Patients with Takayasu arteritis combined with aortic valve disease often have a poor prognosis following surgical valve replacement, frequently encountering complications such as perivalvular leakage, valve detachment, and anastomotic aneurysm. This article presents a high-risk case wherein severe aortic valve insufficiency associated with Takayasu arteritis was successfully managed through transcatheter aortic valve implantation via the transapical approach. The patient had satisfactory valve function with no complications observed during the six-month postoperative follow-up. This case provides a minimally invasive and feasible alternative for the clinical management of such high-risk patients.

Objective To measure the urethral meatus circumference in middle-aged and elderly males to undergo surgery for benign prostatic hyperplasia (BPH), and to collect data for developing endoscopic equipment suitable for the male urethra in China. Methods Clinical data were collected from patients (aged ≥50 years) who underwent transurethral resection of prostate in the First Affiliated Hospital of Xi'an Jiaotong University during Jan. and Dec. 2024. All patients had the urethral meatus circumference measured with a metal urethral probe before surgery, followed by the use of a F26.5 endoscopic sheath for surgery. The passage of urethral meatus using different types of metal urethral probes were observed. Results For the 183 patients, the types of endoscopic sheath smoothly passing through the urethral meatus were distributed as follows:42 cases (22.95%) with F26 or above, 66 cases (36.07%) with F25-26, 27 cases (14.75%) with F23-24, 26 cases (14.21%) with F21-22, 22 cases (12.02%) with F20 or below, and the smallest was F17 (1 case). Of all patients, 59.02% (108/183) were able to insert the F26.5 endoscopic sheath smoothly into the urethral meatus (≥F25), 28.96% (53/183) required force or urethral dilation before inserting (F21-F24), and 12.02% (22/183) needed to open the urethral meatus before inserting the endoscopic sheath (≤F20). Conclusion When the most common F26.5 endoscopic sheath is used, 40.98% of the patients have the possibility of urethral injury, which is significantly too big for male transurethral surgery. For patients undergoing transurethral BPH surgery, a thinner sheath should be used to reduce the possibility of urethral injury and secondary iatrogenic urethral stricture.

Objective: To investigate the trends in incidence and mortality of thyroid cancer in cancer registration areas of Zhengzhou City, Henan Province from 2016 to 2021, so as to provide evidence for developing targeted thyroid cancer prevention and treatment strategies. Methods: Data on incidence and mortality of thyroid cancer with qualified registration quality were collected from cancer registration offices in Zhengzhou City. Crude incidence and crude mortality were calculated. The Chinese population-standardized incidence and world population-standardized incidence were calculated using the standard age structure from the Fifth National Population Census in 2 000 and Segi's world standard population structure, respectively. The average annual percentage change (AAPC) was used to analyze the trends in the incidence and mortality of thyroid cancer in Zhengzhou City from 2016 to 2021 across different gender, age, and urban-rural area. Results: In 2021, the crude incidence, Chinese population-standardized incidence and world population-standardized incidence of thyroid cancer in Zhengzhou City were 42.55/105, 37.43/105, and 32.56/105, respectively. The crude mortality, Chinese population-standardized mortality and world population-standardized mortality were 1.07/105, 0.77/105, and 0.71/105, respectively. The Chinese population-standardized incidence and mortality in females were 2.64 times and 2.83 times those in males, respectively; those in urban areas were 2.25 times and 1.51 times those in rural areas, respectively. The crude incidence peaked in the group aged 55-<60 years at 92.52/105. From 2016 to 2021, the crude incidence and Chinese population-standardized incidence of thyroid cancer showed an upward trend (AAPC=21.797%, 22.725%, both P<0.05), with trends consistent across different genders and urban-rural areas with the total population. The crude incidence showed upward trends in the groups aged 20-<30 years, 30-<40 years, 40-<50 years, 50-<60 years, and 60-<70 years (AAPC=17.237%, 31.026%, 21.289%, 23.010%, and 11.752%, all P<0.05). From 2016 to 2021, the Chinese population-standardized mortality of thyroid cancer showed an upward trend (AAPC=15.196%, P<0.05), while the trend in crude mortality was not statistically significant (P>0.05). The crude mortality (AAPC=21.078%, 25.669%) and Chinese population-standardized mortality (AAPC=24.122%, 28.865%) in females and rural areas showed upward trends (all P<0.05). Conclusions From 2016 to 2021, the Chinese population-standardized incidence and mortality of thyroid cancer in cancer registration areas of Zhengzhou City showed an upward trend. Females, urban residents, and middle-aged and young populations are key groups for thyroid cancer prevention and control.

