ObjectiveTo investigate the feasibility， safety， and efficacy of surgery-assisted transjugular intrahepatic portosystemic shunt （SA-TIPS） in the treatment of portal hypertension comorbid with complex portal vein thrombosis， including cavernous transformation of the portal vein （CTPV）. MethodsAn analysis was performed for the data of 36 patients with portal hypertension and complex portal vein thrombosis who underwent SA-TIPS in Beijing Shijitan Hospital， Capital Medical University， from November 2023 to January 2025， including general status， technical data of the surgical process （surgical success rate， puncture times， time of operation， the number of stents used， and the length of shunt）， perioperative complications， and surgical recovery. The change in portal pressure gradient （PPG） after shunt was compared， and the rate of reaching the standard for PPG reduction was calculated， as well as stent patency rate within 1 week after surgery. The paired samples t-test was used for comparison of continuous data between two groups. ResultsAmong the 36 patients， 34 （94.4%） underwent SA-TIPS successfully. The incidence rate of perioperative complications was 16.7% （6/36）， including 3 cases of thoraco-abdominal hemorrhage， 2 cases of intraoperative arrhythmia， and 1 case of incision infection. There was a significant reduction in PPG after SA-TIPS （t=19.85， P<0.01）， and the patients achieving a ≥50% reduction in PPG accounted for 76.5% （26/34）. Imaging reexamination within 1 week showed a shunt patency rate of 100%. ConclusionSA-TIPS has a high technical success rate， a favorable safety profile， and good efficacy in the treatment of portal hypertension comorbid with complex portal vein thrombosis （including CTPV）， and therefore， it holds promise for clinical application.

OBJECTIVE: To investigate the safety and prognostic factors influencing the treatment of upper urinary tract urothelial carcinoma (UTUC) combined with bladder cancer (BCa) by laparoscopic simultaneous radical cystectomy and nephroureterectomy (RCNU). METHODS: The clinical data of patients admitted to Peking University Third Hospital for laparoscopic RCNU surgery from January 2009 to September 2023 were analyzed retrospectively. Based on the same gender, age (±5 years), history of uroepithelial tumors, underlying diseases, T-stage, N-stage, M-stage, American Society of Anesthesiologists (ASA) score, Charlson comorbidity index, and body mass index (BMI) (±5), 34 patients with RCNU were matched 1 ∶1 with patients with bladder cancer who underwent laparoscopic radical cystectomy (RC) alone. Kaplan-Meier survival analysis was used to calculate patient survival, and Cox proportional regression risk model was used to analyze clinical factors affecting prognosis. RESULTS: Of the 68 patients enrolled, the follow-up rate was 100% with a median follow-up time of 27.0 (11.7, 60.2) months. Comparison of intraoperative conditions (including operation time, estimated intraoperative bleeding, intra-operative blood transfusion, etc.) between the two groups of patients showed no significant difference (P>0.05). Comparison of preoperative creatinine and postoperative creatinine between the two groups of patients showed significant differences (P < 0.05). The perioperative Clavien grade Ⅲ-Ⅳ complication rates were 2.9% (1/34) in the RC group and 5.9% (2/34) in the RCNU group. There was no significant difference in terms of perioperative complications between the two groups. Overall survival was significantly lower in the patients receiving RCNU compared with the matched group receiving RC alone (P < 0.05). Cox regression analysis suggested that two factors, high N stage and high postoperative creatinine, were independent risk factors affecting the prognosis of patients in the 2 groups (P < 0.05). CONCLUSION The overall survival prognosis of patients undergoing RCNU surgery was worse compared with laparoscopic RC surgery alone during the same period. There was no clinically significant difference between the two groups in terms of operation time, intraoperative bleeding, and perioperative complications, and there were clinically significant differences in preoperative renal function and post-operative renal function.
Humans ; Laparoscopy/methods* ; Nephroureterectomy/methods* ; Cystectomy/methods* ; Prognosis ; Male ; Retrospective Studies ; Female ; Urinary Bladder Neoplasms/mortality* ; Middle Aged ; Aged

