To evaluate the application value of the Peyton four-step teaching method in the standardized training of intestinal ultrasound and compare it with traditional teaching methods, so as to provide an optimized approach for clinical ultrasound training.

This paper summarizes Professor WANG Xixing's clinical experience in treating immune checkpoint inhibitor-related pneumonitis （CIP） based on the theory of "cough attributed to the five zang （脏） organs". Cough is a common predominant symptom of CIP. According to the theory of "cough attributed to the five zang organs"， drug toxicity triggers cancer toxin， leading to disharmony among the five zang organs， and then lung failing to diffuse and govern descent as the core pathogenesis. Therefore， treatment should focus on harmonizing the five zang organs to restore the normal function of lung qi to diffuse and govern descent. In clinical practice， CIP can be classified into four syndrome patterns， including lung yin depletion， deficiency of both the lung and the spleen with phlegm-dampness， liver fire harassing the lung， and lung-kidney yin deficiency. Correspondingly， Chaimai Jinluo Runfei Decoction （柴麦金络润肺汤） is used to nourish yin and moisten the lung； Qigui Peitu Huayin Decoction （芪桂培土化饮汤） is used to fortify the spleen and tonify the lung， resolve dampness and dispel phlegm； Chaidan Shuyu Runjin Decoction （柴丹疏郁润金汤） is used to drain liver and clear the lung； and Dimai Jinshui Xiangsheng Decoction （地脉金水相生汤） is used to nourish the kidney and moisten the lung.

To summarize Professor WANG Xixing's clinical experience in treating advanced breast cancer with anxiety and depression from the perspective of shaoyang pivot. It is believed that the core pathogenesis of advanced breast cancer with anxiety and depression lies in the dysfunction of shaoyang pivot （referring to the imbalanced regulatory function of the shaoyang meridian system that governs the transportation and transformation of qi， blood， and body fluids）. This dysfunction can lead to abnormal circulation of qi， blood， and body fluids， as well as the intermingling of phlegm and blood stasis， which further promotes the spread and diffusion of cancer toxin. Meanwhile， it disturbs mental activity， resulting in a condition characterized by stagnation of cancer toxin and concurrent disorders of both the physical body and the spirit. Based on this pathogenesis， the basic therapeutic principles of harmonizing shaoyang， regulating the pivot to calm the spirit， and dissipating masses and resolving toxins are proposed. Clinically， the disease is classified into three syndromes for differentiation and treatment. For shaoyang pivot dysfunction syndrome， treatment should use self-prescribed Chaiqin Hengshu Ningxin Decoction （柴芩衡枢宁神汤）； for sanjiao pivot dysfunction syndrome， treatment should prescribe Chaigui Tongshu Dashen Decoction （柴归通枢达神饮）； for gallbladder function disorder syndrome， treatment should apply Wendan Qishu Shoushen Decoction （温胆启枢守神汤）. Throughout the treatment process， the concept of "simultaneous treatment of cancer and depression" is implemented to smooth the shaoyang pivot， block the vicious cycle where cancer toxin and emotional abnormalities mutually reinforce each other.

This article reports a diagnostically and therapeutically challenging case of small intestinal marginal zone lymphoma. The patient presented with recurrent abdominal pain as the chief complaint, and imaging revealed multifocal small bowel wall thickening with high uptake, multisegmental luminal stenosis, and proximal dilation. Initial diagnostic workup, including gastroscopy, colonoscopy, and enteroscopy with biopsy, failed to establish a definitive diagnosis. Empirical anti-tuberculosis therapy was ineffective. A repeat enteroscopic biopsy performed over eight months after symptom onset eventually confirmed the diagnosis of mucosa-associated lymphoid tissue (MALT) extranodal marginal zone lymphoma. Despite three different chemotherapy regimens, the patient's intestinal obstruction symptoms persisted, with imaging still showing multifocal bowel wall thickening and hypermetabolic activity. A critical diagnostic dilemma arose regarding whether the PET/CT-positive lesions represented residual lymphoma or fibrotic scarring, whether further chemotherapy adjustments were warranted, and whether surgical resection was necessary. Multidisciplinary discussion concluded that imaging had limited discriminatory value in this scenario and that surgical intervention should be pursued if feasible. The patient successfully underwent partial small bowel resection, with postoperative pathology confirming no residual lymphoma but significant fibrotic changes. The patient has since resumed a normal diet, with body weight nearly restored to pre-illness levels. This case highlights that fibrotic transformation is a common sequela of treated marginal zone lymphoma and that PET/CT may misleadingly suggest residual disease, potentially leading to unnecessary chemotherapy. Timely surgical intervention is crucial in such scenarios.