Objective To investigate the therapeutic effects and mechanisms of dexmedetomi-dine and remimazolam on neuropathic pain.Methods A total of 60 SD rats were divided into sham operation group(n=12),spinal nerve ligation(SNL)+NC group(n=12),SNL+DEX group(n=12),SNL+REM group(n=12)and DEX+REM group(n=12).Mechanical withdrawal threshold(MWT)was analyzed in each group.The expression level of pain-related protein c-Fos was detected by Western blot.Autophagy was assessed by immunofluorescence analysis.Enzyme-linked immunosorbent assay(ELISA)was used to measure the expression levels of inflammatory factors[tumor necrosis factor-α(TNF-α),interleukin-1 β(IL-1 β),interleukin-6(IL-6)and interleukin-10(IL-10)]of each group.The expression level of oxidative stress factor in each group was ana-lyzed.The expression levels of NFE2L2/NRF2 pathway related proteins were analyzed by Western blot.Results MWT in the SNL+DEX,SNL+REM and DEX+REM groups was significantly high-er than that in the SNL+NC group(P＜0.05).The expression level of c-Fos protein in the SNL+NC group was significantly higher than that in the SNL+DEX,SNL+REM and DEX+REM groups(P＜0.05).The immunofluorescence intensity of LC3 and NeuN in SNL rats was lower than that in sham operation rats,indicating that autophagy of neurons in SNL rats was damaged.The immunofluorescence intensity of LC3 and NeuN in the SNL+DEX group,SNL+REM group and DEX+REM group were significantly higher than those in the SNL+NC group(P＜0.05).The expression levels of TNF-α,IL-1 β and IL-6 in the SNL+DEX group,SNL+REM group and DEX+REM group were signifi-cantly lower than those in the SNL+NC group(P＜0.05).Glutathione(GSH)and catalase(CAT)levels in the SNL+DEX,SNL+REM and DEX+REM groups were significantly higher than those in the SNL+NC group,while malondialdehyde(MDA)levels were significantly lower(P＜0.05).The expression levels of NFE2L2 protein in the SNL+DEX,SNL+REM and DEX+REM groups were significantly lower than that in the SNL+NC group,with the lowest level observed in the DEX+REM group(P＜0.05).Conclusion Dexmedetomidine and remimazolam can re-lieve neuropathic pain in SNL rats by inhibiting the expression of NFE2L2/NRF2 pathway-related proteins and decreasing oxidative stress levels.

Objective To explore the anesthesia management experience in the interventional treatment of pediatric congenital heart diseases (CHD) percutaneously guided by transthoracic echocardiography (TTE) on a mobile operating platform. Methods From March to July 2023, a total of 13 patients from remote areas underwent interventional treatment for CHD on the mobile operating platform of Fuwai Yunnan Cardiovascular Hospital. Patients who received non-tracheal intubation general anesthesia were retrospectively included. Results Eight children who had difficulty cooperating with the surgery (due to young age, emotional tension, crying) received monitored anesthesia care with local anesthesia supplemented by sedative and analgesic drugs while maintaining spontaneous breathing under the monitoring and management of an anesthesiologist (i.e., non-tracheal intubation general anesthesia). Among them, there were 5 males and 3 females, with an age of (6.95±3.29) years and a body weight of (19.50±6.04) kg. Through transthoracic echocardiography, they were diagnosed with atrial septal defect (6 patients), residual shunt after patent ductus arteriosus ligation (1 patient), and severe pulmonary valve stenosis (1 patient). The surgery proceeded smoothly, with satisfactory anesthesia and surgical effects, complete analgesia, and satisfactory postoperative recovery. There was 1 patient of body movement and 1 patient of respiratory depression during the operation, and both patients completed the surgery successfully after treatment. All children had no serious surgery- and anesthesia-related complications. The anesthesia time was 40.5 (34.5, 47.5) min, the surgery time was 39.0 (33.0, 45.5) min, and the recovery time was 43.0 (28.0, 52.5) min Conclusion Interventional surgery for CHD guided by TTE at a mobile platform is a minimally invasive approach without radiation damage. Non-tracheal intubation general anesthesia with spontaneous breathing can be safely and effectively implemented in children who cannot cooperate.

