Objective Flexible ureteroscopic holmium laser lithotripsy for the treatment of calculi in caliceal diverticulum complicated with perirenal hematoma has a low incidence.This paper discusses the clinical features and preventive strategies of the disease. Case Presentation The patient was a 58-year-old male, admitted due to repeated left lower back pain for two months. CT scan indicated left calyceal diverticulum stones. Transurethral flexible ureteroscopic holmium laser lithotripsy was performed. A follow-up CT scan revealed a left perirenal hematoma and the stones had shifted to the perirenal area. Percutaneous nephrolithotripsy was then performed. Four weeks after surgery, CT scan showed that the left perirenal hematoma had absorbed well. Conclusion The risk of perirenal hematoma and stone displacement may occur during ureteroscopic holmium laser lithotripsy for calyceal diverticulum stones. The risk can be effectively reduced by negative suction sheath, reduction of intraoperative perfusion pressure, reasonable use of holmium laser, and control of related factors.

Female reproductive system diseases,such as premature ovarian insufficiency(POI),premature ovarian failure(POF),polycystic ovary syndrome(PCOS),intrauterine adhesions(IUA),ulterus scar diverticulum,salpingitis,and tubal obstruction,may induce infertility,severely impacting patients'physical and mental health and quality of life.Currently,the umbilical cord mesenchymal stem cells(UCMSCs)have emerged as a research focus in gynecological and obstetric fields,demonstrating significant therapeutic potential for female reproductive system disorders.UCMSCs secrete various cytokines,activate relevant signaling pathways and key molecules,reduce inflammation mediators and oxidative stress,and prevent excessive cellular damage and apoptosis,thereby achieving therapeutic effects.In recent years,extensive studies have explored the therapeutic effects of UCMSCs on female reproductive system diseases.This article review the current in vitro and in vivo research progress in UCMSCs for treating female reproductive system diseases,aiming to provide the novel strategies and directions for future research and clinical applications.

Objective To investigate the effect of long non-coding ribonucleic acid cancer susceptibility can-didate gene 19(lncRNA CASC19)regulating the microRNA(miR)-490-3p/high mobility group protein A2(HMGA2)axis on the proliferation,migration,and chemotherapy resistance of colorectal cancer(CRC)cells.Methods Human normal colonic epithelial cells(FHC)and CRC cell lines(LOVO,HCT116,SW480)were cultured.LOVO cells were randomly divided into Control group,sh-NC group,sh-CASC19 group,sh-CASC19+anti-NC group and sh-CASC19+anti-miR-490-3p group.The lncRNA CASC19,miR-490-3p and HMGA2 mRNA expression were detected by real-time fluorescence quantitative polymerase chain reaction(qRT-PCR).The relationship between lncRNA CASC19 and miR-490-3p and between miR-490-3p and HM-GA2 were detected by Dual luciferase assay.The cell proliferation ability was detected by cell counting kit-8(CCK-8)assay and colony formation assay.The cell migration ability was detected by cell scratch assay.The cell invasion ability was detected by Transwell assay.The cell metastasis-related proteins(MMP2,MMP9)and HMGA2 protein expression were detected by Western blot assay.The chemotherapy resistance was detec-ted by cisplatin and fluorouracil.Results The lncRNA CASC19 and HMGA2 mRNA expression increased in CRC cell lines,and miR-490-3p expression decreased.The lncRNA CASC19,miR-490-3p and HMGA2 mRNA expression in LOVO cells were the most significant,LOVO cells were selected for subsequent experiments.The dual luciferase assay showed that,after the transfection of lncRNA CASC19 and HMGA2,compared with mimic-NC group,the luciferase activity in miR-490-3p mimic group decreased(P＜0.05).Compared with sh-NC and Control groups,the survival rate,clone number,migration rate,invasion rate,MMP2,MMP9,HMGA2 mRNA and protein expression of LOVO cells in sh-CASC19 group were decreased,and the miR-490-3p ex-pression was increased(P＜0.05).Compared with sh-CASC19 group and sh-CASC19+anti-NC group,the survival rate,clone number,migration rate,invasion rate,MMP2,MMP9,HMGA2 mRNA and protein expres-sion of LOVO cells in sh-CASC19+anti-miR-490-3p group were increased,and the miR-490-3p expression was decreased(P＜0.05).The chemotherapy resistance experiment showed that,compared with Control group,the chemotherapy resistance sensitivity of LOVO cells in sh-CASC19 group increased(P＜0.05).Compared with sh-CASC19 group,the chemoresistance sensitivity of LOVO cells in sh-CASC19+anti-miR-490-3p group was decreased(P＜0.05).In the same group,with the increase of the concentration of fluorou-racil and cisplatin,the cell survival rate gradually decreased(P＜0.05).Conclusion Knockdown of lncRNA CASC19 can regulate miR-490-3 p/HMGA2 signaling pathway,inhibit the proliferation and migration of CRC cells,and increase the sensitivity of chemotherapy resistance.

