( HR=1.94, 95% CI: 1.237-3.041, P=0.004), history of upper gastrointestinal reconstruction ( HR=2.28, 95% CI: 1.064-4.891, P=0.034), endoscopic sphincterectomy ( HR=1.65, 95%CI: 1.012-2.679, P=0.045), early procedure period ( HR=0.57, 95% CI: 0.352-0.923, P=0.022), operation time >30 minutes ( HR=1.74, 95% CI: 1.094-2.759, P=0.019), preoperative white blood cell count >9.5×10 9/L ( HR=2.66, 95% CI: 1.661-4.257, P<0.001) and procalcitonin ≥0.05 ng/L ( HR=2.54, 95% CI: 1.172-5.513, P=0.018) were independent risk factors for post-ERCP complications. Conclusion:ERCP is safe and effective for super-aged patients. However, much attention should be paid to post-ERCP complications of patients with hypertension, history of upper gastrointestinal reconstruction, endoscopic sphincterectomy, operation time >30 minutes, preoperative white blood cell count >9.5×10 9/L and procalcitonin ≥0.05 ng/L to avoid serious adverse events such as mortality.

Objective:To analyze the global research hotspots in the field of pediatrics based on the Essential Science Indicators (ESI) database and explore the inspiration to domestic editors and pediatrics researchers.Methods:The journal distribution, country (region) distribution, cooperation, organization distribution, funding, publication language, hot topic words and other data of highly cited papers in the field of pediatrics in ESI database were collected and analyzed.Results:A total of 682 highly cited pediatrics papers were collected from 77 pediatrics journals included in Science Citation Index(SCI). Most of the highly cited pediatrics papers (182) were found to be published in Pediatrics.All 682 paper were published in English and frequently, characterized by multiple authors, institutions and fund support.Of 682 highly cited pediatrics papers, 435 papers were published in the United States(the first), 123 papers in England(the second) and 86 paper in Canada(the third). Novel coronavirus pneumonia, coronavirus, SARS coronavirus, autism and multiple system inflammatory syndrome are the main frontiers of global pediatric research at present.Specifically, focal pediatric system diseases mainly include respiratory system diseases, digestive system diseases, cardiovascular diseases, etc. Conclusions:ESI-based analysis of global research hotspots in the field of pediatrics provides reference materials for domestic and foreign pediatrics researchers to understand the global academic frontiers and development trends in the field of pediatrics and select topics for future scientific research.More importantly, this analysis can help domestic editors of pediatrics journals to plan topics and organize hot papers, so as to improve the academic quality and international influence of the journals.