Congenital lower urinary tract obstruction (CLUTO) is a spectrum of fetal malformations caused by anatomical abnormalities of the urethra, characterized by high rates of perinatal complications and mortality. The 2024 joint guideline from the European Association of Urology (EAU) and the European Society for Paediatric Urology (ESPU) introduced systematic revisions to the comprehensive management of CLUTO. Key updates encompass advancements in prenatal and postnatal screening and precise diagnosis, refined fetal prognosis assessment, clearer indications and modality selection for prenatal intervention, optimization of postnatal treatment strategies, and the establishment of a lifelong follow-up framework within an integrated care pathway. This article elucidates these key updates by comparing the 2024 EAU/ESPU guideline with the 2022 European Rare Kidney Disease Reference Network (ERKNet) consensus. It also discusses ongoing controversies and future research directions. The aim is to provide clinicians with the latest evidence-based insights to inform practice, ultimately improving outcomes and quality of life for children with CLUTO.
Humans ; Urology ; Female ; Urethral Obstruction/therapy* ; Pregnancy ; Child ; Europe ; Prenatal Diagnosis ; Infant, Newborn ; Urethra/abnormalities*

Objective To evaluate the cost-effectiveness of enzalutamide in the treatment of metastatic prostate cancer from the perspective of healthcare in China.Methods Based on the published phase Ⅲ randomized controlled trial(ENZAMET),the disease process of metastatic prostate cancer was classified into three states:progression-free survival,progression survival and death,and the model period was defined as 28 days,and the study period was lifelong,and a Markov model was established to evaluate the cost-effectiveness of the treatment of enzalutamide versus standard antiandrogen drugs in metastatic prostate cancer.Setting the willingness-to-pay(WTP)threshold at 3 times our 2022 gross domestic product(GDP)per capita and the robustness of the model analysis was verified by sensitivity analysis.Results Compared to the control group standard antiandrogen therapy,the incremental effect of enzalutamide was 0.92 quality-adjusted life years(QALYs),the incremental cost was 311 863.30 yuan,and the incremental cost-effectiveness ratio(ICER)was 338 981.85 yuan/QALY,which was higher than WTP threshold(257 094 yuan/QALY).The results of univariate sensitivity analyses showed that the total cost of the enzalutamide group,the PFS utility value,the cost of the PD status of enzalutamide group,and the unit price of enzalutamide had a greater impact on the model results.The results of the probabilistic sensitivity analysis suggested that the enzalutamide treatment regimen was not economical within the willingness-to-pay threshold of 3 times our 2022 GDP per capita.Conclusion Compared with the standard anti-androgen drugs,enzalutamide does not offer a cost-effectiveness advantage in the treatment of metastatic prostate cancer.

BACKGROUND:Unicompartmental knee arthroplasty has been paid more and more attention because of its advantages of fewer traumas,less blood loss,less complications,faster recovery,excellent knee function and high prosthetic survival rate.Most of the relevant reports focused on its clinical effect,but the changes in the levels of relevant inflammatory cytokines in patients after unicompartmental knee arthroplasty were rarely reported. OBJECTIVE:To investigate the effect of unicompartmental knee arthroplasty in patients with medial compartment osteoarthritis of the knee and the changes of interleukin-1,interleukin-6,and tumor necrosis factor-α levels. METHODS:A total of 30 patients with medial compartment osteoarthritis of the knee who received unicompartmental knee arthroplasty from September 2021 to March 2023 and met the inclusion criteria were selected as the study subjects.Medial angle of proximal tibia,femoral and tibial angle,pain visual analog scale score,hospital for special surgery score,knee joint range of motion,synovial fluid interleukin-1,interleukin-6,and tumor necrosis factor-α levels before and after surgery were compared and statistically analyzed. RESULTS AND CONCLUSION:(1)All 30 patients had grade I wound healing.All patients were followed up for more than 6 months after surgery.There were no complications such as prosthesis loosening and dislocation of prosthesis liner in all patients.(2)The medial proximal tibia angle and the femoral and tibial angles measured after operation were significantly improved(P<0.05).(3)The visual analog scale score,hospital for special surgery score and range of motion measured at 1,3,and 6 months after operation were better than those before operation(P<0.05),and showed a gradual improvement(P<0.05).(4)The levels of interleukin-1,interleukin-6,and tumor necrosis factor-α in synovial fluid at 3 and 6 months after operation were decreased gradually compared with those before operation(P<0.05)and showed a gradual downward trend at each time point after operation.(5)It is indicated that unicompartmental knee arthroplasty can effectively treat medial compartment osteoarthritis of the knee,significantly relieve pain,restore knee joint function,improve knee varus deformity and lower limb strength line,and reduce the levels of inflammatory cytokines interleukin-1,interleukin-6,and tumor necrosis factor-α in joints to a certain extent.

It is a common problem for all mentors to cultivate the capacity for scientific research of master degree candidates in plastic surgery under the current training program of "double-track in one" and "four-certificate in one". This study introduces the "COME" training mode that includes clinical study, off-hour, multiple modalities, and efficient feedback. This study elaborates the composition and method of this training mode, and compares the number and quality of published papers and thesis before and after its implementation. Results show that the "COME" training mode can significantly improve the capacity for scientific research of master degree candidates in plastic surgery.

