Objective To analyze the clinical characteristics of renal cell carcinoma patients with extracapsular segmental vein tumor thrombus during partial nephrectomy and to explore the clinical significance,thereby contributing to an advanced comprehension of the pathogenesis of cancer thrombus in renal cell carcinoma.Methods A retrospective analysis was conducted on the clinical data of 209 renal cell carcinoma patients(162 with T1a stage,47 with T1b stage)who underwent partial nephrectomy in our hospital during Sep.2023 and Jul.2025.Among them,8 patients with extracapsular segmental vein tumor thrombus were identified,and the clinical and pathological characteristics were analyzed.Results Among the 8 cases of extracapsular segmental vein tumor thrombus,1 was in T1a stage and 7 were in T1b stage.Preoperativc CT revealed roundish,solid renal masses with heterogeneous density on non-contrast scans,significant enhancement on contrast-enhanced scans,and markedly weaker enhancement in the renal parenchymal phase compared to normal renal tissue.The average tumor diameter was(4.9±0.2)cm,with clear boundaries and no evidence of vascular invasion.Postoperative pathology confirmed clear cell carcinoma in all cases,with International Society of Urological Pathology(ISUP)grades ranging from Ⅰ to Ⅳ,and all surgical margins were negative.After surgery,5 patients received adjuvant immunotherapy.In a median follow-up of 10.3(3.8-22.8)months,no tumor recurrence or metastasis was observed.Conclusion Renal cell carcinoma has a high propensity of vascular invasion,and even clinically staged T1 tumors may develop extracapsular segmental vein tumor thrombus.This finding is significant for clinical prognosis.

Objective:To evaluate the clinical equivalence between a domestic calcipotriol/betamethasone dipropionate ointment and the originator product in the treatment of stable plaque psoriasis.Methods:A multicenter, randomized, double-blind, three-arm, parallel-group, active- and placebo-controlled study was conducted, and 449 patients aged 18 - 65 years with stable plaque psoriasis were enrolled from 25 hospitals (such as the First Affiliated Hospital of China Medical University). Eligible patients had a baseline physician's global assessment (PGA) score of ≥ 3 points, baseline body surface area (BSA) involvement of 5% - 30%, and a target lesion psoriasis area and severity index (TL-PASI) for plaque elevation of ≥ 3 points. Participants were randomly assigned in a 2:2:1 ratio to the test group ( n = 179), reference group ( n = 180), and placebo group ( n = 90), and applied the domestic calcipotriol/betamethasone dipropionate ointment, originator product, and ointment base respectively, once daily in the evening for 4 weeks. Efficacy and safety were assessed at weeks 1, 2, and 4. The primary efficacy endpoints were the treatment success rates and clinical success rates in each group at week 4. The per-protocol set (PPS) was used for the primary efficacy analysis, and the intention-to-treat (ITT) set for supplementary efficacy analysis. Equivalence between the test and reference preparations was tested using the Cochran-Mantel-Haenszel method adjusted for randomization strata. Superiority of the test and reference preparations over the placebo was also tested. Measurement data were compared among the 3 groups using analysis of variance or non-parametric tests, while treatment success rates, clinical success rates, and incidence rates of adverse reactions were compared using the chi-square test. Results:The ITT, PPS, and safety sets included 447, 420, and 448 patients, respectively. In the ITT set, patients were aged 43.6 ± 12.8 years, including 320 (71.6%) males and 127 (28.4%) females, and the disease duration was 11.21 ± 9.05 years; 316 (70.7%) had a PGA score of 3 points and 131 (29.3%) had a PGA score of 4 - 5 points. No significant differences in the baseline characteristics (including age, sex, disease duration and disease severity) were observed among the 3 groups (all P > 0.05). Based on the PPS analysis, the treatment success rates were 57.9% (99/171) in the test group, 50.3% (86/171) in the reference group, and 7.7% (6/78) in the placebo group, and the clinical success rates were 57.9% (99/171), 50.3% (86/171), and 10.3% (8/78), respectively; both the test and reference groups were superior to the placebo group in both treatment and clinical success rates (all P < 0.001) ; the rate differences for treatment success (90% confidence interval [ CI]: -1.3% - 16.4%) and clinical success (90% CI: -1.3% - 16.3%) between the test and reference groups were entirely within the pre-defined equivalence margin (-20% - 20%). Subgroup analyses by baseline PGA scores: for patients with a baseline PGA score of 3 points, the treatment success rates in the test, reference, and placebo groups were 60.8% (73/120), 52.1% (62/119), and 11.1% (6/54), respectively, and the corresponding clinical success rates were 61.7% (74/120), 53.8% (64/119), and 13% (7/54), respectively; the test and reference groups did not differ significantly in treatment or clinical success rates (both P > 0.05), but both showed higher success rates than the placebo group (all P < 0.001) ; the results of statistical comparisons among the 3 groups in patients with a baseline PGA score of 4 - 5 points were consistent with those observed in patients with a baseline PGA score of 3 points. The percentage reductions in PGA and TL-PASI scores from baseline to weeks 1, 2, and 4 showed significant differences among the 3 groups, which were significantly higher in the test and reference groups than in the placebo group (all P < 0.001), but did not differ between the test and reference groups (all P > 0.05). The primary adverse reactions were local skin reactions, such as pruritus, pain, and erythema. The incidence rates of adverse reactions were 8.9% (16/179) in the test group, 7.3% (13/179) in the reference group, and 7.8% (7/90) in the placebo group, with no significant difference among the 3 groups ( P > 0.05) . Conclusions:The domestic calcipotriol/betamethasone dipropionate ointment demonstrated clinical equivalence to the originator product in the treatment of stable plaque psoriasis, and the two agents exhibited comparable efficacy for patients with varying degrees of disease severity, and were comparable in the speed and degree of clinical improvement, with similar favorable safety profiles.

