With advancements in imaging technology, the detection rate of localized renal neoplasms has significantly increased. Minimally invasive partial nephrectomy now represents the mainstream approach for nephron-sparing surgery. However, the potential impairment of residual renal function due to warm ischemia-reperfusion injury and renal wound suturing during traditional surgical procedures constitutes key challenges in current therapeutic management. Maximizing renal parenchymal preservation and reducing ischemia time are core objectives for optimizing efficacy. Zero ischemia techniques aim to avoid or minimize warm ischemia and thereby prevent ischemia-reperfusion injury. This is achieved through strategies including preoperative superselective transarterial embolization, segmental renal artery clamping, early unclamping, or completely off-clamp renal artery management. An completely off-clamp partial nephrectomy is considered the ideal approach for maximal renal function preservation, although it presents challenges in bleeding management. Compared to traditional suturing, sutureless techniques, designed to overcome renal parenchymal damage and reduce ischemia time, leverage tools like electrocoagulators, argon beam coagulator, and various lasers for efficient hemostasis at the renal wound. These techniques significantly reduce damage to renal parenchyma, potentially improving postoperative renal function and lowering the incidence of complications such as urinary leakage. Zero ischemia and sutureless techniques are pivotal developmental directions in renal functional preservation within the field of minimally invasive partial nephrectomy. Therefore, this article reviewed the literature pertaining to these innovative techniques, summarizing the relevant clinical experiences and potential limitations, in order to furnish actionable guidance and essential theoretical support for their broader clinical implementation.

BACKGROUND:Digital three-dimensional reconstruction technology is gradually applied to orthopedic diseases with the advantages of visualization,accuracy and non-invasiveness,but there is less evidence-based support for its use in artificial hip hemiarthroplasty for intertrochanteric fractures of the femur in the elderly. OBJECTIVE:To investigate the application value and economic effects of digital three-dimensional reconstruction techniques in artificial hip hemiarthroplasty of intertrochanteric fractures of the femur in the elderly. METHODS:One hundred and thirty elderly patients with intertrochanteric femur fractures admitted to Zunyi First People's Hospital from January 2019 to December 2022 were selected and randomly divided into a control group(n=65)and an observation group(n=65).Artificial hip hemiarthroplasty was performed in both groups.The control group adopted the film template measurement method for manual preoperative planning while the observation group adopted a digital three-dimensional reconstruction technique.Preoperative planning and intraoperative actual application of prosthesis compliance rate,fibrinogen,D-dimer,bilateral femoral eccentric distance difference,bilateral lower limb length difference,Harris hip function score,visual analog scale score,excellent and good rate of hip function,complications,and hospitalization cost were observed in both groups. RESULTS AND CONCLUSION:(1)The proportion of acetabular side and femoral side prosthesis in grade 0(fully compliant)was higher in the observation group than that in the control group(P<0.05).(2)Fibrinogen and D-dimer levels in the observation group were lower than those in the control group 3 days after surgery(P<0.05).(3)The difference in bilateral femoral eccentric distance and the difference in bilateral lower limb length in the observation group were smaller than those in the control group immediately after surgery(P<0.05).The differences in Harris and visual analog scale scores were not significantly different between the two groups preoperatively,6 and 12 months postoperatively(P>0.05).There was no significant difference in excellent and good rate of hip function between the two groups 12 months postoperatively(P>0.05).(4)There was no significant difference in the complication rate between the two groups(P>0.05).The hospitalization cost of the observation group was higher than that of the control group(P<0.05).(5)It is indicated that digital three-dimensional reconstruction technology applied in artificial hip hemiarthroplasty of intertrochanteric femoral fracture in the elderly can not only accurately determine the prosthesis type before surgery,but also accurately reconstruct the bilateral lower limbs offline,but its hospitalization cost is high.