Objective To investigate lymphocyte interstitial infiltration condition and the changes of immune checkpoint gene expression in different stages of early esophageal cancer.Methods A ret-rospective analysis was conducted on the clinical data of 90 patients with early esophageal cancer.Based on the pathological depth of infiltration,they were divided into three types:T1a-M1,T1a-M2,and T1a-M3,with 30 cases in each type.Additionally,30 cases of paired normal mucosa tissues adja-cent to the cancer were selected.Hematoxylin-eosin(HE)staining was used to observe tissue morpholo-gy.Immunohistochemistry was employed to detect the expression of CD3,CD4,CD8,and CD20.Real-time fluorescence quantitative polymerase chain reaction(RT-qPCR)was applied to measure the mRNA expression levels of immune checkpoint genes[programmed death ligand-1(PD-L1),cytotoxic T-lym-phocyte-associated protein 4(CTLA4),T-cell immunoglobulin and mucin domain-3(TIM-3),lympho-cyte activation gene 3(LAG3),programmed death receptor-1(PD-1),programmed death ligand-2(PD-L2),and T-cell immunoreceptor with Ig and ITIM domains protein(TIGIT)].Results As the stage of early esophageal cancer progressed,the ratio of tumor cells to lymphocytes increased.The number of CD3+T cells was greater than that of CD20+B cells,and the proportion of CD4+T cells among total T cells was higher than that of CD8+T cells(P＜0.001).The mRNA expression levels of gene in immune checkpoints in patients were elevated(P＜0.05).Compared with normal adja-cent tissues,the expression levels of PD-L1 mRNA,CTLA4 mRNA,TIM-3 mRNA,PD-1 mRNA,and TIGIT mRNA were elevated in patients with T1a-M1,T1a-M2,and T1a-M3 types(P＜0.05).Compared with normal adjacent tissues,the expression levels of LAG3 mRNA and PD-L2 mRNA were increased in patients with T1a-M2 and T1a-M3 types(P＜0.05).Conclusion The progres-sion of early esophageal cancer staging is correlated with increased immune checkpoint gene expres-sion and a decreased lymphocyte ratio,suggesting that changes in the immune microenvironment may be involved in tumor progression.

Abstract Breastfeeding has an irreplaceable effect on the growth and development of premature infants and the reduction of complications during hospitalization. In recent years, with the opening of China′s birth policy, the incidence of premature babies has increased, and the corresponding complications have also gradually increased. Breast milk not only carries a rich supply of nutrients, including rich proteins, lipids, sugars to support the normal growth and development of infants, but also contains a large number of immunoglobulins, hormones and other bioactive substances to promote the improvement of body immune function and the development of nervous system. In recent years, many studies have been carried out on the current situation of breast milk operation in breast milk bank, the collection and influencing factors of breast milk, the strategies of breast milk enrichment and its effects on the growth and development of premature infants and complications. Therefore, breast-feeding and intensive breast-feeding can effectively promote the growth and development of premature infants, and reduce the occurrence of complications.

