To analyze the clinical and genetic features of oculopharyngodistal myopathy (OPDM) patients and compare the phenotypic differences among various causative genes.

Objective:To explore the technique methods and clinical application value of β-electrode (a plasma needle shape electrode) assisted laparoscopic repair of complex vesicovaginal fistula (VVF).Methods:Clinical data of one patient with complex VVF admitted to Chinese PLA General Hospital in April 2025 was retrospectively analyzed. A 36-year-old female presented with urinary leakage 2 months after hysterectomy. Computed tomography urography excluded ureterovaginal fistula. Cystoscopy revealed a 2 cm fistula on the posterior bladder wall with both ureteral orifices adjacent to the fistula edge. The procedure involved two steps: first, transurethral β-electrode pretreatment was performed to protect the ureteral orifices and create a passage from the bladder to the abdominal cavity. Then, laparoscopic separation, suture closure of the fistula, and omental flap coverage were conducted.Results:Total operation time was 180 min (the time of β- electrode operation was 30 min) with intraoperative estimated blood loss of 50 mL. The catheter was removed 3 weeks postoperatively, and the patient voided well without leakage during 4-month follow-up.Conclusions:β- electrode assisted laparoscopic repair of complex VVF have the advantage of precise manipulation, minimal invasion and rapid recovery. No similar technique have been reported domestically or internationally. This technique provides a new approach for the treatment of complex VVF.

Bladder urothelial carcinoma is one of the common malignant tumors of the urinary system.The traditional treatment is transurethral resection of bladder tumor (TURBT)，which is mainly used for non-muscle invasive bladder cancer.However，this surgical procedure has problems such as fragmented specimens，inaccurate staging，and high incidence of complications.With the development of surgical techniques and equipment，en bloc resection of bladder tumor (ERBT) is gradually replacing traditional TURBT thanks to advantages of minimal trauma，fewer complications，and so on.ERBT based on various types of lasers provides clinicians with multiple choices，such as neodymium laser，holmium laser，thulium laser，blue laser，and diode laser.However，lasers have different advantages as well as limitations.This paper explores the current application of various lasers in ERBT，and analyzes the challenges and plans in handling large volume bladder tumors and collecting specimens，so as to provide reference for clinical urologists.

Objective:To investigate the difference in intracranial infection rate between long-tunneled external ventricular drainage(LTEVD)and conventional external ventricular drainage(EVD),as well as the risk factors for intracranial infection.Methods:A retro-spective analysis was performed for the clinical data of 45 patients who were admitted to Department of Neurology Center,The Third Affiliated Hospital of Chongqing Medical University,from January 2020 to December 2022 and underwent EVD,among whom 13 patients underwent LTEVD(LTEVD group)and 32 patients underwent conventional EVD(EVD group).Related data were recorded for both groups,including general information,postoperative catheter-related complications,and postoperative management,to investi-gate the effect on reducing the rate of intracranial infection.According to the presence or absence of intracranial infection after surgery,the patients were divided into the infection group with 10 patients and non-infection group with 35 patients,and related clini-cal data were analyzed to investigate the risk factors for intracranial infection.Results:The LTEVD group had a significantly lower secondary infection rate of catheterization days than the EVD group[2.40‰(1/417)vs.27.19‰(9/331),P=0.009].The duration of catheterization was 14-85 days[27.00(22.50,36.50)days]in the LTEVD group and 8-22 days[9.00(8.00,11.50)days]in the EVD group,suggesting that the LTEVD group had a significantly longer duration of catheterization than the EVD group(P=0.000).The multivariate logistic regression analysis showed that the times of cerebrospinal fluid sampling was an independent risk factor for post-operative intracranial infection in patients undergoing EVD,and the use of LTEVD was a protective factor against intracranial infection after EVD.Conclusion:Compared with conventional EVD,LTEVD can safely prolong the duration of catheterization and reduce the rate of postoperative intracranial infection in patients undergoing EVD.The use of LTEVD procedure and the reduction in the times of cerebrospinal fluid sampling can reduce the risk of postoperative in-tracranial infection.