All four patients were female, with an average age of 28.8 days and an average weight of 3.64 kg. Only case 4 was born prematurely at 34 W+5 and was treated conservatively until 71 days to complete operation. All the others completed primary corrective surgery in the neonatal period, and all survived after operation. Two different surgical techniques were used to repair the aortic-pulmonary window and the aortic origin of the right pulmonary artery, including 1 case using the aortic internal baffle technique and another 3 cases underwent replantation of the right pulmonary artery (1 case was reconstructed in situ, and the other 2 cases were reconstructed by moving the right pulmonary artery in the anterior of aorta). Case 2 who received aortic internal baffle technique underwent two reoperation because of right pulmonary artery stenosis. While, right pulmonary artery of cases 3 and 4 developed well after being reconstructed the right pulmonary artery anterior translocation. After the diagnosis of Berry syndrome through cardiac color ultrasound and CT angiography, a primary surgical radical treatment should be performed as soon as possible at an experienced pediatric cardiac center. Although the surgery is high-risk and complex, it is safe and effective.

Objective To explore the efficacy of DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy for management of cancer pain and provide reference for its standardized clinical application.Methods and Results Recommendations were formulated based on literature review and expert group discussion,and consensus was reached following expert consultation.The consensus recommendations are comprehensive,covering the entire treatment procedures from preoperative assessment and preparation,surgical operation process,postoperative management and traditional Chinese medicine treatment to individualized treatment planning.The study results showed that the treatment plans combining traditional Chinese with Western medicine effectively alleviated cancer pain,reduced the use of opioid drugs,and significantly improved the quality of life and enhanced immune function of the patients.Postoperative follow-up suggested good treatment tolerance among the patients without serious complications.Conclusion The formulated consensus is comprehensive and can provide reference for clinicians to use DSA-guided intrathecal drug delivery system combined with Zi Wu Liu Zhu Acupoint Therapy.The combined treatment has a high clinical value with a good safety profile for management of cancer pain.

Objective:To investigate the effect and potential mechanism of circular RNA-centrosome and spindle pole-associated protein 1 (circ-CSPP1) on the malignant biological behavior of hepatoma cells.Methods:Real-time fluorescence quantitative polymerase chain reaction (RT-PCR) was used to detect the expressions of circ-CSPP1 and microRNA-582-5p (miR-582-5p) in hepatoma cells, and Western blotting was used to detect the expression of karyopherins α2 (KPNA2). HepG2 cells were divided into the circ-CSPP1 overexpression group, the circ-CSPP1 overexpression control group, the si-CSPP1 group, the si-NC group, the si-CSPP1+ miR-582-5p inhibition group, and the si-CSPP1+ miR-582-5p inhibition control group. circ-CSPP1 overexpression plasmid, CSPP1 interfering small RNA, CSPP1 interfering small RNA, miR-582-5p inhibition sequence and negative control were transfected respectively in these groups. Cell proliferation in each group was detected by 5-acetylene-2'-deoxyuridine (Edu), invasion ability was detected by Transwell assay, and the binding of circ-CSPP1 and KPNA2 to miR-582-5p was verified by dual-luciferase assay. In the si-CSPP1 group, HepG2 cells transfected with si-CSPP1 lentivirus were subcutaneously injected into the back of nude mice ( n=12), and in the si-NC group, HepG2 cells transfected with negative control lentivirus ( n=12) were injected. The tumor mass, volume, circ-CSPP1 and KPNA2 were detected. Results:In the circ-CSPP1 overexpression group, the relative expression of circ-CSPP1 was (1.68±0.17), the expression of KPNA2 was (1.52±0.16), and the number of invasive cells in the 100-fold field of view was (128.4±13.5), which were all higher than those in the circ-CSPP1 overexpression control group [(1.25±0.16), (1.24±0.15), (128.4±13.5)], while the expression of miR-552-5p was lower than that in the circ-CSPP1 overexpression control group [(0.96±0.11) vs (1.31±0.15)]; The relative expression of circ-CSPP1 in the si-CSPP1 group was (1.02±0.13), KPNA2 was (0.74±0.09), and the number of invasive cells was (53.5±6.7), which were lower than those in the si-NC group [(1.28±0.14), (1.22±0.13), (74.6±8.3)], while the expression of miR-582-5p was higher than that in the si-NC group [(1.71±0.18) vs (1.32±0.14)]; The expression of circ-CSPP1 and KPNA2 and the number of invasion cells in the si-CSPP1+ miR-582-5p inhibition group was higher than that in the si-CSPP1+ miR-582-5p inhibition control group, and the differences were statistically significant (all P<0.05). The results of cell proliferation were consistent with those of invasion. The dual-luciferase gene report showed that, compared with the miR-NC group, the relative luciferase activity in HepG2 cells co-transfected with circ-CSPP1-WT or KPNA2-WT wild-type reporter vectors in the miR-882-5p mimic group decreased [(0.46±0.05) vs (1.03±0.11), (0.42±0.03) vs (1.01±0.09)]. The differences were all statistically significant (both P<0.05). However, there was no statistically significant difference in the relative luciferase activity in HepG2 cells co-transfected with the circ-CSPP1-MUT or KPNA2-MUT mutant reporter vectors (both P>0.05). The tumor weight, volume and circ-CSPP1 and KPNA2 expressions in tumor tissue of nude mice in the si-CSPP1 group were all lower than those in the si-NC group, and the expression of miR-582-5p was higher than that in the si-NC group. The differences were statistically significant (all P<0.05). Conclusion:Inhibition of circ-CSPP1 suppressed the malignant biological behavior of hepatoma cells and tumor growth by upregulating miR-582-5p and downregulating KPNA2.