Objective:To evaluate the value of ultrasound radiomics combined with machine learning for early diagnosis of seronegative Hashimoto’s thyroiditis (SN-HT) .Methods:This retrospective study included 164 patients from Liaoning Provincial People’s Hospital , Lixin County People’s Hospital, Linghai Dalinghe Hospital, Fengcheng Phoenix Hospital, who underwent thyroidectomy for solitary nodules with normal thyroid function between Nov. 2016 and Jan. 2024. Postoperative pathology confirmed Hashimoto’s thyroiditis (HT) in some cases, who were further categorized into antibody-positive and antibody-negative groups based on serum antibody status. Patients without Hashimoto’s thyroiditis served as the control group. A total of 298 ultrasound images were analyzed. Radiomics features were extracted from hypoechoic non-nodular areas within 0.5 cm surrounding the tumor. Two senior pathologists and two senior ultrasound physicians independently assessed lymphocytic infiltration, eosinophilic changes of follicular epithelium, and the proportion of hypoechoic areas in pathology and ultrasound images, respectively. A machine learning model, CCH-NET, was developed using linear regression and t-distributed stochastic neighbor embedding (t-SNE) techniques. The dataset was divided into a training set (80%) and a validation set (20%) to compare the diagnostic accuracy of CCH-NET with that of senior ultrasound physicians. Results:In internal validation, CCH-NET achieved a diagnostic accuracy of 88.89% for both antibody-positive and antibody-negative groups, significantly higher than the 66.67% accuracy of senior ultrasound physicians ( P<0.01). In external validation, CCH-NET achieved 75.00% and 66.67% accuracy for the two groups, compared to 50.00% by senior ultrasound physicians. For the control group, both methods achieved 93.33% accuracy. The AUC of CCH-NET was 0.848, outperforming senior ultrasound physicians (0.681) ,demonstrating superior diagnostic performance. Conclusion:The radiomics-based CCH-NET model, using non-nodular hypoechoic areas as a specific indicator, can accurately identify early SN-HT in euthyroid patients. It significantly outperforms senior ultrasound physicians, improving diagnostic accuracy and reducing missed diagnoses.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective:To evaluate the value of ultrasound radiomics combined with machine learning for early diagnosis of seronegative Hashimoto’s thyroiditis (SN-HT) .Methods:This retrospective study included 164 patients from Liaoning Provincial People’s Hospital , Lixin County People’s Hospital, Linghai Dalinghe Hospital, Fengcheng Phoenix Hospital, who underwent thyroidectomy for solitary nodules with normal thyroid function between Nov. 2016 and Jan. 2024. Postoperative pathology confirmed Hashimoto’s thyroiditis (HT) in some cases, who were further categorized into antibody-positive and antibody-negative groups based on serum antibody status. Patients without Hashimoto’s thyroiditis served as the control group. A total of 298 ultrasound images were analyzed. Radiomics features were extracted from hypoechoic non-nodular areas within 0.5 cm surrounding the tumor. Two senior pathologists and two senior ultrasound physicians independently assessed lymphocytic infiltration, eosinophilic changes of follicular epithelium, and the proportion of hypoechoic areas in pathology and ultrasound images, respectively. A machine learning model, CCH-NET, was developed using linear regression and t-distributed stochastic neighbor embedding (t-SNE) techniques. The dataset was divided into a training set (80%) and a validation set (20%) to compare the diagnostic accuracy of CCH-NET with that of senior ultrasound physicians. Results:In internal validation, CCH-NET achieved a diagnostic accuracy of 88.89% for both antibody-positive and antibody-negative groups, significantly higher than the 66.67% accuracy of senior ultrasound physicians ( P<0.01). In external validation, CCH-NET achieved 75.00% and 66.67% accuracy for the two groups, compared to 50.00% by senior ultrasound physicians. For the control group, both methods achieved 93.33% accuracy. The AUC of CCH-NET was 0.848, outperforming senior ultrasound physicians (0.681) ,demonstrating superior diagnostic performance. Conclusion:The radiomics-based CCH-NET model, using non-nodular hypoechoic areas as a specific indicator, can accurately identify early SN-HT in euthyroid patients. It significantly outperforms senior ultrasound physicians, improving diagnostic accuracy and reducing missed diagnoses.