This paper reported a type 1 diabetes patient who had severe diabetic nephropathy, retinopathy, hypertension, and hypothyroidism before pregnancy. The patient's blood glucose control was poor before pregnancy, and the complications were not properly treated. This was an unintended pregnancy, with a pre-pregnancy glycated hemoglobin A1c of 7.8% and early pregnancy urine protein of 3.81-4.53 g/24 h. Considering the patient's poor blood glucose control before pregnancy and the lack of proper treatment for multiple complications including nephropathy, a multidisciplinary consultation at an external hospital recommended termination of the pregnancy. However, the patient was determined to continue the pregnancy and was referred to Peking University First Hospital. Through strict blood glucose control, monitoring and evaluation of complications, and comprehensive management, the patient's blood glucose and blood pressure were well controlled during pregnancy. Regular monitoring of urine protein, renal function, and ocular fundus was conducted. At 31 weeks and 4 days of gestation, the patient's 24-hour urine protein significantly increased. After promoting fetal lung maturity, a cesarean section was performed at 34 weeks and 1 day of gestation, resulting in a successful delivery with good maternal and neonatal outcomes. At the 42-day postpartum follow-up, the patient's blood glucose and blood pressure were stable, urine protein returned to pre-pregnancy levels, and the infant was in good general condition.

Objective:To evaluate the efficacy of ultrasound-guided median interspinous in-plane approach to subarachnoid puncture in obese pregnant patients.Methods:This study was a randomized controlled trial. Eighty obese parturients who underwent elective cesarean section from March 2022 to January 2024 in our hospital were divided into 2 groups( n=40 each) by the random number table method: median interspinous in-plane approach group(group M) and paramedian interlaminar in-plane approach group(group P). After successful puncture, 0.5% ropivacaine 15 mg(3 ml) was intrathecally injected in both groups. The first-attempt success of puncture, the number of puncture attempts, operation time, the total success of puncture, and the visibility scores of the anterior and posterior union, positioning structure(lamina in group P, spinous process in group M) and puncture needle under ultrasound were recorded. Results:Compared with group P, the visibility score of positioning structure under ultrasound was significantly increased, the success rate of puncture at the first attempt was increased, the number of puncture attempts was decreased, the operation time was shortened, the total success rate of puncture was increased( P<0.05), and no significant change was found in the visibility scores of the anterior and posterior union and puncture needle in group M( P>0.05). Conclusions:For obese pregnant patients, the ultrasound-guided median interspinous in-plane approach can accurately and quickly perform subarachnoid puncture, which has more advantages than the traditional paramedian interlaminar in-plane approach.

