Objective:To explore the preliminary results of using the UreteroPyeloVisClear Catheter (VCC) in the treatment of ureteral stones.Methods:A retrospective analysis was conducted on the clinical data of 18 patients with ureteral stones who underwent treatment with VCC at Beijing Tsinghua Changgung Hospital from November 2023 to March 2024. The cohort consisted of 15 men and 3 women, with a mean age of 53 years (range: 27-75 years). The preoperative CT measurements showed that the mean maximum stone diameter was 9 mm (range: 3-18 mm), and the mean maximum CT value of the stones was 870 HU (range: 260-1 480 HU). The distribution of stones was as follows: 3 cases in the upper ureter, 8 in the middle ureter, and 7 in the lower ureter. Gravity-assisted perfusion was used, and all patients underwent VCC combined with Holmium laser lithotripsy, with flexible ureteroscopy used if necessary. A ureteral stent was routinely placed for 2 weeks postoperatively. Perioperative conditions and complications were analyzed.Results:All 18 patients successfully underwent VCC lithotripsy, with one patient experiencing stone migration during the procedure. The average operation time was 53 minutes (range: 20-100 minutes), and the average lithotripsy time was 25.5 minutes (range: 6–60 minutes). There were no significant changes in serum creatinine or hemoglobin levels on the first postoperative day. The average hospital stay was 2 days (range: 1–3 days). One patient experienced a fever (maximum temperature of 38.5℃), which resolved with antibiotic treatment. The visual analogue scale (VAS) scores on postoperative day 1 were 0 for 15 patients, 2 for 1 patient, 3 for 1 patient, and 4 for 1 patient. No complications of Clavien-Dindo grade Ⅱ or higher were observed. At 1-month follow-up, the stone-free rate (SFR) was 100%(18/18), and no hydronephrosis was observed in the affected kidney.Conclusions:The results of this study indicates that VCC is a safe and effective method for treating ureteral stones, with a low incidence of postoperative complications and a high stone clearance rate.

Objective:To investigate the effects and mechanism of Jianpi Yangzheng Xiaozheng Prescription in lung pre-metastatic niche formation of gastric cancer by regulating the content of programmed death receptor ligand 1 (PD-L1) in gastric cancer exosomes.Methods:Totally 30 615 mice were divided into normal group, model group, Jianpi Yangzheng Xiaozheng Prescription low- and high-dosage groups, and exosome inhibitor group according to random number table method, with 6 mice in each group. The mouse model of lung pre-metastatic niche formation of gastric cancer was established by tail vein injection of MFC cells. After 12 days of administration, the lung metastasis under the intervention of Jianpi Yangzheng Xiaozheng Prescription was evaluated by observing the infiltration of tumor into lung tissue, weighing lung weight and hematoxylin-eosin (HE) staining of lung tissue. Mouse serum exosomes were extracted by ExoQuick kit and identified by transmission electron microscopy and nanoparticle tracking analysis (NTA). The content of PD-L1 in serum exosomes and the expression levels of serum transforming growth factor-β (TGF-β), interleukin-10 (IL-10) and interleukin-6 (IL-6) were detected by enzyme-linked immunosorbent assay (ELISA). Immunofluorescence was used to detect the phenotype of myeloid-derived suppressor cells (MDSC) and tumor-associated macrophages (TAM) and the expression of PD-L1 in MDSC and TAM.Results:Compared with the model group, after the intervention of Jianpi Yangzheng Xiaozheng Prescription, the lung metastases of mice were reduced ( P<0.05), and the weight of metastatic tumors decreased ( P<0.05). PD-L1 in serum exosomes and the proportion of MDSC and M2 TAM in lung tissue microenvironment decreased, as well as the expression of PD-L1 on MDSC and TAM decreased ( P<0.05). The serum levels of IL-10 and IL-6 significantly decreased ( P<0.05). Conclusion:Jianpi Yangzheng Xiaozheng Prescription can reduce the proportion of MDSC and M2 TAM and the expression level of PD-L1 in the microenvironment of lung tissue before metastasis by inhibiting the transmission of gastric cancer exosome PD-L1 to MDSC and TAM, and reduce the contents of inflammatory factorsIL-10 and IL-6, so as to play a role in improving the microenvironment before lung metastasis of gastric cancer.