Objective:To investigate the clinical diagnosis and treatment of granulomatous prostatitis（GP）in patients with Prostate Imaging Reporting and Data System（PI-RADS）scores ≥ 4 on magnetic resonance imaging（MRI）.Methods:The data of 12 GP patients with PI-RADS score ≥ 4 who were admitted to Beijing Chaoyang Hospital，Capital Medical University，from February 2015 to February 2025，were retrospectively analyzed. The patients were aged 51?73 years（mean 66 years）. Presenting complaints included elevated prostate-specific antigen（PSA）levels in 6 cases，prostatic mass in 2 cases，urinary retention in 3 cases，and gross hematuria in 1 case. All 12 patients had concomitant lower urinary tract symptoms. Medical history revealed pulmonary tuberculosis in 2 cases，testicular tuberculosis in 1 case，close contact with tuberculosis in 1 case（spouse diagnosed with pulmonary tuberculosis 5 years earlier），allergic granulomatous vasculitis in 1 case，and intravesical bacillus Calmette-Guérin（BCG）instillation in 1 case. Digital rectal examination（DRE）showed gradeⅠprostatic hyperplasia in 2 cases，grade Ⅱ in 9 cases，and grade Ⅲ in 1 case. Nodules were palpable in 6 patients. The median PSA was 7.20 ng/ml（ranging 1.11?21.90 ng/ml），with 2 cases < 4 ng/ml. Transrectal ultrasound was performed in 10 patients，and prostate volumes were ranging from 29.48 to 109.78 cm3，with 6 cases > 45 cm3. All 12 patients underwent MRI，and all demonstrated PI-RADS scores ≥ 4，typically presenting as low signal intensity on T2-weighted imaging，high signal on diffusion-weighted imaging（DWI），and low apparent diffusion coefficient（ADC）values. Contrast-enhanced MRI in 8 cases revealed heterogeneous enhancement. One patient underwent 68Ga-prostate-specific membrane antigen positron emission tomography-computed tomography（ 68Ga-PSMA PET-CT），which showed band-like increased uptake in the central zone. All 12 patients were preoperatively suspected of prostate cancer，of whom 10 underwent transrectal biopsy and 2 underwent transperineal biopsy. Pathological characteristics and follow-up results were analyzed. Treatment outcomes were analyzed，The International Prostate Symptom Score（IPSS），quality of life（QOL）score，maximum urinary flow rate（Q max），and post-void residual urine（PVR）volume were compared before and 1 month after treatment. Results:Histopathology confirmed GP in all cases，with chronic inflammation in 11 cases and acute inflammation in 1 case. Immunohistochemistry demonstrated positivity for CD68（macrophage marker），high-molecular weight cytokeratin（HCK），and reticulin staining；periodic acid-Schiff（PAS）and acid-fast staining were positive in 2 cases，corresponding to 1 patient with a prior history of pulmonary tuberculosis and 1 with testicular tuberculosis. Two patients underwent thulium laser enucleation of the prostate，while 10 received conservative treatment，including 2 patients with tuberculosis infection who were referred for anti-tuberculosis therapy and 8 patients treated with oral tamsulosin 0.2 mg once daily. Follow-up was completed in 10 patients：9 were followed for 1 ? 3 months（mean 2.4 months），and 1 patient was followed for 9 years before being diagnosed with prostate cancer. Two additional patients，whose pathological findings suggested a possible diagnosis of tuberculous granulomatous prostatitis，were advised to undergo anti-tuberculosis treatment at another hospital and were subsequently lost to follow-up. Among the 2 patients who underwent thulium laser enucleation，IPSS decreased from 26 and 25 to 6 and 5 respectively，QOL scores decreased from 6 and 5 to 1 and 0 respectively，Q max increased from 4.5 and 4.3 ml/s to 23.0 and 21.9 ml/s respectively. In the 8 patients treated conservatively，IPSS decreased from 18.45±7.17 to 14.45±5.03，and QOL score decreased from 5.09±1.04 to 4.09±0.70 at 1 month after treatment，showing significant improvement（ P < 0.05）. Additionally，one patient initially diagnosed with GP and managed conservatively remained stable for 9 years，but subsequently developed urinary retention and underwent thulium laser enucleation，with postoperative pathology confirming prostate cancer. Conclusions:Clinical manifestations of GP are nonspecific，and the condition can easily be mistaken for prostate cancer due to elevated PSA levels and PI-RADS scores ≥4. Some patients may present with acute urinary retention，but definitive diagnosis still relies on prostate biopsy and immunohistochemistry. Treatment should be individualized according to the underlying etiology，with medication as the mainstay，while transurethral surgical intervention may be considered in cases with obstruction. Although GP is a benign lesion，its potential association with prostate cancer warrants vigilance and emphasizes the importance of long-term follow-up.

