OBJECTIVES: In recent years, the incidence and detection rate of pancreatic cystic lesions (PCLs) have increased significantly. Endoscopic ultrasound (EUS) plays an indispensable role in the diagnosis and differential diagnosis of PCLs. However, evidence comparing the diagnostic performance of EUS-guided fine-needle aspiration (EUS-FNA) and fine-needle biopsy (FNB) remains limited. This study aims to compare the diagnostic yield, adequacy of tissue acquisition, and safety between EUS-FNA and EUS-FNB in evaluating PCLs to inform clinical practice. METHODS: A retrospective review was conducted on patients with PCLs who underwent either EUS-FNA or EUS-FNB between January 2014 and August 2021. The diagnostic yield, tissue acquisition adequacy, and incidence of adverse events were compared between the 2 groups. RESULTS: A total of 90 patients with PCLs were included (52 in the FNA group and 38 in the FNB group). The diagnostic yield was similar between the FNA and FNB groups (94.2% vs 94.7%, P>0.05). The adequacy of tissue acquisition was 71.2% in the FNA group and 81.6% in the FNB group (P>0.05). No statistically significant difference was observed in the incidence of adverse events between the 2 groups (P>0.05). CONCLUSIONS Both EUS-FNA and EUS-FNB demonstrate equally high diagnostic yields and tissue adequacy in PCLs, with excellent safety profiles. Both methods are safe and effective diagnostic tools for evaluating PCLs.
Humans ; Endoscopic Ultrasound-Guided Fine Needle Aspiration/adverse effects* ; Retrospective Studies ; Female ; Male ; Pancreatic Cyst/diagnostic imaging* ; Middle Aged ; Biopsy, Fine-Needle/adverse effects* ; Aged ; Pancreatic Neoplasms/diagnosis* ; Adult ; Endosonography/methods* ; Pancreas/pathology* ; Diagnosis, Differential

Objective To compare the effects of quadratus lumborum block at the lateral supra-arcuate ligament(QLB-LSAL)and erector spinae plane block(ESPB)on early postoperative recovery in patients undergoing posterior lumbar surgery.Methods Ninety-three patients,aged 25～70 years,BMI 18～30 kg/m2 and ASA physical status Ⅱ or Ⅲ and scheduled for posterior lumbar surgery,were randomly divided into QLB-LSAL combined with general anesthesia(Group Q),ESPB combined with general anesthesia(Group E),and general anesthesia alone(Group N).Postoperatively,all groups received patient-controlled intravenous analgesia(PCIA).The following parameters were recorded:the scores of Richmond Agitation-Sedation Scale(RASS)and Bergman Comfort Scale(BCS)at awakening,6 h,12 h,and 24 h postoperatively;Likert scale score at PCIA cessation;the scores of Pittsburgh Sleep Quality Index(PSQI)and Early Postoperative Quality of Recovery-15(QoR-15)at 1 day preopera-(P<0.05).(2)Compared with Group N,group Q exhibited lower PSQI scores and higher QoR-15 scores at 1 and 3 days postoperatively(P<0.05).No statistically significant difference in PSQI scores was observed between group E and N(P>0.05),while group E had higher QoR-15 score than group N only at 1 day postoperatively(P<0.05).Both at 1 and 3 days postoperatively,group Q had lower PSQI scores and higher QoR-15 scores than group E(P<0.05).(3)Postoperative awakening time,extubation time,PACU stay time,time to first anal exhaust and time to first ambulation were significantly shorter in group Q than those in group N(P<0.05).Group E only showed shorter time to first anal exhaust compared to group N(P<0.05).Furthermore,group Q had a significantly shorter PACU stay time than group E(P<0.01).(4)There was no statistically significant difference in the incidence of adverse reactions among the three groups of patients.(P>0.05).Conclusions Both QLB-LSAL and ESPB effectively improve postoperative analgesia and early recovery quality.However,QLB-LSAL demonstrates advantages in enhancing patient comfort,analgesia satisfaction,sleep quality,and accelerating overall postoperative recovery.