Objective To discuss the clinical efficacy of microwave ablation(MWA)combined with percutaneous vertebroplasty(PVP),radiofrequency ablation(RFA)combined with PVP,and simple PVP in the treatment of vertebral metastatic tumors.Methods A total of 65 patients with vertebral metastatic tumors,who were admitted to the Northern Jiangsu People's Hospital of China to receive treatment from January 2019 to June 2023,were enrolled in this study.The patients were divided into MWA plus PVP group(M+P group,n=25,27 diseased vertebral bodies in total),RFA plus PVP group(R+P group,n=20,23 diseased vertebral bodies in total),and simple PVP group(P group,n=20,24 diseased vertebral bodies in total).Visual analog scale(VAS)score was used to assess the preoperative pain degree and the postoperative relief degree.Bone cement distribution and leakage at one week after surgery were evaluated.Results Successful operation was accomplished in all of the patients.No serious procedure-related complications occurred in all the patients of three groups.In R+P group,P group and M+P group,the preoperative mean VAS scores were(8.48±0.80)points,(8.57±0.98)points and(8.20±1.00)points respectively;the differences among the three groups were not statistically significant(P＞0.05).One week after operation,the pain was significantly relieved in all the patients of three groups;the mean VAS scores in R+P group,P group and M+P group were(4.10±0.85)points,(3.17±0.93)points and(2.44±1.23)points respectively,and the reduction in VAS score was most pronounced in M+P group(P＜0.05).Six months after operation;the mean VAS scores in R+P group,P group and M+P group were(1.87±0.84)points,(4.60±1.09)points and(1.48±0.71)points respectively;and the reduction in VAS score was most pronounced in the M+P group(P＜0.05).The used amount of bone cement in M+P group,R+P group and P group was(7.54±1.44)mL,(5.48±1.12)mL and(4.59±1.56)mL respectively,the difference among the three groups was statistically significant(P＜0.05).The vascular leakage rate(34.8％)and non-vascular leakage rate(52.2％)in P group were remarkably higher than those in R+P group and in M+P group(P＜0.05).No statistically significant difference in the rate of cement leakage existed between R+P group and M+P group(P＞0.05).Conclusion For the treatment of vertebral metastases,MW A plus PVP is superior to RFA plus PVP in pain relief rate.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Objective:To explore the preliminary results of using the UreteroPyeloVisClear Catheter (VCC) in the treatment of ureteral stones.Methods:A retrospective analysis was conducted on the clinical data of 18 patients with ureteral stones who underwent treatment with VCC at Beijing Tsinghua Changgung Hospital from November 2023 to March 2024. The cohort consisted of 15 men and 3 women, with a mean age of 53 years (range: 27-75 years). The preoperative CT measurements showed that the mean maximum stone diameter was 9 mm (range: 3-18 mm), and the mean maximum CT value of the stones was 870 HU (range: 260-1 480 HU). The distribution of stones was as follows: 3 cases in the upper ureter, 8 in the middle ureter, and 7 in the lower ureter. Gravity-assisted perfusion was used, and all patients underwent VCC combined with Holmium laser lithotripsy, with flexible ureteroscopy used if necessary. A ureteral stent was routinely placed for 2 weeks postoperatively. Perioperative conditions and complications were analyzed.Results:All 18 patients successfully underwent VCC lithotripsy, with one patient experiencing stone migration during the procedure. The average operation time was 53 minutes (range: 20-100 minutes), and the average lithotripsy time was 25.5 minutes (range: 6–60 minutes). There were no significant changes in serum creatinine or hemoglobin levels on the first postoperative day. The average hospital stay was 2 days (range: 1–3 days). One patient experienced a fever (maximum temperature of 38.5℃), which resolved with antibiotic treatment. The visual analogue scale (VAS) scores on postoperative day 1 were 0 for 15 patients, 2 for 1 patient, 3 for 1 patient, and 4 for 1 patient. No complications of Clavien-Dindo grade Ⅱ or higher were observed. At 1-month follow-up, the stone-free rate (SFR) was 100%(18/18), and no hydronephrosis was observed in the affected kidney.Conclusions:The results of this study indicates that VCC is a safe and effective method for treating ureteral stones, with a low incidence of postoperative complications and a high stone clearance rate.

