Objective To compare the efficacy and safety of flexible ureteral lithotripsy(FURL)and non-retrograde percutaneous nephrolithotomy(NR-PCNL)for treating1.5-2.0 cm upper ureteral stones.Methods We retrospectively analyzed clinical data of 130 patients with upper ureteral stones treated between October 2022 and October 2024.Sixty-two patients underwent FURL and 68 underwent NR-PCNL.Comparisons included operative time,pre-and postoperative changes in white blood cells(WBC),hemoglobin(Hb),and creatinine(Cr),postoperative C-reactive protein(CRP)levels,stone-free rate after primary surgery,postoperative hospitalization duration,pain scores,complications,and need for auxiliary treatments.Results Compared to the FURL group,the NR-PCNL group demonstrated advantages in operative time[54.0(44.3,69.3)min vs.82.5(66.0,101.0)min,Z=-5.565,P<0.001],WBC elevation[1.9(0.5,3.5)×109/L vs.4.5(3.0,6.0)×109/L,Z=-4.528,P<0.001],and secondary surgery rate[0%(0/68)vs.14.5%(9/62),P<0.001].The FURL group showed lower Hb reduction[3.0(2.0,6.3)g/L vs.8.0(5.0,11.0)g/L,Z=-4.262,P<0.001],less postoperative Visual Analogue Scale(VAS)pain scores[1.0(1.0,2.0)points vs.2.0(1.0,2.0)points,Z=-2.840,P=0.005],and shorter hospitalization duration[2.0(1.0,2.0)d vs.3.0(2.0,3.0)d,Z=-5.815,P<0.001].No significant differences were observed in Cr elevation,CRP levels,stone-free rate after primary surgery,complications,or analgesic requirements(P≥0.05).Conclusions Both NR-PCNL and FURL are safe and effective for 1.5-2.0 cm upper ureteral stones.FURL offers better patient comfort,while NR-PCNL shows superior overall safety.

The presence of magnetic fields in a magnetic resonance accelerator (MR-linac) can affect the reference dosimetry, and thus the existing Code of Practices (CoPs) are inadequate for MR-linac. In this article, the characteristics of adsorbed dose to water and ionization chamber response in the presence of magnetic fields were introduced and a formalism for reference dosimetry in MR-linac was developed based on the existing CoPs, aiming to provide reference for dosimetric quality control and research work of MR-linac in China.

The 2021 version of the Baveno Ⅶ consensus on portal hypertension and the 2023 guidelines from the European Association for the Study of the Liver define recompensated cirrhosis as the restoration and stabilization of liver function, improvement of liver fibrosis, and absence of decompensated cirrhosis for a long time following effective treatment of the underlying etiology of cirrhosis. Recompensated cirrhosis has become an important research direction in the field with the gradually increasing number of these patients. Temporary recompensation, stable recompensation, and long-term recompensation are the three stages into which patients with cirrhosis are divided, based on varying recompensation stages. Clinical characteristics and prognosis are significantly different among different stages. Patients in the temporary compensation stage have significant fluctuations in their condition and poor stability, with a high risk of recurrent complications. The prognosis of patients in the stable recompensation stage is significantly affected by the cause and the type of initial decompensation event, while the condition of patients in the long-term recompensation stage is more stable, and the long-term prognosis is close to that of compensated cirrhosis. This article aims to summarize and explore the recompensation rates at different stages of liver cirrhosis, the occurrence risk of various complications and liver cancer, and long-term management and treatment following recompensation, providing new directions for future research in this field.