Objective:To evaluate the relationship between transverse sinus stenosis (TSS) and cerebral blood flow in normal adults based on four-dimensional flow (4D Flow) MRI.Methods:The study was a cross-sectional study. Totally 81 normal volunteers who underwent magnetic resonance venography (MRV) and 4D Flow MRI were prospectively enrolled at Beijing Friendship Hospital, Capital Medical University from January 2020 to December 2022. Based on MRV evaluation of transverse sinus dysplasia, the volunteers were divided into a dysplasia group (26 cases) and a non-dysplasia group (55 cases); The area of the stenosis and the normal transverse sinus at the distal end were measured. The degree of TSS and the bilateral average transverse sinus stenosis (BA-TSS) were calculated. TSS was determined using TSS levels of 1/3, 1/2, and 2/3 as thresholds, and was divided into three groups: no TSS group, unilateral TSS group, and bilateral TSS group, with 28, 39, and 14 cases, 37, 37, and 7 cases, and 43, 36, and 2 cases, respectively. Based on 4D Flow MRI, the blood flow of the internal carotid artery, vertebral artery, superior sagittal sinus, straight sinus, and transverse sinus distal and proximal ends were measured. The cerebral blood flow (bilateral internal carotid artery blood flow+bilateral vertebral artery blood flow), venous sinus return blood flow 1 (superior sagittal sinus blood flow+straight sinus blood flow), return blood flow 2 (sum of bilateral transverse sinus distal end blood flow), return blood flow 3 (sum of bilateral transverse sinus proximal end blood flow), and the ratio of return blood flow to cerebral blood flow were calculated. Independent sample t-test was used to compare the differences between the group with and without transverse sinus dysplasia; Single factor analysis of variance was used to compare the differences between the TSS free group, unilateral TSS group, and bilateral TSS group. Based on single factor linear regression, the relationships between BA-TSS and blood flow parameters were analyzed.Results:There was no statistically significant difference in various blood flow parameters between the group with and without transverse sinus dysplasia (all P>0.05). When using 1/3, 1/2, and 2/3 as thresholds, there was no statistically significant difference in various blood flow parameters between the non TSS group, unilateral TSS group, and bilateral TSS group (all P>0.05). BA-TSS was linearly positively correlated with cerebral blood flow (β=0.986, 95% CI 0.108-1.865, P=0.028), but not linearly correlated with return blood flow 1, 2, and 3 (all P>0.05). The degree of BA-TSS was linearly negatively correlated with return blood flow 1/cerebral blood flow (β=-0.001, 95% CI -0.002-0, P=0.009) and return blood flow 2/cerebral blood flow (β=-0.001, 95% CI -0.002-0, P=0.018), but not with return blood flow 3/cerebral blood flow ( P=0.076). Conclusion:The BA-TSS degree in normal adults is positively correlated with cerebral blood inflow and negatively correlated with the proportion of venous sinus outflow.

Objective To assess the clinical efficacy of intravitreal anti-vascular endothelial growth factor(VEGF)agents plus panretinal photocoagulation(PRP)for treating young and middle-aged patients with proliferative diabetic reti-nopathy(PDR).Methods A retrospective case study was conducted on young and middle-aged PDR patients presenting to the Ophthalmology Department of Shaanxi Provincial People's Hospital between January 1,2021 and October 1,2024.The patients were divided into three groups according to Chinese Clinical Guidelines for Diabetic Retinopathy(2022):se-vere non-proliferative diabetic retinopathy(NPDR),early proliferative diabetic retinopathy(E-PDR)and fibrous prolifera-tive diabetic retinopathy(F-PDR).A total of 53 patients(94 eyes)were included in this study,and the mean age was(41.66±10.24)year old.There were 17 cases(31 eyes)in the NPDR group,18 cases(33 eyes)in the E-PDR group,and 18 cases(30 eyes)in the F-PDR group.All the patients were treated with the intravitreal injection of anti-VEGF agents(0.5 mg ranibizumab)about 3.5 mm from the sclerocorneal limbus at the inferior temporal sector,once a month,for three consecutive months.Routine PRP treatment was given 1 week after the first injection.Best-corrected visual acuity[BCVA(logMAR)],intraocular pressure,slit-lamp,slit-lamp fundus,optos fundus photography and OCT examinations were per-formed.The central macular thickness(CMT),average macular thickness(AMT),and the incidence of diabetic vitreous hemorrhage and emerging epiretinal membrane were recorded 1 month and 3 months after the first injection.Results Pa-tients in the F-PDR group were younger than those in NPDR and E-PDR groups(all P＜0.05).The BCVA values of eyes in all the three groups increased to varying degrees after 3 months of treatment,compared with those before treatment(all P＜0.05).The eyes in the F-PDR group had poorer vision than those in NPDR and E-PDR groups after 3 months of treat-ment(all P＜0.05).CMT and AMT decreased in all groups after 3 months of treatment,compared with those before treat-ment(all P＜0.05).No significant difference was found in CMT and AMT among the three groups at the same period(all P＞0.05).Eyes in the F-PDR group had higher risk of diabetic vitreous hemorrhage and emerging epiretinal membrane than those in NPDR and E-PDR groups 3 months after treatment(all P＜0.05).Conclusion Intravitreal anti-VEGF therapy combined with PRP can effectively slow the progression of PDR and improve vision acuity in young and middle-aged pa-tients.PDR patients with fibrovascular proliferation are at higher risk of diabetic vitreous hemorrhage and emerging epireti-nal membrane during the treatment with intravitreal anti-VEGF therapy plus PRP.These patients need a close follow-up,and vitrectomy should be performed in a timely manner to relieve vitreous traction when necessary.