Objective:To evaluate the clinical equivalence between a domestic calcipotriol/betamethasone dipropionate ointment and the originator product in the treatment of stable plaque psoriasis.Methods:A multicenter, randomized, double-blind, three-arm, parallel-group, active- and placebo-controlled study was conducted, and 449 patients aged 18 - 65 years with stable plaque psoriasis were enrolled from 25 hospitals (such as the First Affiliated Hospital of China Medical University). Eligible patients had a baseline physician's global assessment (PGA) score of ≥ 3 points, baseline body surface area (BSA) involvement of 5% - 30%, and a target lesion psoriasis area and severity index (TL-PASI) for plaque elevation of ≥ 3 points. Participants were randomly assigned in a 2:2:1 ratio to the test group ( n = 179), reference group ( n = 180), and placebo group ( n = 90), and applied the domestic calcipotriol/betamethasone dipropionate ointment, originator product, and ointment base respectively, once daily in the evening for 4 weeks. Efficacy and safety were assessed at weeks 1, 2, and 4. The primary efficacy endpoints were the treatment success rates and clinical success rates in each group at week 4. The per-protocol set (PPS) was used for the primary efficacy analysis, and the intention-to-treat (ITT) set for supplementary efficacy analysis. Equivalence between the test and reference preparations was tested using the Cochran-Mantel-Haenszel method adjusted for randomization strata. Superiority of the test and reference preparations over the placebo was also tested. Measurement data were compared among the 3 groups using analysis of variance or non-parametric tests, while treatment success rates, clinical success rates, and incidence rates of adverse reactions were compared using the chi-square test. Results:The ITT, PPS, and safety sets included 447, 420, and 448 patients, respectively. In the ITT set, patients were aged 43.6 ± 12.8 years, including 320 (71.6%) males and 127 (28.4%) females, and the disease duration was 11.21 ± 9.05 years; 316 (70.7%) had a PGA score of 3 points and 131 (29.3%) had a PGA score of 4 - 5 points. No significant differences in the baseline characteristics (including age, sex, disease duration and disease severity) were observed among the 3 groups (all P > 0.05). Based on the PPS analysis, the treatment success rates were 57.9% (99/171) in the test group, 50.3% (86/171) in the reference group, and 7.7% (6/78) in the placebo group, and the clinical success rates were 57.9% (99/171), 50.3% (86/171), and 10.3% (8/78), respectively; both the test and reference groups were superior to the placebo group in both treatment and clinical success rates (all P < 0.001) ; the rate differences for treatment success (90% confidence interval [ CI]: -1.3% - 16.4%) and clinical success (90% CI: -1.3% - 16.3%) between the test and reference groups were entirely within the pre-defined equivalence margin (-20% - 20%). Subgroup analyses by baseline PGA scores: for patients with a baseline PGA score of 3 points, the treatment success rates in the test, reference, and placebo groups were 60.8% (73/120), 52.1% (62/119), and 11.1% (6/54), respectively, and the corresponding clinical success rates were 61.7% (74/120), 53.8% (64/119), and 13% (7/54), respectively; the test and reference groups did not differ significantly in treatment or clinical success rates (both P > 0.05), but both showed higher success rates than the placebo group (all P < 0.001) ; the results of statistical comparisons among the 3 groups in patients with a baseline PGA score of 4 - 5 points were consistent with those observed in patients with a baseline PGA score of 3 points. The percentage reductions in PGA and TL-PASI scores from baseline to weeks 1, 2, and 4 showed significant differences among the 3 groups, which were significantly higher in the test and reference groups than in the placebo group (all P < 0.001), but did not differ between the test and reference groups (all P > 0.05). The primary adverse reactions were local skin reactions, such as pruritus, pain, and erythema. The incidence rates of adverse reactions were 8.9% (16/179) in the test group, 7.3% (13/179) in the reference group, and 7.8% (7/90) in the placebo group, with no significant difference among the 3 groups ( P > 0.05) . Conclusions:The domestic calcipotriol/betamethasone dipropionate ointment demonstrated clinical equivalence to the originator product in the treatment of stable plaque psoriasis, and the two agents exhibited comparable efficacy for patients with varying degrees of disease severity, and were comparable in the speed and degree of clinical improvement, with similar favorable safety profiles.