Background Existing studies have confirmed that fine particulate matter (PM_2.5)is one of the important factors inducing pulmonary fibrosis. Pulmonary fibrosis is the terminal stage of a major category of lung diseases characterized by the destruction of tissue structure, and eventually leading lung ventilation and ventilation dysfunction. No effective pulmonary fibrosis treatment is available yet. Objective To investigate the protective effect of salidroside on pulmonary fibrosis induced by the exposure of PM_2.5 and its molecular mechanism. Methods Seventy 7-week-old male C57BL/6 mice were randomly divided into four groups: control group (intratracheal instillation of normal saline + saline by gavage, n=25), Sal group (intratracheal instillation of normal saline + Sal 60 mg·kg⁻¹ by gavage, n=10), PM_2.5 group (intratracheal instillation of PM_2.5 5 mg·kg⁻¹ + saline by gavage, n=10), and Sal + PM_2.5 group (intratracheal instillation of PM_2.5 5 mg·kg⁻¹ +Sal 60 mg·kg⁻¹ by gavage, n=10). The mice were administered by gavage once daily, intratracheal instillation once every 3 d, and every 3 d constituted an experimental cycle. At the end of the 26-30th cycles, 3 mice in the control group and 3 mice in the PM_2.5 group were randomly sacrificed, and the lung tissues were collected for Masson staining to verify whether the pulmonary fibrosis model was successfully established. After 30 cycles, the model was successfully constructed. After 1 week of continuous observation, the mice were sacrificed, and the blood and lung tissues of the mice were collected to make lung tissue sections. Assay kits were correspondingly employed to detect oxidative stress indicators such as serum malondialdehyde (MDA) and superoxide dismutase (SOD). Western blotting was used to detect the expression of fibrosis-related proteins (Collagen-III, α-SMA), mitochondrial dynamics-related proteins (MFN1, Drp1), and mitophagy-related proteins (PINK1, Parkin, and LC3). Results Compared with the control group, the weight gain rate of the PM_2.5 group was slowed down (P<0.05), which was alleviated by the Sal intervention (P<0.05). The lung coefficient increased after the PM_2.5 exposure (P<0.05), which was alleviated by Sal intervention. Compared with the control group, the PM_2.5 group showed severe alveolar structure damage, inflammatory cell infiltration, and blue collagen deposition, and significantly increased the lung injury score, collagen volume fraction (CVF), Szapiel score, and Ashcroft score (P<0.05), as well as serum oxidative stress levels (P<0.05). The protein expression levels of Collagen-III, α-SMA, Drp1, PINK1, Parkin, and LC3 II/I were increased (P<0.05), and the expression of MFN1 was decreased (P<0.05). Compared with the PM_2.5 group, the Sal intervention alleviated lung injury, reduced inflammatory cell infiltration and collagen deposition, showing decreased lung injury score, CVF, Szapiel score, and Ashcroft score (P<0.05), and decreased serum oxidative stress levels (P<0.05); the protein expression levels of Collagen-III, α-SMA, PINK1, Parkin, and LC3 II/I were decreased (P<0.05), the expression level of Drp1 was decreased, and the expression level of MFN1 was increased. Conclusion In the process of pulmonary fibrosis induced by PM_2.5 exposure in mice, Sal may affect mitochondrial autophagy through PINK1/Parkin pathway and play a protective role. The specific mechanism needs to be further verified.