Objective:To systematically evaluate the incidence and risk factors of acute kidney injury (AKI) induced by vancomycin in pediatric patients.Methods:Databases of PubMed, Embase, The Cochrane Library, Web of Science, CNKI, Wanfang, VIP, Chinese Biomedical Database (CBM) were searched and articles about the risk factors of AKI induced by vancomycin in pediatric patients from inception to June 2024 were collected. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS) for the included studies. Meta-analysis of the data for relevant exposure factors extracted from the included literature was conducted using Rev Man 5.4. The strength of association between the exposure factors and AKI was expressed using the odds ratio ( OR) and its 95% confidence interval ( CI). Results:A total of 13 studies were entered, involving 11 073 patients. Of them, 1 388 patients were in AKI group and 9 685 patients in non-AKI group. The incidence of AKI was 12.53%, ranging from 4.62% to 27.07%. The quality evaluation results showed that the 13 documents were all of high-quality (NOS score ≥7 points). Meta-analysis showed that admission to intensive care unit (ICU) ( OR=2.39, 95% CI: 1.59-3.59, P<0.001), vancomycin using time ≥7 d ( OR=2.19, 95% CI: 1.44-3.34 P=0.003), vancomycin steady-state trough concentration ≥15 mg/L ( OR=2.98, 95% CI: 2.22-4.01, P<0.001), combined with nephrotoxic drugs ≥2 kinds ( OR=2.92, 95% CI=1.84-4.64, P<0.001), combined with piperacillin sodium and tazobactam sodium ( OR=2.71, 95% CI: 1.72- 4.27, P<0.001), combined with carbapenem ( OR=2.36, 95% CI: 1.36-4.10, P=0.002), combined with aminoglycosides ( OR=1.78, 95% CI: 1.35-2.35, P<0.001), combined with loop diuretics ( OR=3.16, 95% CI: 2.36- 4.23, P<0.001), combined with amphotericin B ( OR=2.26, 95% CI: 1.35-3.79, P=0.002), combined with contrast medium ( OR=2.34, 95% CI: 1.04-5.25, P=0.040), and combined with aciclovir ( OR=1.74, 95% CI: 1.04-2.84, P=0.030) were all risk factors of AKI induced by vancomycin in pediatric patients. Conclusions:The incidence of vancomycin-related AKI in pediatric patients was 12.53%. Admission to ICU, vancomycin trough concentration ≥15 mg/L, medication time ≥7 d, and concomitant use of ≥2 nephrotoxic drugs and etc.were risk factors of vancomycin-related AKI.

Objective:To investigate the complications, along with their diagnosis and management, that follow local excision for rectal cancer after neoadjuvant therapy.Methods:The clinical data of 53 patients with rectal cancer who underwent local resection after neoadjuvant treatment in Peking Union Medical College Hospital from January, 2010 to December, 2024 were retrospectively collected for this descriptive case series study. Indications for local resection were: (1) age ≥ 18 years; (2) American Society of Anesthesiologists (ASA) classification I-III; (3) pathologically confirmed rectal adenocarcinoma; (4) distance from the lower edge of the tumor to the anal edge of less than 8 cm; and (5) use of preoperative neoadjuvant therapy. Contraindications of local resection were: (1) multiple primary colorectal cancer and (2) intestinal obstruction, intestinal perforation, or and gastrointestinal bleeding that required emergency surgery. There were 36 males and 17 females, and the median age was 62 (26-85) years. After neoadjuvant therapy, the median distance from the tumor to the anal margin was 4.5 (range, 2.2-6.9) cm. The main outcome measures included: surgical details, pathological findings, postoperative complications, anorectal function, and oncological outcomes (recurrence and survival).Results:Surgical methods included transanal endoscopic microsurgery (TEM) in 47 cases, transanal minimally invasive surgery (TAMIS) in 3 cases, and traditional transanal local resection in 3 cases. Of the 53 patients, 29 (54.7%) had pathological complete response (pCR), namely pT0 stage; 8 cases were pT1, 15 cases were pT2, and 1 case was pT3. Twenty-four cases (45.3%) had 33 complications. Clavien-Dindo grade I-II accounted for 97.0% (32/33), including 14 cases (26.4%) of wound dehiscence. Low anterior resection syndrome (LARS) occurred in 7 cases (13.2%), including 5 minor cases and 2 major cases. Postoperative fever occurred in 7 cases (13.2%); urinary retention occurred in 3 cases (5.7%); and diarrhea occurred in 1 case (1.9%). Clavien Dindo grade III was observed in only 3.0% (1/33) of patients, which was a rectovaginal fistula. Among the 14 patients with wound dehiscence, 7 cases only suffered anal pain and were cured after symptomatic analgesic treatment. Five cases suffered anal pain with hematochezia but improved after treatment with essential diet, hemostasis, intravenous antibiotics, pain relief, and sitz bath. Two cases of secondary perianal infection were treated with intravenous antibiotics, local drainage, parenteral nutrition support, and symptomatic treatment, and the wounds healed within 2 months. One patient with rectovaginal fistula underwent transverse colostomy. After six months, the fistula healed and stoma reversal was performed. Seven patients with LARS received anal lifting exercise and defecation reflex training, and anal function recovered to the preoperative level after 1 year. Other complications improved after symptomatic treatment, pain relief, or catheter replacement. The median follow-up time was 60 months. Local recurrence occurred in 4 patients (7.5%) and distant metastasis occurred in 12 patients (22.6%). Seven patients (13.2%) died. The 5-year disease-free survival rate was 75.5%, and the 5-year overall survival rate was 86.8%.Conclusions:Local excision for rectal cancer following neoadjuvant therapy has a high incidence of complications, mainly wound-related, due to the decline of rectal wound healing ability after radiotherapy. However, most of the complications were relieved after symptomatic treatment, and the risk was controllable.