Based on the education and work experience in the radiotherapy and radiation protection industries in China and the United States, combined with comprehensive surveys into relevant websites and public materials of American health physics, this review introduces the education system of health physics and the certification system for health physicists in the United States. Furthermore, this paper provides a summary of the current status of academic education in radiation protection, the practical operations of radiation protection in medical institutions, and the staffing related to radiation safety in China. Accordingly, this study offers opinions and suggestions for further improving the disciplinary system of radiation protection in China.

Objective To assess early clinical safety and efficacy of transfemoral transcatheter aortic valve replacement (TF-TAVR) for pure aortic regurgitation (PAR). Methods The clinical data of PAR patients who underwent TAVR in Wuhan Asia Heart Hospital and Wuhan Asia General Hospital from January 2018 to October 2022 were retrospectively analyzed. Patients were divided into a TF-TAVR group and a transapical transcatheter aortic valve replacement (TA-TAVR) group. The clinical data of the patients were analyzed. Results A total of 54 patients were enrolled, including 34 males and 20 females with an average age of 74.43±6.87 years. The preoperative N-terminal pro-B-type natriuretic peptide level was lower [808.50 (143.50, 2 937.00) pg/mL vs. 2 245.00 (486.30, 7 177.50) pg/mL, P=0.015], and the left ventricular end-diastolic diameter (56.00±6.92 mm vs. 63.07±10.23 mm, P=0.005) and sinus junction diameter (32.47±4.41 mm vs. 37.65±8.08 mm, P=0.007) were smaller in the TF-TAVR group. There was no death in the two groups during the hospitalization. Only 1 new death within postoperative 1 month in the TF-TAVR group (cerebral hemorrhage). A total of 2 new deaths in the TF-TAVR group (1 patient of sudden cardiac death and 1 of multiple organ failure), and there was no death in the TA-TAVR group within postoperative 3 months. There was 1 new death in the TA-TAVR group (details unknown), and there was no death in the TF-TAVR group within postoperative 6 months. There was no statistical difference between the two groups in the all-cause mortality and the cumulative survival rate during the follow-up period (P>0.05). The incidence of high atrioventricular block was 36.0% in the TF-TAVR group and 10.3% in the TA-TAVR group (P=0.024). There were no significant differences between the two groups in the perivalvular leakage (≥moderate), valve in valve, a second valve implantation, valve migration, cerebrovascular events, major vascular complications, complete left bundle branch block, new permanent pacemaker implantation or transferring to surgery (P>0.05). However, the incidence rates of complete left bundle branch block and new permanent pacemaker implantation were higher in the TF-TAVR group, accounting for 56.0% and 40.0%, respectively. Conclusion TF-TAVR is a safe and feasible treatment for PAR patients, which is comparable to TA-TAVR in the early postoperative safety and efficacy.