It is a common problem for all mentors to cultivate the capacity for scientific research of master degree candidates in plastic surgery under the current training program of "double-track in one" and "four-certificate in one". This study introduces the "COME" training mode that includes clinical study, off-hour, multiple modalities, and efficient feedback. This study elaborates the composition and method of this training mode, and compares the number and quality of published papers and thesis before and after its implementation. Results show that the "COME" training mode can significantly improve the capacity for scientific research of master degree candidates in plastic surgery.

Hip fracture is considered as the most severe osteoporotic fracture characterized by high disability and mortality in the elderly. Improved surgical techniques and multidisciplinary team play an active role in alleviating prognosis, which places higher demands on perioperative nursing. Dysfunction, complications, and secondary impact of anaesthesia and surgery add more difficulties to clinical nursing. Besides, there still lack clinical practices in perioperative nursing for elderly patients with hip fracture in China. In this context, led by the Orthopedic Nursing Committee of Chinese Nursing Association, the Expert consensus on clinical practice in perioperative nursing for elderly patients with hip fracture ( version 2023) is developed based on the evidence-based medicine. This consensus provides 11 recommendations on elderly patients with hip fracture from aspects of perioperative health education, condition monitoring and inspection, complication risk assessment and prevention, and rehabilitation, in order to provide guiding advices for clinical practice, improve the quality of nursing and ameliorate the prognosis of elderly patients with hip fracture.

IgG 4-related disease (IgG 4-RD) is an immune-mediated fibroinflammatory condition characterized by tumefactive lesions in multi-organs. It is a novel entity presented by variable manifestations. In recent years, there has been progress toward recognizing IgG 4-RD. However, the diagnosis and treatment of IgG 4-RD still present challenges due to insufficient experience. To address this, the Chinese Rheumatology Association has developed standardized guidelines for the diagnosis and treatment of IgG 4-RD based on domestic and international experience. These guidelines aim to enhance the understanding and management of IgG 4-RD, ultimately improving the prognosis for patients with IgG 4-RD.

Objective To investigate the difference of matrix stiffness in different regions of tibial plateau in osteoarthritis (OA) and its effects on morphology of the cartilage and mitochondria. Methods The tibial plateau cartilage specimens of OA were obtained for nanoindentation test, transmission electron microscopy and histological analysis. The stiffness of cartilage matrix in different regions of OA tibial plateau was detected by nano-indentation. The morphology of cartilage mitochondria in different regions was observed by transmission electron microscopy, and the changes of mitochondrial plane area, shape and ridge volume density were quantitatively analyzed. Cartilage injury in different regions of OA tibial plateau was observed by histological staining. Results The cartilage of OA tibial plateau showed regional heterogeneity, and the cartilage and mitochondria on medial side of varus knee OA were more severe, and the matrix stiffness was higher. The OA scores were positively correlated with matrix stiffness. There was also a significant correlation between OA scores and mitochondrial morphology: the higher OA scores, the larger and rounder mitochondrial plane area, and the lower cristae volume density. Conclusions The differences of tibial plateau revealed the correlation between cartilage matrix stiffness, OA scores and mitochondrial morphological parameters. The increased cartilage matrix stiffness may be the main cause of chondrocyte mitochondrial injury, and further aggravate the progression of OA.

Objective:To scope review of studies on the risk factors for vessel catheter associated infection in children with intestinal failure was reviewed, so as to provide a reference for clinical medical staff to prevent and control infection.Methods:Based on the framework of scope review method, PubMed, Embase, CINAHL, APA PsycInfo, Web of Science, Scopus, Cochrane Library, China Biomedical Literature Database, China Knowledge Networkand Wanfang database are retrieved. The retrieval period was from the database construction to February 1, 2022. The included literatures were Summarized and analyzed.Results:A total of 28 articles were included, and the risk factors of vessel catheter associated infection in children with intestinal failure were found to include 7 aspects: basic information of children, catheter nursing measures, type of tube-sealing solution, catheter factors, residual intestinal condition of children, nursing level of caregivers, therapeutic factors.Conclusions:The risk factors of vessel catheter associated infection in children with intestinal failure were found to include 7 aspects, which are complex and diverse with distinctive disease characteristics. In the future, medical staff can optimize the pipeline nursing measures; construct the model of cross-specialty health education and improve the nursing level of caregivers to reduce the incidence of vessel catheter associated infection.

Objective:To explore the critical value of different blood group antibody titration in ABO blood group incompatible kidney transplant(ABOi-KT)recipients by tube and gel methods to provide rationales for selecting the threshold value of antibody titration before ABOi-KT.Methods:From January 2019 to April 2021, 681 blood group antibody titrations were performed for 214 ABOi-KT recipients.There were type A( n=135), type B( n=168)and type O( n=378). The difference, correlation and consistency of two methods were statistically analyzed. Results:Tube method was 2 gradients lower than gel method(4-fold dilution)and the results were significantly different( P<0.000 1). Spearman's test indicated that the results of two methods were significantly correlated( P<0.000 1). The results of intraclass correlation coefficient showed that the consistency of two methods was general for type A recipients(ICC=0.640), decent for type B recipients(ICC=0.751)and poor for type O recipients(ICC<0.4). When the critical value of tube method was set, titration of type A anti-B was 16, titration of type B anti-A 8 and titration of type O anti-A/B 8.And the corresponding critical values of gel was type A anti-B 32, type B anti-A 16 and type O anti-A/B 16. Conclusions:The results of ABO blood group IgM antibody titration by gel and tube methods are correlative.And gel method is recommended for more stable and reproducible results.