Objective To explore the efficacy and safety of dapagliflozin in patients with paroxysmal atrial fibrillation (PAF) combined with heart failure with preserved ejection fraction (HFpEF). Methods A total of 120 patients with PAF combined with HFpEF treated at Jinshan Hospital of Fudan University from July 2022 to July 2023 were selected and randomly divided into the dapagliflozin group (n＝60, standard treatment combined with dapagliflozin) and the control group (n＝60, standard treatment combined with placebo). After 12 months of follow-up, the Kansas City Cardiomyopathy Questionnaire-Total Symptom Score (KCCQ-TSS), PAF duration, recurrence rate and frequency of PAF, left atrial diameter, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, left ventricular ejection fraction, P-wave dispersion, blood pressure, plasma N-terminal pro-brain natriuretic peptide (NT-proBNP), estimated glomerular filtration rate (eGFR), and glycated hemoglobin A_1C (HbA_1C) were compared between the two groups. Cardiovascular outcomes and adverse events were observed. Results A total of 10 patients lost to follow-up, and 110 patients were included in the analysis (55 in each group). After 12 months of treatment, the KCCQ-TSS in the dapagliflozin group was significantly higher than that in the control group ([61.68±2.65] points vs [44.98±4.76] points, P＜0.001). The PAF duration in the dapagliflozin group was significantly shorter than that in the control group ([144±18] min vs [270±24] min, P＝0.045). After treatment, frequency of PAF, NT-proBNP levels, left ventricular end-systolic diameter, left ventricular end-diastolic diameter, left atrial diameter, P-wave dispersion, and HbA_1C levels showed statistical differences between the two groups (P＜0.05). The heart failure readmission rate and PAF recurrence rate in the dapagliflozin group were significantly lower than those in the control group (P＜0.05). There was no significant difference in the incidence of adverse events between the two groups during treatment. Conclusions Dapagliflozin improves patients’ quality of life, reduces PAF duration and recurrence rate, decreases heart failure readmission rate, lowers NT-proBNP levels, reverses cardiac remodeling, and demonstrates favorable safety in patients with PAF combined with HFpEF.

The aim of this updated guideline is to provide comprehensive recommendations for the management of gout in patients with common comorbidities, such as chronic kidney disease(CKD), cardiovascular disease(CVD), diabetes, osteoarthritis(OA), and gastrointestinal disorders. This guideline was developed by a multidisciplinary expert panel consisting of specialists in endocrinology, rheumatology, nephrology, cardiology, gastroenterology, and methodology. The development process adhered to standard methodologies, including PICO(population, intervention, comparator, and outcomes) question deconstruction, systematic literature review, the Grading of Recommendations Assessment, Development and Evaluation(GRADE) for evidence and recommendation evaluation, Delphi voting, and expert consensus. The guideline presents 26 evidence-based recommendations addressing 7 clinical questions for patients with hyperuricemia and gout in the context of comorbidities. Key recommendations include the maintenance of strict serum urate targets, particularly for patients with CKD stage≥3, chronic gouty arthritis, and OA, in order to prevent disease progression. In patients with CVD or diabetes, intra-articular triamcinolone is preferred over systemic glucocorticoids. Prioritized anti-inflammatory treatments for patients with CKD, gastrointestinal diseases and OA are recommended. The guideline also introduces emerging therapies, such as interleukin-1 inhibitors and selective urate transport inhibitors, as potential treatment options for refractory cases. The update offers a comprehensive, patient-centered approach to managing gout, particularly in individuals with associated comorbidities. Multidisciplinary collaboration and emerging new treatments and evidence ensure the optimization of the recommendations.