Objective:To investigate the clinical efficacy and safety of a modified injection technique for improving temporal concavity deformities.Methods:A prospective study was conducted on 157 female patients who underwent temporal concavity augmentation at the Department of Plastic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, from June 2019 to June 2022. The patients were aged from 32 to 48 (38.2±3.1) years. Granular fat was obtained through liposuction and purification. Using the midpoint of the frontotemporal line as the entry point, the granular fat tissue was injected evenly at multiple points under the skin and superficial temporal fascia. Additional granular fat was injected in the temporal edge area to ensure a smooth appearance. The visual analogue scale (VAS) was used to assess the patients' intraoperative pain levels. Follow-up visits were conducted for one year postoperatively to assess patient satisfaction with the improvement in temporal concavity, local pigmentation, and fine lines in the lateral orbital area based on preoperative and postoperative photographs. Complications, including swelling, ecchymosis, hematoma, fat embolism, infection, fat liquefaction, and subcutaneous induration, were recorded immediately after surgery and at the one-year follow-up.Results:All the 157 patients experienced mild swelling in the injection area postoperatively, which resolved within 3 to 6 days. Ecchymosis occurred in 15 patients and spontaneously resolved within 10 days. Eleven patients had asymmetry in the filled area, with 3 recovering after local massage and observation, and the remaining 8 undergoing a second fat grafting procedure. A total of 25 patients underwent more than two fat grafting procedures, including 4 who underwent three procedures. Mild local hematoma occurred in 3 patients postoperatively. The intraoperative pain VAS was (1.8±0.5) score. After treatment, the improvement scores for temporal concavity, local pigmentation, and fine lines in the lateral orbital area were (7.4±0.7), (6.8±0.7), and (7.9±0.7) scores, respectively. After one year of follow-up, no complications such as fat embolism, infection, fat liquefaction, or subcutaneous induration were observed in the 157 patients.Conclusion:The modified injection technique for improving temporal concavity deformities is safe and effective, with high patient satisfaction.

Kidney transplantation is widely recognized as the optimal treatment for children with end-stage renal disease(ESRD),offering significant improvements in growth,development,and long-term quality of life compared with prolonged dialysis.However,kidney transplantation in low-age(＜5 years old)and low-weight(＜15 kg)children presents significant clinical challenges due to their delicate vas-cular structures,limited surgical space,and complex perioperative management.This report presents two cases of kidney transplantation in low-age,low-weight children performed at Peking University People's Hospital.Case 1:a 2-year-3-month-old boy(8.8 kg),presenting a preoperative serum creatinine of 248μmol/L post-dialysis and the estimated glomerular filtration rates(eGFR)of 35.17 mL/(min·1.73 m2).Case 2:a 3-year-8-month-old girl(11.25 kg),presenting a preoperative creatinine of 281 μmol/L post-dialysis and the eGFR of 22.63 mL/(min·1.73 m2).Both recipients underwent transplantation via the extraperitoneal approach,with end-to-side anastomosis of the donor renal artery and vein to the recipient's common iliac artery and vein,respectively.The ureters were anastomosed to the bladder using the tunnel technique,and double-J stents were placed intraoperatively.The surgeries were uneventful,and both pa-tients exhibited rapid recovery of renal function.Postoperatively,serum creatinine levels decreased to 26μmol/L(Case 1)and 39 μmol/L(Case 2)by the third day,with the eGFR reaching 245.23 mL/(min·1.73 m2)and 164.12 mL/(min·1.73 m2),respectively.No complications,such as vascular thrombosis,ureteral stenosis,or abdominal compartment syndrome were observed during follow-up.A comprehensive literature review was conducted to contextualize these cases within global advancements in pediatric renal transplantation.Current evidence highlights the growing adoption of kidney transplantation for low-age,low-weight children,though debates persist regarding optimal surgical strategies(specifical-ly,the intraperitoneal versus extraperitoneal approaches).This case report underscores the feasibility of the extraperitoneal approach in overcoming anatomical limitations of low-weight pediatric recipients,with distinct advantages including reduced gastrointestinal complications and enhanced accessibility for post-operative ultrasound monitoring.Furthermore,mean arterial pressure(MAP)and central venous pressure(C VP)were systematically monitored intraoperatively to ensure optimal renal blood perfusion and graft viability.Our single-center experience provides valuable insights into surgical strategy selection and peri-operative management for this high-risk population.Nevertheless,larger multicenter studies are warranted to validate long-term outcomes and refine standardized protocols.