Cholelithiasis is one of the most common diseases of the digestive system,and the accurate preoperative diagnosis of cholelithiasis is important to guiding treatment and improving prognosis.Dual-energy CT based on material decomposition and post-processing techniques can generate virtual monoenergetic images,virtual noncontrast images,calcium-and fat-based material decomposition images and Rho/Z images which are helpful for detecting isoattenuating gallstones,and offer objective evidence for diagnosing gallstone disease and its complications.This article reviews the principle of dual-energy CT and its progress in cholelithiasis.

Objective:To evaluate the histocompatibility and biomechanical properties of domestically produced abdominal wall segment polylactic acid absorbable microhook urethral sling in an animal model.Methods:Twenty four rabbits were divided into two groups: polylactic acid microhook sling group ( n=12) and TVT ABBREVO sling group ( n=12). Segments of the slings (abdominal wall portion and urethral portion) were implanted into the rabbit′s abdominal wall and the vesicovaginal space, respectively. Specimens were harvested via euthanasia at postoperative 0 day ( n=3 per group), 4 weeks ( n=3 per group) and 12 weeks ( n=6 per group) for simulated clinical fixation test, histomorphological observation (to evaluate histocompatibility), and biomechanical property analysis (tensile testing). Results:In the simulated clinical fixation test, the domestically produced abdominal wall segment polylactic acid absorbable microhook urethral sling maintained tight integration with the tissue without detachment across the range of abdominal pressure fluctuations associated with normal human activity (1-34 kPa); in contrast, TVT ABBREVO sling shifted and detached under pressure as low as 15 kPa. At 4 weeks post-implantation in the abdominal wall, none displacement occurred in polylactic acid microhook sling group (0/6 sites), whereas displacement occurred in 5 out of 6 in TVT ABBREVO sling group; at 12 weeks, displacement occurred in 4 out of 24 sites (17%) for polylactic acid microhook sling group, compared to 12 out of 24 sites (50%) for TVT ABBREVO sling group. These differences were statistically significant at both time points (both P<0.01). Tensile testing revealed that the sling of polylactic acid microhook sling group exhibited significantly lower thickness, tensile strength, and elongation percentage after implantation for 12 weeks compared to TVT ABBREVO sling group (all P<0.05). Histocompatibility: both sling types integrated well with host tissues after implantation subcutaneously in the abdominal wall and in the vesicovaginal space. Both induced a mild local inflammatory response. No pathological changes were observed in the surrounding tissues for either sling type, and there were no statistically significant differences in histopathological scores between the two groups (all P>0.05). Conclusions:The domestically produced abdominal wall segment polylactic acid absorbable microhook urethral sling demonstrates favorable histocompatibility. The polylactic acid microhooks significantly enhance the sling′s fixation to the tissue, effectively preventing early postoperative displacement caused by abrupt changes in abdominal pressure, and thus offer superior clinical applicability.