Objective This study aimed to investigate the antimicrobial resistance profiles of bacterial strains isolated from pediatric intensive care units(PICU)in China for better antimicrobial therapy.Methods Clinical isolates were collected from 17 institutions,including tertiary care children's hospitals and pediatric department of tertiary general hospitals in China from January 1,2020 to December 31,2022.Antimicrobial susceptibility testing was carried out according to a unified protocol using Kirby-Bauer method or automated systems.Results were interpreted according to the breakpoints released by the Clinical and Laboratory Standards Institute(CLSI)in 2020.Results A total of 10 688 isolates were collected,including gram-positive organisms(39.2％)and gram-negative organisms(60.8％).The top three organisms were S.aureus(13.6％,1 453/10 688),A.baumannii(10.0％,1 067/10 688),and coagulase-negative Staphylococcus(9.9％,1 058/10 688).Multi-drug resistant organisms(MDROs)were very common in children.The prevalence of methicillin-resistant Staphylococcus aureus(MRSA),carbapenem-resistant Enterobacterales(CRE),carbapenem-resistant E.coli,carbapenem-resistant K.pneumoniae(CRKP),carbapenem-resistant A.baumannii(CRAB),and carbapenem-resistant P.aeruginosa(CRPA)was 41.1％,19.4％,8.8％,30.9％,67.4％,and 28.8％,respectively.Overall,more than 50％of Enterobacteriales isolates were resistant to cephalosporins,while nearly 25％of Enterobacteriales isolates were resistant to carbapenems.MDROs were highly resistant to commonly used antibiotics.More than 80％of CRE and CRAB strains were resistant to all beta-lactam antibiotics.CRE and CRAB showed low resistance rates to tigecycline and polymyxin.CRPA showed lower resistance rates to piperacillin,beta-lactamase inhibitor combinations than the resistance rates to third and fourth generation cephalosporins.All of the Staphylococcus and Enterococcus isolates were susceptible to vancomycin and tigecycline.None of PRSP strains isolated from meningitis and nonmeningitis samples were resistant to rifampicin,vancomycin,or linezolid.The prevalence of β-lactamase-negative ampicillin-resistant(BLNAR)strains was 43.3％in Haemophilus influenzae.Conclusions MDROs were prevalent in PICU.It is necessary to establish an effective multidisciplinary team(MDT)to control the antimicrobial resistance.

Objective:To investigate the detection of bone marrow tumor cells in small cell lung cancer (SCLC) patients and their relationship with clinical features, treatment response and prognosis.Methods:A total of 113patients with newly diagnosed SCLC from January 2018 to October 2022 at Beijing Chest Hospital were prospectively enrolled. Before treatment, bone marrow was aspirated and separately submitted for tumor cells detection by liquid-based cytology and disseminated tumor cells (DTCs) detection by the substrction enrichment and immunostaining fluorescence in situ hybridization (SE-iFISH) platform. The correlation between the detection results of the two methods with patients' clinical features and treatment response was evaluated by Chi-square. Kaplan-Meier method was applied to create survival curves and the Cox regression model was used for multivariate analysis.Results:The positive rate of bone marrow liquid-based cytology in SCLC was 15.93% (18/113). The liver and bone metastases rates were significantly higher (55.56% vs 11.58% for liver metastasis, P＜0.001; 77.78% vs 16.84% for bone metastasis, P＜0.001) and thrombocytopenia was more common (16.67% vs 2.11%, P=0.033) in patients with tumor cells detected in liquid-based cytology than those without detected tumor cells. As for SE-iFISH, DTCs were detected in 92.92% of patients (105/113), the liver and bone metastasis rates were significantly higher (37.93% vs 11.90% for liver metastasis, P=0.002; 44.83% vs 20.23 % for bone metastasis, P=0.010), and the incidence of thrombocytopenia was significantly increased (13.79% vs 1.19%, P=0.020) in patients with DTCs≥111 per 3 ml than those with DTCs＜111 per 3 ml. The positive rates of bone marrow liquid-based cytology in the disease control group and the disease progression group were 12.00% (12/100) and 46.15% (6/13), respectively, and the difference was statistically significant ( P=0.002). However, the result of SE-iFISH revealed the DTCs quantities of the above two groups were 29 (8,110) and 64 (15,257) per 3 ml, and there was no statistical difference between the two groups ( P=0.329). Univariate analysis depicted that the median progression-free survival (PFS) and median overall survival (OS) of liquid-based cytology positive patients were significantly shorter than those of tumor cell negative patients (6.33 months vs 9.27 months for PFS, P=0.019; 8.03 months vs 19.50 months for OS, P=0.019, P=0.033). The median PFS and median OS in patients with DTCs≥111 per 3 ml decreased significantly than those with DTCs＜111 per 3 ml (6.83 months vs 9.50 months for PFS, P=0.004; 11.2 months vs 20.60 months for OS, P=0.019). Multivariate analysis showed that disease stage ( HR=2.806, 95% CI:1.499-5.251, P=0.001) and DTCs quantity detected by SE-iFISH ( HR=1.841, 95% CI:1.095-3.095, P=0.021) were independent factors of PFS, while disease stage was the independent factor of OS ( HR=2.538, 95% CI:1.169-5.512, P=0.019). Conclusions:Both bone marrow liquid-based cytology and SE-iFISH are clinically feasible. The positive detection of liquid-based cytology or DTCs≥111 per 3 ml was correlated with distant metastasis, and DTCs≥111 per 3 ml was an independent prognostic factor of decreased PFS in SCLC.