Objective To investigate the risk factors of thrombus head shedding and bleeding during endoscopic treatment of patients with esophageal varices veins,and build a risk prediction model.Methods 209 cases of esophageal varices with thrombus head found by endoscopy from February 2009 to July 2024 were retrospectively analyzed,and divided into non-shedding group(n=186)and shedding group(n=23)according to whether thrombus head shedding bleeding occurred during endoscopic treatment.Clinical and endoscopic data of the two groups were compared.Statistically significant factors were included in multivariate Logistic regression analysis and their independent risk factors were explored.A nomogram risk prediction model was constructed by R software,and its prediction efficiency was evaluated.Results Multivariate Logistic regression analysis showed that red thrombus head((O＾R)=6.231,95%CI:1.748～22.208),thrombus head diameter≥3 mm((O＾R)=4.355,95%CI:1.341～14.144),conical thrombus head((O＾R)=8.555,95%CI:2.427～30.154),and the presence of hematoma in the stomach((O＾R)=7.079,95%CI:1.665～30.103)were risk factors for bleeding after thrombus head shedding during endoscopic diagnosis and treatment.A nomogram prediction model was constructed with a sensitivity of 0.870(95%CI:0.732～1.000)and a specificity of 0.887(95%CI:0.842～0.933).Conclusion The thrombus head being red,conical in shape,with a diameter of≥3 mm and the presence of hematoma in the stomach are independent risk factors for thrombus head shedding and bleeding during endoscopic diagnosis and treatment.Timely intervention should be made for the above factors to benefit patients.

Objective:To investigate the incidence of basal ganglia calcification (BGC), and risk factors for BGC in acute ischemic stroke (AIS) patients.Methods:A total of 730 patients with nervous system diseases hospitalized in Department of Neurology, Shanghai Punan Hospital of Pudong New Area from January 2023 to December 2023 were enrolled. These patients were divided into AIS group ( n=380) and non-AIS group ( n=350). Propensity score matching (PSM) was firstly used for 1:1 matching to eliminate the differences in baseline data of these patients; BGC incidence was compared between the two groups. Univariate and multivariate Logistic regression analyses were used to screen the independent risk factors for BGC in AIS patients. Results:After PSM, there were 251 patients in the AIS group and 251 patients in the non-AIS group. No significant difference was noted between the two groups in age, gender, histories of hypertension, diabetes, hyperlipidemia, coronary heart disease, smoking and drinking, ratio of previous stroke, and serum calcium, low-density lipoprotein cholesterol, homocysteine, uric acid, estimated glomerular filtration rate, or parathyroid hormone ( P>0.05). BGC incidence in the AIS group was 33.1% (83/251), with mild BGC in 55 patients (21.9%), moderate BGC in 19 patients (7.6%), and severe BGC in 9 patients (3.6%). BGC incidence in the AIS group was significantly higher than that in the non-AIS group (33.1% vs. 16.7%, P<0.05). Univariate and multivariate Logistic regression analyses showed that female ( OR=1.842, 95% CI: 1.021-3.324, P=0.043) and diabetes ( OR=1.953, 95% CI: 1.205-3.167, P=0.007) were independent risk factors for BGC in AIS patients. Conclusion:Compared with non-AIS patients, AIS patients trend to have BGC; female AIS patients with diabetes mellitus are more likely to have BGC.