Objective:To investigate the recognition of the post competency index system among rural general practice assistant physicians and its influencing factors.Methods:This study was a cross-sectional survey. A questionnaire survey on the recognition of post competency index system was conducted from October 2020 to September 2021 among rural general practice assistant physicians from 10 provinces/municipalities selected by stratified cluster sampling method. The recognition of rural general practice assistant physicians at all levels of indexs and the factors influencing recognition were analyzed.Results:A total of 1 123 questionnaires were distributed and 1 024 valid ones were collected with a recovery rate of 91.18%. Of the 1 024 respondents, 529 were male(51.7%) and 435 were aged 40-49 years(42.5%), which was the highest proportion by age group. The average overall recognition score of the index system was 4.41, and the scores of the primary indexes were 4.32-4.45. Three primary indexes had the highest recognition scores: professional competence, basic health care services, and interpersonal communication and teamwork. The recognition scores on the second level index were 4.18-4.61, and the proportion of recognition scores greater than 4 was over 80%. There were significant differences in the recognition scores of the index system among assistant physicians with different working years, educational background, professional title and work unit ( F/H=6.41, 14.83, 12.45, 7.53, P<0.01). Educational background(associate degree: B=0.091, P=0.015; bachelor degree and above: B=0.196, P<0.001) and professional title(intermediate professional title and above: B=-0.234, P<0.001) were the independent factors influencing the recognition degree of the index system for rural general practice assistant physicians. Conclusions:The post competency index system is generally recognized by rural general practice assistant physician, and academic qualifications and professional title status may influence its recognition.

Objective:To evaluate the application feasibility of the post competency index system of rural general practice assistant physicians, and to analyze and compare the post competency of rural general practice assistant physicians with different characteristics through a survey among rural general practice assistant physicians in China.Methods:This study was a cross-sectional study. A questionnaire survey was conducted among rural general practice assistant physicians in 10 provinces/municipalities selected by stratified cluster sampling method from October 2020 to September 2021. The post competency scores were self-evaluated based on the post competency index system of rural general practice assistant physicians. The results of the survey were analyzed and the application feasibility of the index system was evaluated.Results:A total of 1 123 questionnaires were distributed and 1 024 valid questionnaires were returned with a recovery rate of 91.2%. Of the 1 024 respondents, 529 were males (51.7%), 435 were aged 40-49 years (42.5%), 434 had a secondary school education or less (42.4%), and 531 were junior practitioners (51.9%). The Cronbach′s α coefficient of the overall questionnaire was 0.987, and the Cronbach′s α coefficient of the first level index ranged from 0.897 to 0.974. The cumulative variance contribution rate of exploratory factor analysis was 72.012%. The confirmatory factor analysis showed χ2/ df=3.926, RMSEA=0.076, CFI=0.858, IFI=0.859, indicating that the model fit was basically good. The average self-evaluation scores of the first level index ranged from 3.95 to 4.25, and the average self-evaluation scores of the second level index ranged from 3.74 to 4.36. There were significant differences in self-evaluation scores of post competency among rural general practice assistant physicians with different working years, professional titles, working units and economic regions( F=4.67, 10.54, 22.16 and 20.90,all P<0.05). People with low self-evaluation scores of post competency had the following characteristics: working 10-19 years, intermediate or above titles, working in community health service centers, located in the eastern region.People with high self-evaluation scores of post competency had the following characteristics: primary professional title, working in the village clinic. Conclusion:The competency index system of rural general practice assistant physicians has good application feasibility,and it can be used to evaluate post competency for the education and training of rural general practice assistant physicians.

Hereditary breast cancer-related gene mutations significantly increase the risk of breast cancer in women. In this regard, the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Genetic/Familial High-Risk Assessment was developed to guide genetic assessment and counseling in mutation carriers of breast cancer risk genes, providing crucial information for the prevention, screening and treatment of breast cancer. This article provided an interpretation of the NCCN Clinical Practice Guidelines in Genetic/Familial High-Risk Assessment, integrating the clinical practice experience of Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine.