Objective:To evaluate the efficacy of liposomal bupivacaine (LB) for sciatic nerve block in mice.Methods:Twenty-four healthy adult male C57BL/6 mice, aged 6-8 weeks, weighing 25-30 g, were divided into 4 groups ( n=6 each) using a random number table method: 1.33% LB 80 μl group (group A), 1.33% LB 40 μl group (group B), 0.66% LB 80 μl group (group C), and 0.66% LB 40 μl group (group D). The sciatic nerve block was performed using the corresponding concentration of LB or the equal volume of LB in each group. The mechanical paw withdrawal threshold (MWT) was measured using Von Frey filaments immediately after sciatic nerve block, at 5 min of block, and every 1 h until MWT recovered to the baseline level. The sciatic nerve block time-MWT curve was plotted to calculate the area under the curve (AUC). Results:The time-MWT curves exhibited similar bimodal characteristics in each group. From the time point immediately after the blockade to the first MWT peak after the blockade, there were no statistically significant differences in the AUC among the four groups ( P>0.05). From the first MWT peak to the first trough, the AUC was significantly greater in A group than in B, C and D groups and in B and C groups than in D group ( P<0.05). From the first trough to the second MWT peak, there was no significant difference in the AUC between A group and D group ( P>0.05), and the AUC was significantly greater in B and C groups than in A and D groups ( P<0.05). From the second MWT peak to the baseline level, the AUC was significantly greater in A group than in B, C and D groups ( P<0.05), and there was no significant difference in the AUC among B, C and D groups ( P>0.05). In the total duration of the sciatic nerve block, the AUC was significantly greater in A group than in B, C and D groups and in B and C groups than in D group ( P<0.05).There was no significant difference in the AUC between B group and C group ( P>0.05). Conclusions:LB exhibits characteristic bimodal changes when used for sciatic nerve block; higher concentrations and volume of LB result in stronger and longer-lasting block effects in mice.

Objective:To evaluate the efficacy of liposomal bupivacaine (LB) for sciatic nerve block in mice.Methods:Twenty-four healthy adult male C57BL/6 mice, aged 6-8 weeks, weighing 25-30 g, were divided into 4 groups ( n=6 each) using a random number table method: 1.33% LB 80 μl group (group A), 1.33% LB 40 μl group (group B), 0.66% LB 80 μl group (group C), and 0.66% LB 40 μl group (group D). The sciatic nerve block was performed using the corresponding concentration of LB or the equal volume of LB in each group. The mechanical paw withdrawal threshold (MWT) was measured using Von Frey filaments immediately after sciatic nerve block, at 5 min of block, and every 1 h until MWT recovered to the baseline level. The sciatic nerve block time-MWT curve was plotted to calculate the area under the curve (AUC). Results:The time-MWT curves exhibited similar bimodal characteristics in each group. From the time point immediately after the blockade to the first MWT peak after the blockade, there were no statistically significant differences in the AUC among the four groups ( P>0.05). From the first MWT peak to the first trough, the AUC was significantly greater in A group than in B, C and D groups and in B and C groups than in D group ( P<0.05). From the first trough to the second MWT peak, there was no significant difference in the AUC between A group and D group ( P>0.05), and the AUC was significantly greater in B and C groups than in A and D groups ( P<0.05). From the second MWT peak to the baseline level, the AUC was significantly greater in A group than in B, C and D groups ( P<0.05), and there was no significant difference in the AUC among B, C and D groups ( P>0.05). In the total duration of the sciatic nerve block, the AUC was significantly greater in A group than in B, C and D groups and in B and C groups than in D group ( P<0.05).There was no significant difference in the AUC between B group and C group ( P>0.05). Conclusions:LB exhibits characteristic bimodal changes when used for sciatic nerve block; higher concentrations and volume of LB result in stronger and longer-lasting block effects in mice.