Objective:ANXA2 plays a crucial role in cancer metastasis, but its mechanism is not yet fully understood. Therefore, it is necessary to establish an ANXA2 gene knockout mouse model to provide an effective tool for subsequent studies on ANXA2-related mechanisms.Methods:A gene knockout mouse model was constructed using CRISPR/Cas9 technology. The model was validated through tissue DNA extraction followed by polymerase chain reaction (PCR), sequencing, and western blot to confirm ANXA2 genotype and protein expression. The successfully constructed models were divided into a model group and a wild-type (WT) group for the creation of a mouse tail vein injection Lewis lung carcinoma (LLC) metastasis model. Metastatic foci formation was monitored using in vivo imaging technology, and the survival rates of the two groups were compared. Results:An sgRNA sequence targeting the first exon of ANXA2 was designed, and 16 founder mice were obtained through microinjection. Through consanguineous hybridization, 30 homozygous offspring were ultimately acquired. After establishing the strains of the mouse model, mice were divided into the ANXA2 knockout group and the WT group, with 8 mice in each group. An LLC lung metastasis model was established in both groups. Compared with the WT group, the number of metastatic foci was significantly increased in the ANXA2 knockout group (7 vs. 1), and the fluorescence intensity was stronger in the WT group than in the knockout group ( P=0.002). Using the GEPIA2 database to analyze ANXA2 gene expression in tumor tissues and normal tissues of lung cancer patients, it was found that ANXA2 expression levels were significantly higher in lung cancer tumor tissues compared to normal tissues ( P＜0.05). The database included data from 478 lung cancer patients, and patients were stratified into high-expression and low-expression groups based on ANXA2 levels. Compared to the low-expression group, patients in the high-expression group exhibited significantly shorter disease-free survival and overall survival ( P＜0.05, respectively). The survival time of mice in the ANXA2 knockout group (median survival time, 43 days) was significantly longer compared to the WT group (median survival time, 26 days; P=0.017). Additionally, ANXA2 expression is significantly associated with the prognosis of lung cancer patients ( P=6.4e-14). Conclusions:ANXA2 is closely associated with cancer metastasis and holds potential as a new target for metastasis treatment. Further in-depth research will greatly facilitate the transition of ANXA2 from basic research to clinical application.

Objective:To investigate the diagnostic value and imaging features of high resolution magnetic resonance imaging(HR-MRI)in patients with lesions in carotid artery and intracranial artery.Methods:Sixty-nine patients with suspected lesions in carotid artery and intracranial artery who admitted to Handan Central Hospital from June 2021 to December 2023 were selected,and they underwent routine MRI and HR-MRI examinations.Digital subtraction angiography(DSA)examination was used as the"gold standard"to analyze the detection rates of different MRI examinations for lesions in carotid artery and intracranial artery.The diagnostic efficacy of them was calculated,and the HR-MRI imaging features of positive cases and negative patients were compared under the"gold standard".Results:For 69 patients with suspected lesions in carotid artery and intracranial artery,41 cases(59.42%)were confirmed by"gold standard"examination,and 31 positive cases were confirmed by routine MRI examination,and 35 positive cases were confirmed by HR-MRI examination,and 39 positive cases were confirmed by combined examination of routine MRI and HR-MRI.The results indicated that the accuracy,sensitivity,specificity,positive and negative predictive values of the combined examination of routine MRI and HR-MRI were respectively 88.41%,87.80%,89.29%,92.31%and 83.33%,all of which were higher than those of single image examination,and the differences were statistically significant(x2=5.459,7.329,6.216,6.395,6.141,P<0.05).The irregular shape,blurred boundary,high signal,plaque formation,intra-plaque bleeding,displacement of common carotid artery or vein,and calcification of lesion in HR-MRI imaging features of positive patients were significantly higher than those of negative patients,and the differences were statistically significant(x2=8.918,4.418,7.001,4.746,8.743,5.951,4.947,P<0.05),respectively.Conclusion:The detection rates both of routine MRI and HR-MRI are higher in patients with lesions in carotid artery and intracranial artery.However,the combined examination of them can improve the diagnostic sensitivity and specificity,and the morphology,boundary,signal and calcification foci of confirmed patients are more obvious in HR-MRI examination,which can provide reference for subsequent diagnosis and treatment.

Objective To explore the effect of transcutaneous auricular vagus nerve stimulation(taVNS)combined with dual-task training(DTT)on upper limb function recovery in patients with ischemic stroke.Methods From January to October,2024,60 ischemic stroke patients with upper limb dysfunction admitted to Zhejiang Rehabilitation Medical Center were selected and randomly divided into control group(n=30)and observation group(n=30).Both groups received conventional rehabilitation training.The control group underwent sham-taVNS combined with DTT,while the observation group received active taVNS combined with DTT,for four weeks.Before and after treatment,they were assessed with Fugl-Meyer Assessment-Upper Extremities(FMA-UE),Action Research Arm Test(ARAT),modified Barthel Index(MBI)and motor-evoked potential(MEP)tests.Results The FMA-UE scores,ARAT scores,MBI scores,MEP amplitude and MEP latency improved in both groups af-ter treatment(|t|>3.670,P<0.01),and were superior in the observation group than in the control group(|t|>3.081,P<0.01).Conclusion The combination of taVNS and DTT can significantly improve upper limb function,enhance activities of daily living,and promote neurological recovery in patients with ischemic stroke.