Objective To compare the efficacy and safety of flexible ureteral lithotripsy(FURL)and non-retrograde percutaneous nephrolithotomy(NR-PCNL)for treating1.5-2.0 cm upper ureteral stones.Methods We retrospectively analyzed clinical data of 130 patients with upper ureteral stones treated between October 2022 and October 2024.Sixty-two patients underwent FURL and 68 underwent NR-PCNL.Comparisons included operative time,pre-and postoperative changes in white blood cells(WBC),hemoglobin(Hb),and creatinine(Cr),postoperative C-reactive protein(CRP)levels,stone-free rate after primary surgery,postoperative hospitalization duration,pain scores,complications,and need for auxiliary treatments.Results Compared to the FURL group,the NR-PCNL group demonstrated advantages in operative time[54.0(44.3,69.3)min vs.82.5(66.0,101.0)min,Z=-5.565,P<0.001],WBC elevation[1.9(0.5,3.5)×109/L vs.4.5(3.0,6.0)×109/L,Z=-4.528,P<0.001],and secondary surgery rate[0%(0/68)vs.14.5%(9/62),P<0.001].The FURL group showed lower Hb reduction[3.0(2.0,6.3)g/L vs.8.0(5.0,11.0)g/L,Z=-4.262,P<0.001],less postoperative Visual Analogue Scale(VAS)pain scores[1.0(1.0,2.0)points vs.2.0(1.0,2.0)points,Z=-2.840,P=0.005],and shorter hospitalization duration[2.0(1.0,2.0)d vs.3.0(2.0,3.0)d,Z=-5.815,P<0.001].No significant differences were observed in Cr elevation,CRP levels,stone-free rate after primary surgery,complications,or analgesic requirements(P≥0.05).Conclusions Both NR-PCNL and FURL are safe and effective for 1.5-2.0 cm upper ureteral stones.FURL offers better patient comfort,while NR-PCNL shows superior overall safety.