Objective:To investigate the efficacy of the supercharged gracilis myocutaneous flap in reconstruction of the surgical defects following resection of soft tissue sarcoma (STS) in extremities.Methods:A retrospective analysis was conducted on 6 patients who received surgery to remove STS in extremities followed by reconstructive surgery with a supercharged gracilis myocutaneous flap to reconstruct the surgical defect (16.0 cm×4.8 cm-25.0 cm×8.0 cm), at the Department of Microsurgery, the 4th Medical Centre, Chinese PLA General Hospital between January 2023 and January 2024. The locations of sarcoma were: 3 in left forearm, 2 in right calf and 1 in left calf. The pathological types of the sarcoma were: 1 of myxoid liposarcoma, 1 of dedifferentiated liposarcoma, 1 of alveolar rhabdomyosarcoma, 1 of low-grade myxofibrosarcoma and 2 of fibrosarcoma. According to the Enneking classification, 2 sarcomas were in stage I and 4 in stage Ⅱa. All patients underwent expanded resection of the sarcoma and followed by reconstruction of the surgical defect with supercharged gracilis myocutaneous flap. The flap size ranged from 18.0 cm×5.2 cm to 27.7 cm×10.2 cm, with the length of the muscle flap at 25.92 cm±5.57 cm and 17.0 cm×2.8 cm×2.7 cm-32.0 cm×6.0 cm×3.5 cm in volume. The surgical defects were filled with muscle flaps, while the wounds were covered by cutaneous flaps. The perforating branches of the deep femoral artery carried by proximal vascular pedicle of the myocutaneous flap were anastomosed end-to-end with the prominent vessels of the recipient site. Where, the perforators of the distal femoral artery of the myocutaneous flap were anastomosed end-to-end with the recipient vessels for external blood perfusion, and the great saphenous vein of the flap was anastomosed end-to-end with the superficial veins of the recipient site. All donor sites were directly sutured. Scheduled postoperative follow-ups at outpatient clinic were conducted to assess the viability of the transferred myocutaneous flap. Limb function was evaluated using the Musculoskeletal Tumour Society-93 (MSTS-93) and the Toronto Extremity Salvage Score (TESS).Results:The postoperative follow-up lasted for 12 to 20 months. All 6 myocutaneous flaps survived without distal necrosis. All patients regained daily activities and functioned well. The MSTS-93 scores achieved 24 to 30 (27.0 ± 2.4) points; while the recovery rate of limb function were 85% to 100% (90.00% ± 7.89%) and the TESS were 85% to 100% (93.65% ± 5.47%). No patients exhibited tumour recurrence over the period of follow-up.Conclusion:The supercharged gracilis myocutaneous flap is a safe and effective myocutaneous flap. It serves as an effective method for soft tissue reconstruction after surgical resection of STS in extremities.