Nerve regeneration in adult mammalian spinal cord is poor because of the lack of intrinsic regeneration of neurons and extrinsic factors - the glial scar is triggered by injury and inhibits or promotes regeneration. Recent technological advances in spatial transcriptomics (ST) provide a unique opportunity to decipher most genes systematically throughout scar formation, which remains poorly understood. Here, we first constructed the tissue-wide gene expression patterns of mouse spinal cords over the course of scar formation using ST after spinal cord injury from 32 samples. Locally, we profiled gene expression gradients from the leading edge to the core of the scar areas to further understand the scar microenvironment, such as neurotransmitter disorders, activation of the pro-inflammatory response, neurotoxic saturated lipids, angiogenesis, obstructed axon extension, and extracellular structure re-organization. In addition, we described 21 cell transcriptional states during scar formation and delineated the origins, functional diversity, and possible trajectories of subpopulations of fibroblasts, glia, and immune cells. Specifically, we found some regulators in special cell types, such as Thbs1 and Col1a2 in macrophages, CD36 and Postn in fibroblasts, Plxnb2 and Nxpe3 in microglia, Clu in astrocytes, and CD74 in oligodendrocytes. Furthermore, salvianolic acid B, a blood-brain barrier permeation and CD36 inhibitor, was administered after surgery and found to remedy fibrosis. Subsequently, we described the extent of the scar boundary and profiled the bidirectional ligand-receptor interactions at the neighboring cluster boundary, contributing to maintain scar architecture during gliosis and fibrosis, and found that GPR37L1_PSAP, and GPR37_PSAP were the most significant gene-pairs among microglia, fibroblasts, and astrocytes. Last, we quantified the fraction of scar-resident cells and proposed four possible phases of scar formation: macrophage infiltration, proliferation and differentiation of scar-resident cells, scar emergence, and scar stationary. Together, these profiles delineated the spatial heterogeneity of the scar, confirmed the previous concepts about scar architecture, provided some new clues for scar formation, and served as a valuable resource for the treatment of central nervous system injury.
Mice ; Animals ; Gliosis/pathology* ; Cicatrix/pathology* ; Spinal Cord Injuries ; Astrocytes/metabolism* ; Spinal Cord/pathology* ; Fibrosis ; Mammals ; Receptors, G-Protein-Coupled

Objective:To construct a post competency index system for rural general practice assistant physicians.Methods:On the basis of previous literature research and behavioral event interviews, the questionnaire of Delphi consultation was designed. Two rounds of Delphi expert consultation were conducted from October 2019 to January 2020 to develop an index system of post competency for rural general practice assistant physicians, and the analytic hierarchy process methods was used to calculate the weight of each index.Results:A total of 26 experts were included, with an average age of (48.7±8.6) years and an average working seniority of (22.8±8.8) years. After 2 rounds of consultation, the competency index system was developed, including 6 first level items and 60 seconds level items. The positive coefficient of experts in the 2 rounds was 87% and 100%, respectively; the expert authority coefficient was 0.7-1.0; the coordination coefficient was 0.312 and 0.241, respectively ( P<0.001). According to the order of weight, the first level items were basic medical and health services (0.311 1), basic public health services (0.196 0), medical knowledge and lifelong learning (0.196 0), interpersonal communication and team cooperation (0.138 6), professional quality (0.102 8), information utilization and management ability (0.055 5). The top 2 secondary indexes were clinical expertise (0.079 2), learning awareness and ability (0.055 3). The last 2 secondary indexes were achievement orientation (0.001 6) and inductive thinking (0.002 0). Conclusion:A post competency index system for rural general practice assistant physicians has been preliminary constructed in this study, which may provide reference for the selection, training and assessment of relevant medical workers.