This paper reported a type 1 diabetes patient who had severe diabetic nephropathy, retinopathy, hypertension, and hypothyroidism before pregnancy. The patient's blood glucose control was poor before pregnancy, and the complications were not properly treated. This was an unintended pregnancy, with a pre-pregnancy glycated hemoglobin A1c of 7.8% and early pregnancy urine protein of 3.81-4.53 g/24 h. Considering the patient's poor blood glucose control before pregnancy and the lack of proper treatment for multiple complications including nephropathy, a multidisciplinary consultation at an external hospital recommended termination of the pregnancy. However, the patient was determined to continue the pregnancy and was referred to Peking University First Hospital. Through strict blood glucose control, monitoring and evaluation of complications, and comprehensive management, the patient's blood glucose and blood pressure were well controlled during pregnancy. Regular monitoring of urine protein, renal function, and ocular fundus was conducted. At 31 weeks and 4 days of gestation, the patient's 24-hour urine protein significantly increased. After promoting fetal lung maturity, a cesarean section was performed at 34 weeks and 1 day of gestation, resulting in a successful delivery with good maternal and neonatal outcomes. At the 42-day postpartum follow-up, the patient's blood glucose and blood pressure were stable, urine protein returned to pre-pregnancy levels, and the infant was in good general condition.

Objective:To evaluate the efficacy of ultrasound-guided median interspinous in-plane approach to subarachnoid puncture in obese pregnant patients.Methods:This study was a randomized controlled trial. Eighty obese parturients who underwent elective cesarean section from March 2022 to January 2024 in our hospital were divided into 2 groups( n=40 each) by the random number table method: median interspinous in-plane approach group(group M) and paramedian interlaminar in-plane approach group(group P). After successful puncture, 0.5% ropivacaine 15 mg(3 ml) was intrathecally injected in both groups. The first-attempt success of puncture, the number of puncture attempts, operation time, the total success of puncture, and the visibility scores of the anterior and posterior union, positioning structure(lamina in group P, spinous process in group M) and puncture needle under ultrasound were recorded. Results:Compared with group P, the visibility score of positioning structure under ultrasound was significantly increased, the success rate of puncture at the first attempt was increased, the number of puncture attempts was decreased, the operation time was shortened, the total success rate of puncture was increased( P<0.05), and no significant change was found in the visibility scores of the anterior and posterior union and puncture needle in group M( P>0.05). Conclusions:For obese pregnant patients, the ultrasound-guided median interspinous in-plane approach can accurately and quickly perform subarachnoid puncture, which has more advantages than the traditional paramedian interlaminar in-plane approach.

Objective To analyze the clinical characteristics of renal cell carcinoma patients with extracapsular segmental vein tumor thrombus during partial nephrectomy and to explore the clinical significance,thereby contributing to an advanced comprehension of the pathogenesis of cancer thrombus in renal cell carcinoma.Methods A retrospective analysis was conducted on the clinical data of 209 renal cell carcinoma patients(162 with T1a stage,47 with T1b stage)who underwent partial nephrectomy in our hospital during Sep.2023 and Jul.2025.Among them,8 patients with extracapsular segmental vein tumor thrombus were identified,and the clinical and pathological characteristics were analyzed.Results Among the 8 cases of extracapsular segmental vein tumor thrombus,1 was in T1a stage and 7 were in T1b stage.Preoperativc CT revealed roundish,solid renal masses with heterogeneous density on non-contrast scans,significant enhancement on contrast-enhanced scans,and markedly weaker enhancement in the renal parenchymal phase compared to normal renal tissue.The average tumor diameter was(4.9±0.2)cm,with clear boundaries and no evidence of vascular invasion.Postoperative pathology confirmed clear cell carcinoma in all cases,with International Society of Urological Pathology(ISUP)grades ranging from Ⅰ to Ⅳ,and all surgical margins were negative.After surgery,5 patients received adjuvant immunotherapy.In a median follow-up of 10.3(3.8-22.8)months,no tumor recurrence or metastasis was observed.Conclusion Renal cell carcinoma has a high propensity of vascular invasion,and even clinically staged T1 tumors may develop extracapsular segmental vein tumor thrombus.This finding is significant for clinical prognosis.