Objective:To evaluate the safety and efficacy of digital technology-assisted debridement and bone and soft tissue reconstruction in the treatment of chronic osteomyelitis of the tibia.Methods:This retrospective study analyzed clinical data from 38 patients (26 males, 12 females; mean age 45.61±18.36 years, range 16-83 years) with chronic post-traumatic osteomyelitis complicated by soft tissue defects in the tibia, treated at the Department of Orthopaedics, Fourth Medical Center of PLA General Hospital between June 2021 and June 2023. There were 18 cases of traffic accidents, 6 cases of high-altitude falls, 6 cases of heavy objects and 6 cases of low-energy falls. Lesion sites: 12 cases in the upper segment of the tibia, 12 cases in the middle segment, and 14 cases in the lower segment. According to the Cierny-Mader classification, there were 24 cases of type III and 14 cases of type IV. Before the operation, the "3D point cloud technology" was used to plan the debridement range of bone and soft tissue. During the operation, the optical navigation system was used to monitor the debridement range in real time. The flap was designed by combining "Reading Tablet Treasure" with CT angiography, and the amount of bone graft was predicted by AI algorithm. The surgical method adopted is the Masquelet technique, namely thorough debridement, bone cement occupation and soft tissue repair in the first stage, and bone reconstruction in the second stage. Comparing the calculated bone defect amount and soft tissue defect area before the operation with the actual measured values after debridement. The cure rate of infection was evaluated by using the McKee bone infection treatment criteria after the operation. The visual analogue scale (VAS) for pain, lower extremity functional scale (LEFS), and self-rating anxiety scale (SAS) were used to evaluate the improvement of the quality of life of postoperative patients.Results:38 patients were followed up with a mean follow-up of 13.53±2.37 months. 37 patients' infections were effectively controlled, and 1 patient had a recurrence of infection, with an effectiveness rate of 97% for the treatment of McKee's infections. The preoperative calculated bone defect amount and soft tissue defect area were 51.05±26.31 cm 3 and 68.42±43.45 cm 2 respectively, and the actual measured values after debridement during the operation were 51.66±26.35 cm 3 and 68.82±43.76 cm 2 respectively. There was no statistically significant difference before and after the operation ( P>0.05). The interval between the first and second stage surgeries was 10.36±1.61 weeks, and all flaps survived after the first stage surgery. Two months after the operation, one case had recurrent osteomyelitis. After palliative treatment, sinus tracts were formed at the infection site. At the 12-month regular dressing change follow-up, there were still purulent secretions in the sinus tracts. There was no recurrence of infection after primary debridement in 37 cases, and the bone grafts healed. The bone healing time was 3.58±0.97 months. The postoperative VAS, LEFS, and SAS scores were 1.00±0.91, 66.68±7.91, and 34.30±4.29, respectively, which were significantly improved compared with the preoperative scores of 7.54±1.52, 21.22±4.29, and 52.70±6.74, respectively, and the difference was statistically significant ( P<0.05). Conclusions:The application of digital technology to precisely design the debridement range of bone and soft tissue, and the real-time holographic visualization monitoring of the debridement range during the operation can achieve precise debridement of bone and soft tissue and personalized and precise repair of soft tissue defects. It is a safe and effective technique for the treatment of chronic osteomyelitis of the tibia.

Objective To observe the effect of ultrasound-guided intercostal nerve block(ICNB)on stress response and postoperative pain in patients with transaxillay gasless endoscopic thyroidectomy(TGET).Methods A total of 60 patients who underwent TGET at Ganzhou People's Hospital from January 2023 to December 2024 were enrolled as subjects,they were divided into ICNB group(n=30)and control group(n=30),by using a random number table method.Intraoperative anesthetic dosage,pain scores within 24 hours postoperatively,levels of prostaglandin E2,norepinephrine,and cortisol,as well as the incidence rates of postoperative adverse reactions including nausea and drowsiness were compared between two groups.Results The dosage of propofol and remifentanil in ICNB group during the operation was lower than that in control group.Prince-Henry score 24h after the operation in ICNB group was lower than that in control group.Levels of prostaglandin E2,norepinephrine and cortisol in ICNB group were all lower than those in control group,and the difference was statistically significant(P＜0.05).The incidences of postoperative nausea and drowsiness in ICNB group were lower than those in control group.Conclusion Ultrasound-guided ICNB for TGET can reduce the use of anesthetic drugs during the operation,alleviate patient's stress response and postoperative pain,and lower the incidence of postoperative adverse reactions.