Objective To evaluate the safety and efficacy of non-retrograde intubation combined with selectively tubeless percutaneous nephrolithotomy(NR-ST-PCNL).Methods A retrospective analysis included 213 patients with upper urinary tract stones and hydronephrosis(renal pelvic separation>10 mm)undergoing PCNL at our hospital from October 2023 to June 2025.Patients were divided into Group A(non-retrograde intuba-tion,n=109)and Group B(retrograde intubation,n=104).Primary endpoint was postoperative complications and secondary endpoints included operative time,stone-free rate(SFR),visual analog scale(VAS)pain scores,postoperative hospital stay,and hospitalization costs.Results Group A demonstrated significantly lower rates of postoperative complications[7.3%(8/109)vs.18.2%(19/104),P=0.017],shorter operative time[51.00(37.00,65.00)min vs.71.50(55.00,90.75)min,P<0.001],lower postoperative VAS scores[1.00(0.00,1.00)vs.1.00(0.00,2.00),P=0.008],shorter hospital stay[3.00(2.00,3.00)days vs.4.00(4.00,4.00)days,P<0.001],and lower hospitalization costs[17 028.00(15 178.05,17 934.50)RMB vs.20 653.00(19 176.25,22 630.00)RMB,P<0.001]compared with Group B.There was no significant difference in SFR between groups(P>0.05).Conclusion For patients with upper urinary tract stones and renal pelvic separation>10 mm,NR-ST-PCNL performed by experienced surgeons achieves comparable stone clearance to conventional techniques while reducing complication risk,shortening operative and hospitalization times,and lowering costs.It represents a safe,efficient,and optimized clinical approach.

Objective By exploring the establishment of a follow-up and pre-visit model,this study aims to facilitate the development of a modernized Chinese medical service model for public hospitals,characterized by optimized workflows,continu-ous care models,efficient services,comfortable environments,and patient-centered attitudes,thereby improving patient experi-ence and enhancing the quality of outpatient follow-up visits.Methods Under the value co-creation framework,with both healthcare providers and patients as core value stakeholders,this program introduced a self-service examination appointment plat-form,established a follow-up and pre-visit process,and implemented time-slot-based appointments for diagnosis and treatment.These steps aim to promote the equitable allocation of medical resources and refine the follow-up and pre-visit model in public hospitals.Results Implementation at Hospital P demonstrated that after process reengineering,patients'average in-hospital time reduced by nearly 135 minutes,significantly enhancing treatment efficiency,satisfaction levels among both medical staff and patients,and accessibility of medical services.Conclusion Grounded in value co-creation theory,the follow-up and pre-visit model of Hospital P is divided into three stages:mutual value positioning of both doctors and patients,collaborative value crea-tion,and sustained value continuation for both.This alignment between process reengineering goals and value co-creation out-comes helps improve the quality of medical services,better meet the medical needs of patients,and achieve a win-win scenario for both doctors and patients.

ObjectiveTo reveal the mechanism of Zuogui Jiangtang Jieyu prescription against damage to hippocampal synaptic microenvironment via suppressing glutamate receptor 2 （GluR2）/Parkin signal-mediated mitophagy in rats with diabetes-related depression （DD）. MethodsEighty male SD rats underwent adaptive feeding for 5 days before the study. Ten rats were randomly assigned to the normal group. The model of DD rats was established with the rest by 2-week high-fat diet + streptozotocin （STZ） tail intravenous injection + 28 days of chronic unpredictable mild stress （CUMS） combined with isolation. The rats were randomly divided into a normal group， a model group， a GluR2 blocker group （5 μg·kg^-1）， a GluR2 agonist group （10 μg·kg^-1）， a metformin + fluoxetine group （0.18 g·kg^-1 metformin + 1.8 mg·kg^-1 fluoxetine）， and high- and low-dose Zuogui Jiangtang Jieyu prescription groups （20.52 and 10.26 g·kg^-1， respectively）. The rats in the GluR2 blocker group and the GluR2 agonist group were continuously injected with CNQX and Cl-HIBO in the dentate gyrus of the hippocampus once a week starting from stress modeling， respectively， while the metformin + fluoxetine group and the high- and low-dose Zuogui Jiangtang Jieyu prescription groups were continuously given intragastric administration for 28 d at the same time of stress modeling. Depression-like behavior was evaluated by open field and forced swimming experiments. The levels of serum insulin and adenosine triphosphate （ATP） in hippocampus were detected by biochemical analysis. The levels of 5-hydroxytryptamine （5-HT） and dopamine （DA） in hippocampus were detected by enzyme-linked immunosorbent assay （ELISA）. The autophagosomes of hippocampal neurons were observed by transmission electron microscopy. The morphology and structure of dendrites and spines of hippocampal neurons were evaluated by Golgi staining. Western blot detected the expression levels of GluR2 and Parkin proteins in hippocampus. The expression levels of GluR2， Parkin， regulating synaptic membrane exocytosis protein 3 （RIMS3）， and postsynaptic density protein 95 （PSD95） in the dentate gyrus of the hippocampus were detected by immunofluorescence. ResultsCompared with the normal group， the model group exhibited reduced total activity distance in the open field and increased immobility time in forced swimming （P<0.01）， lowered levels of serum insulin and ATP， 5-HT， and DA in hippocampus （P<0.01）， increased autophagosomes of hippocampal neurons， significantly damaged morphology and structure of dendrites and spines of hippocampal neurons， decreased expression levels of GluR2， RIMS3， and PSD95 in hippocampus， and an increased Parkin expression level （P<0.05， P<0.01）. Compared with the model group， the GluR2 blocker group and the GluR2 agonist group showed aggravation and alleviation of the above abnormal changes， respectively （P<0.05， P<0.01）. The above depression-like behavior was significantly improved in the high- and low-dose Zuogui Jiangtang Jieyu prescription groups to different degrees. Specifically， the two groups saw elevated levels of serum insulin and ATP， 5-HT， and DA in hippocampus （P<0.05， P<0.01）， restrained increase in autophagosomes and damage to morphology and structure of dendrites and spines of hippocampal neurons， up-regulated protein expression levels of GluR2， RIMS3， and PSD95， and down-regulated Parkin expression level （P<0.05， P<0.01）. ConclusionZuogui Jiangtong Jieyu prescription can ameliorate the mitophagy-mediated damage to hippocampal synaptic microenvironment in DD rats， the mechanism of which might be related to the regulation of GluR2/Parkin signaling pathway.