Objective:To compare the efficacy of different drugs in reducing incidence of emergence agitation after tonsillectomy and adenoidectomy in the pediatric patients.Methods:Cochrane Library, PubMed, Web of Science, EMBASE, China National Knowledge Infrastructure, Wanfang and Chinese Biomedical Literature Databases were searched from inception to July 2023 for the randomized controlled trials involving interventions to reduce the incidence of emergence agitation after tonsillectomy and adenoidectomy in pediatric patients. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias in the included studies. STATA 17.0 software was used to conduct a network meta-analysis according to the frequency-ology framework.Results:Twenty randomized controlled trials were finally included, involving 1 687 patients. Compared with placebo, 10 interventions could reduce the incidence of emergence agitation in pediatric patients after tonsillectomy and adenoidectomy, and the order of probability was as follows: dexmedetomidine ( OR and 95% confidence interval [ CI] 0.13 [0.09-0.20]), ketamine ( OR and 95% CI 0.15 [0.08-0.26]), clonidine ( OR and 95% CI 0.15 [0.05-0.50]), tramadol ( OR and 95% CI 0.16 [0.04-0.61]), remazolam ( OR and 95% CI 0.17 [0.06-0.47]), afentanil ( OR and 95% CI 0.22 [0.08-0.62]), remifentanil ( OR and 95% CI 0.24 [0.12-0.48]), desocine ( OR and 95% CI 0.29 [0.12-0.69]), fentanyl ( OR and 95% CI 0.31 [0.19-0.52]) and propofol ( OR and 95% CI 0.46 [0.24-0.86]). Four interventions cloud reduce the usage rate of postoperative rescue drugs, and the probability was ranked as follows: dexmedetomidine ( OR and 95% CI 0.19 [0.11-0.32]), tramadol ( OR and 95% CI 0.20 [0.10-0.42]), ketamine ( OR and 95% CI 0.49 [0.28-0.86]) and fentanyl ( OR and 95% CI 0.49 [0.32-0.77]). One intervention cloud reduce the incidence of postoperative nausea and vomiting: dexmedetomidine ( OR and 95% CI 0.54 [0.31-0.94]). Conclusions:Dexmedetomidine provides the best effect in reducing the incidence of emergence agitation after pediatric tonsillectomy and adenoidectomy.

Objective:To systematically compare the efficacy of different drugs in alleviating remifentanil-induced hyperalgesia.Methods:Databases such as PubMed, Cochrane Library, EMBASE, Web of Science, CNKI, Wanfang Data and CBM were searched using computers from inception to May 2020.The randomized controlled trials comparing the efficacy of different intervention measures for alleviating remifentanil-induced hyperalgesia were searched.After independently identifying the literature, the two reviewers conducted data extraction and evaluated the bias of the included studies, and Stata 14.0, ADDIS 1.16.5 and R4.0.2 softwares were used to analyze the data.Results:Thirty randomized controlled trials were included in our study.Compared with placebo, 3 out of 6 drugs could alleviate remifentanil-induced hyperalgesia, and the probability order for the effect was as follows: butorphanol with MD value (95% CI)-1.50 (-2.80, -0.24), dexmedetomidine with MD value (95% CI)-1.20 (-2.40, -0.09) and ketamine with MD value (95% CI) -0.88 (-1.60, -0.16). After sensitivity analysis, the efficacy of butorphanol remained to be verified.Two drugs could decrease the dosage of opioids within 24 h after operation, and the probability order for the effect was as follows: dexmedetomidine with MD value (95% CI) -14.00 (-28.00, -0.19) and ketamine with MD value (95% CI) -9.20 (-18.00, -0.08). One drug could decrease the incidence of postoperative nausea and vomiting within 24 h after operation: dexmedetomidine with RR value (95%CI) 0.28 (0.16, 0.22). Conclusion:The results of network meta-analyses show that dexmedetomidine has the best efficacy in alleviating remifentanil-induced hyperalgesia.