Objective To investigate the protective effects of butyrate on sepsis-related myocardial dys-function.Methods Thirty healthy 8-week-old male Sprague-Dawley rats were randomly divided into three groups:sham operation group(SH,n=10),sepsis group(CL,n=10),and butyrate group(BU,n=10).The CL and BU groups underwent cecal ligation and puncture(CLP)to establish sepsis models,while the SH group received the same surgical procedure without cecal ligation or puncture.Within 30 minutes post-opera-tion,the SH and CL groups received 5 mL normal saline via gavage,whereas the BU group was administered 5 mL sodium butyrate solution(500 mg/kg)in normal saline.Cardiac output(CO)and ejection fraction(EF)were compared among the three groups.Myocardial histopathological injury was assessed by HE staining,and mitochondrial ultrastructural damage was observed by electron microscopy.Serum levels of brain natriuretic peptide(BNP),cardiac troponin Ⅰ(cTnⅠ),and butyrate were compared among groups.Western blot analysis was performed to detect and compare the expression levels of long-chain acyl-CoA synthetase 4(ACSL4)and glutathione peroxidase 4(GPX4)in myocardial tissues.Results After intervention,the BNP and cTnⅠ levels in the CL group were higher than those in the SH group,while CO and EF were lower than those in the SH group(P＜0.05).The BNP and cTnⅠ levels in the BU group were lower than those in the CL group,whereas CO and EF levels were higher than those in the CL group(P＜0.05).HE staining of myocardial tissues re-vealed more severe inflammatory cell infiltration and myocardial cell edema in the CL group compared with the SH group,while the BU group showed reduced inflammatory cell infiltration.Mitochondrial membrane in-tegrity was impaired in the CL group manifested by unclear cristae,swelling,vacuolar degeneration and rup-ture,whereas mitochondrial damage was attenuated in the BU group.Serum butyrate levels were measured as(61.7±21.6)μg/mL,(95.3±16.6)μg/mL and(302.2±49.7)μg/mL in the CL,SH and BU groups respec-tively(P＜0.05).The ACSL4 expression in the CL group was higher than that in the SH group,while GPX4 protein expression was lower than that in the SH group(P＜0.05).The BU group exhibited lower ACSL4 expression and higher GPX4 protein expression compared with the CL group(P＜0.05).Conclusion Buty-rate can ameliorate myocardial injury in septic rats,and its protective effect may be associated with the inhibi-tion of myocardial ferroptosis.

Objective To investigate the effectiveness and safety of drug-eluting beads bronchial arterial chemoembolization(DEB-BACE)versus BACE for the treatment of stage Ⅲ-Ⅳ lung squamous cell carcinoma.Methods A total of 104 patients with stage Ⅲ-Ⅳ lung squamous cell carcinoma,who were admitted to the Lishui Municipal Central Hospital of China between January 2013 and August 2021,were enrolled in this study.According to the therapeutic scheme,the patients were divided into DEB-BACE group(n=41)and BACE group(n=63).For patients of DEB-BACE group,Cisplatin at 75 mg/m2 dose and gemcitabine at 1 000 mg/m2 dose(400 mg was used as loaded-drug dose)were injected through a microcatheter,which was followed by embolization with CalliSpheres microspheres loaded with 400 mg of gemcitabine.For patients of BACE group,Cisplatin at 75 mg/m2 and gemcitabatin at 1 000 mg/m2 were injected through a microcatheter,which was followed by arterial embolization with blank microspheres.Three weeks after DEB-BACE or BACE,the patients of both groups were started on intravenous chemotherapy.The primary study endpoint was overall survival(OS).The secondary study endpoints included progression-free survival(PFS),objective response rate(ORR),disease control rate(DCR),adverse reactions,and the remission rate of dyspnea.Results Of the 104 patients,63 received BACE sequential intravenous chemotherapy and 41 received DEB-BACE sequential intravenous chemotherapy.The median OS in DEB-BACE group was 23.0 moths,which was obviously longer than 12.0 months in BACE group(P=0.009).Multivariate Cox regression analysis showed that DEB-BACE treatment was an independent risk factor for OS(HR=0.59,95％ CI:0.38-0.91,Log-rank test P=0.018).Meanwhile,the remission rate of dyspnea in DEB-BACE group was significantly higher than that in BACE group(57.1％ vs 30.6％,P＜0.043).Conclusion Compared with BACE sequential intravenous chemotherapy,DEB-BACE sequential intravenous chemotherapy can significantly prolong the survival time of patients with stage Ⅲ-Ⅳ lung squamous cell carcinoma and significantly improve the symptoms of dyspnea,which has important applications in the treatment of patients with advanced lung squamous cell carcinoma.