Objective:To explore the efficacy and prognosis of hepatectomy via Laennec membrane approach in patients with hepatocellular carcinoma (HCC).Methods:The data of 98 patients with HCC who underwent hepatectomy in the First Affiliated Hospital of Soochow University from January 2016 to December 2022 were retrospectively analyzed, including 76 males and 22 females, aged 61.0 (55.0, 66.0) years. Forty-eight patients treated with Laennec membrane approach hepatectomy were included in the study group and 50 patients treated with traditional approach hepatectomy were included in the control group. The age, gender, combined hypertension and diabetes, aspartate transaminase, alanine transaminase, albumin, total bilirubin, prealbumin, platelet, alpha-fetoprotein, carbohydrate antigen 19-9 and carbohydrate antigen 125 were compared between the two groups. The surgical bleeding, operation time and complications (abdominal bleeding, bile leakage, poor incision healing, etc.) were compared between the two groups. The prognosis of the two groups was compared.Results:There were no significant differences in gender, age, underlying diseases, preoperative biochemical and tumor serological indexes between the two groups (all P>0.05). The operation time of the study group was 180.0 (141.3, 227.3) min, which was lower than that of the control group 221.5 (187.5, 256.3) min ( Z=-0.41, P=0.002). The intraoperative blood loss in the study group was 295.0 (127.5, 350.0) ml, which was lower than that in the control group 300.0 (200.0, 500.0) ml, and the difference was statistically significant ( Z=-1.97, P=0.003). The levels of aspartate transaminase and alanine transaminase 1 week after surgery in the study group were 33.4 (24.0, 43.8) U/L and 64.5 (38.3, 119.1) U/L, respectively, which were lower than those in the control group 41.3 (29.7, 63.0) U/L and 102.8 (50.1, 140.7) U/L, the differences were statistically significant ( Z=-2.09, -2.38, P=0.035, 0.028). Postoperative complications occurred in 8 cases (16.7%) in the study group and 10 cases (20.0%) in the control group, with no significant difference between the two groups ( χ2=0.18, P=0.670). The median overall survival was 16 months in the study group and 18 months in the control group, respectively. There was no significant difference in cumulative survival between the two groups ( χ2=1.41, P=0.130). Conclusion:Laennec membrane approach hepatectomy can not only shorten the operation time and reduce the amount of blood loss, but also promote the recovery of liver function.