Objective To explore the interaction between long non-coding RNA growth arrest-specific 5(GAS5)and miR-135b-5p/adenomatous polyposis coli(APC)axis,and to elucidate its biological function in the proliferation,metastasis and invasion of glioma.Methods The relationship of GAS5 expression level with survival rate of glioma patients was analyzed based on CGGA database.qRT-PCR was used to detect the expression level of GAS5 in glioma tissues and cell lines.Human glioma T98 and A172 cell lines were subjected for overexpression and knockdown of GAS5,miR-135b-5p and APC by transfection.Western blotting and qRT-PCR were applied to measure the expression of related genes in glioma tissues or cell lines.CCK-8,Transwell and wound healing assays was conducted to determine the effect of GAS5 on the viability and motility of glioma cells.Moreover,dual luciferase reporter analysis were utilized to elucidate the regulatory mechanisms of GAS5 and miR-135b-5p/APC.Results Analysis on CGGA database showed that the survival rate of glioma patients with low GAS5 expression was significantly decreased(P＜0.001).Western blotting and qRT-PCR indicated that GAS5 was down-regulated in the glioma cell lines and tissues than human normal astrocytes and para-cancer tissues(P＜0.01).The results of CCK-8,Transwell and wound healing assays revealed that overexpression of GAS5 significantly inhibited the viability,invasion and migration abilities in T98 cells when compared with the cells of the vector group(P＜0.01).Dual luciferase reporter analysis displayed that there were binding sites between GAS5 and miR-135b-5p,and the expression of the two was negatively correlated(P=0.019).Further studies suggested that the effect of GAS5 on biological function in glioma cells was through targeting miR-135b-5p,and overexpression of APC reversed the promoting effect of miR-135b-5p on glioma cells(P＜0.01).Western blotting displayed that enhancing miR-135b-5p expression inhibited the expression of APC(P＜0.001),and GAS5 upregulated the expression of APC by targeting miR-135b-5p(P＜0.01).Conclusion GAS5 inhibits the progression of glioma via miR-135b-5p/APC axis,which revealing the molecular regulatory mechanism of GAS5/miR-135b-5p/APC.

OBJECTIVE To explore the short-term efficacy,safety and related influencing factors of subcutaneous immunotherapy(SCIT)in children with allergic rhinitis(AR).METHODS Retrospective analyzed the clinical data of 147 children with AR who underwent SCIT at Shenzhen Hospital of Southern Medical University from August 2020 to May 2024.The clinical characteristics and laboratory parameters were collected,the visual analogue scale(VAS),total symptom score(TSS),total medication score(TMS)and combined symptom medication score(CSMS)were compared at the baseline and 3,6 and 12 months after treatment.The incidence of local adverse reactions(LRs)and systemic adverse reactions(SRs)during treatment was also documented.RESULTS A total of 147 children with AR aged 5-18 years were included in the study.A significant reduction was observed in VAS,TSS,TMS and CSMS at months 3,6 and 12 of follow up compared with baseline(all P<0.001),and the short-term onset time was months 3 after treatment.The level of VitD3 in the effective group was significantly higher than that in the ineffective group(P<0.001).Serum VitD3 level was negatively correlated with clinical symptom(R=-0.3,P=0.026).The total number of injections in 147 children was 3201.LRs occurred in 52 children(35.4％),the number of injections was 69(2.2％).SRs occurred in 21 children(14.3％),and the number of injections was 34(1.1％).No grade Ⅲ or Ⅳ SRs occurred.In the logistic regression analysis,body mass index(BMI)was a risk factor for LRs(OR:2.220,95％CI:1.009-4.887,P=0.048).CONCLUSION SCIT demonstrates significant early efficacy and a favorable safety profile safety in children with AR.Serum Vitamin D3 deficiency can affect the short-term efficacy of SCIT.Overweight and obese children are prone to develop local adverse reactions.