Objective:To analyze the incidence and risk factors of ocular surface disease among power grid construction workers in plateau.Methods:A total of 11 132 construction personnel from the Ngari prefecture-central Tibet power grid interconnection project were included from 2019 to 2020.Baseline characteristics including age, gender, body mass index, developmental and nutritional status, relevant clinical indicators, etc.and follow-up data regarding incidence of ocular surface diseases were obtained from the medical records of Ali interconnection project staff medical station.The altitude of workplace and residence of the study population were obtained from the website (https: //zh-cn.topographic-map.com/legal/).The mean age of the subjects was (36.17±10.48) years, of which 95.33%(10, 612 subjects) were male.The median follow-up time was 1.53 years.The altitude of the residence and workplace were (1 954.77±940.64) and (4 535.09±232.71) meters, respectively.The incidence of ocular surface diseases in groups with different characteristics was calculated.Differential variables for the incidence of ocular surface diseases were screened by univariate Cox proportional hazards regression model.Influencing factors of ocular surface diseases multivariate were explored by Cox proportional hazards model.This study was approved by the Ethics Committee of Peking University Health Science Center (No.IRB00001052-21066).Results:During the follow-up period, the incidence of ocular surface disease was 9.27% (1 032 cases), and the incidence of conjunctivitis and keratitis was 6.58% (733 cases) and 1.80% (200 cases), respectively.Multivariate Cox proportional hazards regression analysis showed that for every 1 000 meters increase in altitude of residence, the risk of ocular surface disease decreased by 15% ( HR[95% CI]: 0.85[0.80~0.91], P<0.001).For every 100 meters increase in altitude of workplace, the risk of ocular surface disease increased by 5% ( HR[95% CI]: 1.04[1.01~1.07], P=0.006).Decreased blood oxygen saturation ( HR[95% CI]: 1.09[1.02~1.16], P=0.007), hearing pulmonary dry rales (hazard ratio ( HR)[95% CI]: 1.53[1.12~2.09], P=0.007) and heart murmurs ( HR[95% CI]: 4.44[1.43~13.83], P=0.010) were associated with ocular surface disease. Conclusions:The incidence of ocular surface disease in personnel engaged in electric grid construction at high altitudes should not be ignored.High working altitude, low residence altitude, pulmonary dry rales, heart murmurs and low blood oxygen saturation are factors associated with the incidence of ocular surface disease.

Objective To compare the effects of quadratus lumborum block at the lateral supra-arcuate ligament(QLB-LSAL)and erector spinae plane block(ESPB)on early postoperative recovery in patients undergoing posterior lumbar surgery.Methods Ninety-three patients,aged 25～70 years,BMI 18～30 kg/m2 and ASA physical status Ⅱ or Ⅲ and scheduled for posterior lumbar surgery,were randomly divided into QLB-LSAL combined with general anesthesia(Group Q),ESPB combined with general anesthesia(Group E),and general anesthesia alone(Group N).Postoperatively,all groups received patient-controlled intravenous analgesia(PCIA).The following parameters were recorded:the scores of Richmond Agitation-Sedation Scale(RASS)and Bergman Comfort Scale(BCS)at awakening,6 h,12 h,and 24 h postoperatively;Likert scale score at PCIA cessation;the scores of Pittsburgh Sleep Quality Index(PSQI)and Early Postoperative Quality of Recovery-15(QoR-15)at 1 day preopera-(P<0.05).(2)Compared with Group N,group Q exhibited lower PSQI scores and higher QoR-15 scores at 1 and 3 days postoperatively(P<0.05).No statistically significant difference in PSQI scores was observed between group E and N(P>0.05),while group E had higher QoR-15 score than group N only at 1 day postoperatively(P<0.05).Both at 1 and 3 days postoperatively,group Q had lower PSQI scores and higher QoR-15 scores than group E(P<0.05).(3)Postoperative awakening time,extubation time,PACU stay time,time to first anal exhaust and time to first ambulation were significantly shorter in group Q than those in group N(P<0.05).Group E only showed shorter time to first anal exhaust compared to group N(P<0.05).Furthermore,group Q had a significantly shorter PACU stay time than group E(P<0.01).(4)There was no statistically significant difference in the incidence of adverse reactions among the three groups of patients.(P>0.05).Conclusions Both QLB-LSAL and ESPB effectively improve postoperative analgesia and early recovery quality.However,QLB-LSAL demonstrates advantages in enhancing patient comfort,analgesia satisfaction,sleep quality,and accelerating overall postoperative recovery.