BACKGROUND:Cadmium is a common environmental pollutant,which can damage multiple organs and tissues,such as the kidney and bone,but its effect on annulus fibrosus cells in the intervertebral disc has been less reported. OBJECTIVE:To investigate the effect of cadmium chloride on the senescence of annulus fibrosus cells and the role of PI3K/Akt signaling pathway. METHODS:Annulus fibrosus cells from Sprague-Dawley rat intervertebral discs were harvested and passage 3 cells were intervened with different concentrations of cadmium chloride(0,1,5,10,20 μmol/L).Cell viability and proliferation were detected by cell counting kit-8 assay.Transcriptome sequencing and Kyoto Encyclopedia of Genes and Genomes functional enrichment analysis were performed on annulus fibrosus cells with or without cadmium chloride addition.Passage 3 annulus fibrosus cells were divided into control group,cadmium chloride group and LY294002 group.Cell proliferation rate was detected by EdU method,positive cell rate was detected by senescence-associated β-galactosidase staining,and expressions of senescence-associated proteins(p16,p21 and p53)and p-Akt at protein and mRNA levels were measured by western blot,RT-PCR and immunofluorescence. RESULTS AND CONCLUSION:5 μmol/L cadmium chloride could inhibit the proliferation of annulus fibrosus cells.Results from the Kyoto Encyclopedia of Genes and Genomes functional enrichment analysis showed that the main signal transduction pathways included PI3K/Akt,cell cycle and p53 signaling pathways,which were related to cell senescence and proliferation.PI3K/Akt signaling pathways with significant differential expression were selected for validation.Compared with the control group,the EdU-positive rate was significantly decreased in the cadmium chloride group(P<0.05),while the β-galactosidase-positive rate,the expression of senescence-associated proteins(p16,p21 and p53)and p-Akt significantly increased(P<0.05).Compared with the cadmium chloride group,the EdU-positive rate and p-Akt expression were significantly decreased in the LY294002 group(P<0.05),while the β-galactosidase-positive rate and the expression of senescence-associated proteins(p16,p21 and p53)significantly increased(P<0.05).To conclude,cadmium chloride can regulate the senescence of annulus fibrosus cells by activating the PI3K/Akt signaling pathway,thereby inducing the occurrence and progression of intervertebral disc degeneration.

Objective:To summarize the experience of designing transplanted hair based on the orbital morphology and tissue characteristics for the treatment of eyebrow defects after burns.Methods:A retrospective analysis was conducted on clinical data of the patients with eyebrow defects after burns who treated at Hair Transplantation Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences between January 2011 and September 2023. The location and appearance of eyebrow were designed according to the orbital morphology and tissue characteristics. The follicles were extracted by incision of scalps strips and follicle unit excision (FUE) on the donor area of the occipital region near the posterior hairline or the posterior ear hairline. Scalps with scars that needed to be removed or had "dog ear" deformities following scalp expansion surgery that needed to be repaired were also be used as donor sites. The follicles were divided as follicle units (FUs) including single hair. The recipient area was punched with syringe needle of 22 or 22 G to subcutaneous superficial layer. Then the hair shaft was clamped with microforceps and the hairs were transplanted to the defective area to restore the appearance of eyebrow. The density, morphology, direction and scars of the donor sites were observed by following-ups.Results:A total of 197 patients with 282 eyebrows were recruited. There were 133 males and 64 females. The average age was 33.7 (9 to 62) years. There were 17 patients with skin graft transplantation in the eyebrow arch, 33 with flap and expanded flap repair, 36 with eyelid skin grafting, 111 with burn scar healing. A total of 51 patients had complete eyebrow defects on both sides, and 34 had partial defects. Sixty-five patients had complete eyebrow defects on single side, and 47 had partial defects. The amount of hair transplantation was from 53 to 600 FUs on 282 eyebrows. Seventy-five patients extracted follicles with incision of scalps strips and 122 with FUE. The patients were followed up for 9 months to 10 years. Folliculitis were found in 17 patients and completely cured by 75% alcohol disinfection. Nine patients with insufficient density underwent hair transplantation for a second time to increase the density of hairs one year later. And the implanted hairs grew well, which were similar to the shape and direction of normal eyebrows. Transplanted hairs of the rest patients grew well. The direction and appearance were satisfied. The scar in the donor site was not obvious.Conclusion:The transplanted hair should be designed primarily based on the orbital morphology and tissue characteristics for the treatment of eyebrow defects after burns. Then the position of the eyebrow and the bilateral symmetry should be considered. The ideal effect of eyebrow reconstruction would depend on the full consideration of the receipt site.