Objective To investigate the value of magnetic resonance diffusion-weighted imaging (DWI) in combination with peripheral serum tumor markers in the diagnosis and therapeutic evaluation of small cell lung cancer (SCLC) brain metastases.Methods Retrospective analysis of 368 SCLC cases diagnosed by histopathology or cytology from February 2009 to February 2012 in Shanxi Provincial Cancer Hospital was made.All patients underwent pathological examination of progastrin-releasing peptide (ProGRP),neuron-specific enolase (NSE) and brain DWI,and measured the apparent diffusion coefficient (ADC) of DWI sequences of brain metastases.The difference between the positive rates of ProGRP and NSE in patients with or without brain metastases was compared by the X2 test,and the diagnostic efficiency of ProGRP,NSE,DWI and combined detection for brain metastases were analyzed.The Kruskal-Wallis H test was used to compare the changes of ADC value,ProGRP and NSE before and after brain irradiation therapy in brain metastases of SCLC.Pearson correlation analysis was made to evaluate the correlation between the changes of ADC value and the levels of ProGRP and NSE in SCLC patients with brain metastases before and after treatment.Results The median expression of serum ProGRP in 169 SCLC patients was 2 664.7 pg/ml (98.4-4 876.8 pg/ml),with a positive rate of 98.2 ％ (166/169).The median expression of NSE was 41.9 μg/L (9.4-264.3 μg/L),with a positive rate of 70.4 ％ (119/169).The median expression of serum ProGRP level was 514.3 pg/ml (3.9-2 899.3 pg/ml) in 199 SCLC patients without brain metastasis,the positive rate was 89.4 ％ (178/199).The median expression of NSE was 40.4 μg/L (0.3-176.1 μ,g/L),with a positive rate of 64.8 ％ (129/199).The difference of ProGRP level between the two groups was statistically significant (u =121.47,P ＜ 0.001),but there was no significant difference in NSE level (u =1.35,P =0.12).The sensitivities of ProGRP,NSE,DWI,ProGRP+DWI and NSE+DWI were 68.4 ％,41.2 ％,66.7 ％,92.2 ％,and 82.4 ％,and the specificities were 52.9 ％,35.3 ％,76.5 ％,94.1％,and 88.2 ％.The sensitivity and specificity of ProGRP+DWI and NSE+DWI were higher than those of single test,and the differences were statistically significant (all P ＜ 0.001).One hundred and fifty-six SCLC patients with brain metastases were treated with whole brain radiotherapy.Pearson correlation analysis showed that ADC values were negatively correlated with ProGRP and NSE levels (r =-0.945,P ＜ 0.001;r =-0.995,P ＜ 0.001).Conclusion DWI combined with ProGRP and NSE can provide objective evidence and clinical guidance for the diagnosis of SCLC brain metastases and the evaluation of whole brain radiotherapy.

Objective To explore the feasibility of tubeless 2 μm laser vaporesection in treating pediatric ureter cysts by ureteroscopy.MethodsClinical data of 33 ureter cysts patients who received tubeless 2 μm laser vaporesections by ureteroscopy were reviewed. The median age of patients was 4 years with a range from 1 to 7 years. The operations were carried out by RevoLix 2 μm laser through ureteroscopy without ureter stents and catheters indwelling.ResultsAll operations were successfully performed. And no serious complications occurred after the operations.ConclusionsTubeless transurethral 2 μm laser treatment by ureteroscopy was a superior micro-invasive surgery method for pediatrics with ureter cysts, with advantages of little blood loss, high safety, convenient operation and infrequent complications.

Objective To investigate the clinical efficacy of RevoLix 2 μm continuous wave laser treatment on bladder neck contracture after benign prostatic hyperplasia operation. Methods A total of 21 cases were enrolled in current research and they all accepted 2 μm continuous wave laser treatment of bladder neck contracture after benign prostatic hyperplasia operation in the 252th Hospital of the Chinese People's Liberation Army. The clinical efficacy was recorded. Results The operation of the 2 μm continuous wave laser vaporesections were successfully performed on 21 cases. The maximum urine flow rate was increased from(6. 86 ± 1. 97)ml/ s to(16. 31 ± 1. 61)ml/ s,and the difference was significant(t = 15. 49,P < 0. 01). After 3 to 23 months(median 14 months)follow-up,20 cases were cured and 1 case was combined with bladder residual urine 110 ml. Conclusion The therapy of 2 μm continuous wave laser is a superior micro-invasive surgery method for patients with Bladder neck contracture,which shows little blood loss,high level safety,convenient operation and infrequent complications.