Objective:To explore the application value of multi-slice spiral CT (MSCT) perfusion imaging and magnetic resonance high-resolution vessel wall imaging (HR-VWI) in the evaluation of atherosclerotic ischemic stroke (IS).Methods:A total of 131 patients with atherosclerotic IS (study group) and 62 patients with non-atherosclerotic IS (control group) diagnosed and treated in Handan Central Hospital from May 2022 to May 2024 were retrospectively selected as the study objects. MSCT perfusion imaging and HR-VWI were completed before treatment. MSCT perfusion imaging indexes and HR-VWI indexes were compared between the two groups, and HR-VWI indexes and MSCT perfusion imaging indexes were compared among the study groups with different disease degrees. Receiver operating characteristics (ROC) curve was used to analyze the diagnostic value of HR-VWI indexes and MSCT perfusion imaging indexes in atherosclerotic IS.Results:The stenosis degree, out wall area at maximal lumen narrowing (OWA MLN), plaque loading rate and remodeling index in the study group were higher than those in the control group: (69.22 ± 12.57)% vs. (60.81 ± 10.38)%, (7.62 ± 1.03) mm 2 vs. (6.53 ± 1.18) mm 2, (42.51 ± 8.22)% vs. (36.53 ± 7.29)%, 1.32 ± 0.41 vs. 1.01 ± 0.29; while the lumen area at maximal lumen narrowing (LA MLN) in the study group was lower than that in the control group: (0.84 ± 0.28) mm 2 vs.(1.17 ± 0.41) mm 2, there were statistical differences ( P<0.05). The cerebral blood flow (CBF) and cerebral blood volume (CBV) in the study group were lower than those in the control group: 20.25 ± 2.83) ml/100 min vs. (23.66 ± 2.52) ml/100 min, (1.82 ± 0.53) ml/100g vs. (2.31 ± 0.63) ml/100 g; and the peak time (TTP) and mean transit time (MTT) in the study group were higher than those in the control group: (23.55 ± 4.86) s vs.(19.73 ± 3.73) s, (7.13 ± 1.22) s vs. (6.17 ± 1.06) s, there were statistical differences ( P<0.05). In the study group, with the aggravation of disease severity, the stenosis degree, OWA MLN, plaque load rate and remodeling index were gradually increased, while LA MLN was gradually decreased, there were statistical differences ( P<0.05). ROC curve analysis results showed that the area under the curve value of HR-VWI index combined evaluation and MSCT perfusion imaging index combined evaluation in the diagnosis of atherosclerotic IS was 0.921 and 0.828, respectively. Conclusions:HR-VWI and MSCT perfusion imaging can be used in the assessment of patient's condition of atherosclerotic IS. HR-VWI may be better in evaluating the condition of atherosclerotic IS.

[Abtract]Nursing safety management is crucial to patient health outcomes,and real-time monitoring and early warning systems play a vital role in enhancing nursing safety and reducing medical incidents.Wearable flexible devices enable non-invasive,continuous monitoring of various physiological parameters and provide timely alerts.These devices not only improve the efficiency and quality of nursing safety management but also offer patients more convenient,accurate,and personalized care services.This article provides a comprehensive review of the application of wearable flexible devices in nursing safety management,examining their application scenarios,advantages,and challenges,and offering insights to facilitate the further integration of this technology into nursing safety practices.

Renal cell carcinoma in a transplanted kidney is rare, and partial nephrectomy in transplanted kidney is even more uncommon. A patient with papillary transplanted renal cell carcinoma who underwent partial nephrectomy was reported. The patient was admitted to the hospital due to the discovery of transplanted kidney mass, and the enhanced examination of CTU found a lesion in the upper pole of the transplanted kidney in the right iliac fossa, which may be renal cancer, with a diameter of about 2 cm. After open partial nephrectomy of the transplanted kidney, the postoperative pathology showed that the tumor was papillary renal cell carcinoma. The antirejection drugs were used after surgery. During the follow-up period of 16 months, there was no recurrence of transplanted kidney tumor.