The CyberKnife, an acronym for the stereotactic radiosurgery platform, represents an image-guided stereotactic radiotherapy technique. This technology precisely delivers ionizing radiation to tissues, effectively damaging tumor cells, and is suitable for radiotherapy of both intracranial and extracranial tumors. This article reports the first performance of CyberKnife by radiotherapy at Peking Union Medical College Hospital, including a patient with uncontrolled pituitary adenoma after surgery and radiotherapy, and another patient with vertebral metastasis following targeted therapy for lung adenocarcinoma. The application of CyberKnife technology in radiotherapy has achieved highly accurate dose delivery, enabling targeted irradiation of tumor lesions while minimizing damage to surrounding normal tissues, thereby yielding relatively ideal clinical outcomes.

ObjectiveTo characterize the changes of metabolites of Blumea balsamifera in the process of sweating by non-targeted metabolomics， and to investigate the influence of sweating processing on the constituents of B. balsamifera. MethodsUltra performance liquid chromatography-quadrupole/electrostatic field orbitrap high resolution mass spectrometry（UPLC-Q-Exactive Orbitrap-MS） metabolomics was used to identify the metabolites in no sweating group（F1）， sweating 2 d group（F2） and sweating 4 d group（F3）， the differences of metabolites between the groups were compared by principal component analysis（PCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA）， and differential metabolites were screened according to the variable importance in the projection（VIP） value>1 and P<0.05， and the pathway enrichment of the differential metabolites was analyzed by Kyoto Encyclopedia of Genes and Genomes（KEGG）. ResultsThe results of PCA and OPLS-DA showed a clear distinction between the three groups of samples， indicating significant differences in the compositions of the three groups of samples. A total of 433 differential metabolites were screened between the F1 and F2， with 154 up-regulated and 279 down-regulated， the significant up-regulated metabolites were tangeritin， 5-O-demethylnobiletin and so on， while the metabolites with significant down-regulation included alternariol， fortunellin， etc. A total of 379 differential metabolites were screened between the F2 and F3， with 150 up-regulated and 229 down-regulated， the significant up-regulated metabolites were isoimperatorin， helianyl octanoate and so on， and the significant down-regulated metabolites were hovenoside I， goyasaponin Ⅲ， etc. KEGG pathway enrichment analysis showed that tyrosine metabolism， isoquinoline alkaloid biosynthesis， phenylalanine， tyrosine and tryptophan biosynthesis， tryptophan metabolism， valine， leucine and isoleucine biosynthesis， pantothenate and coenzyme A biosynthesis may be the key pathways affecting metabolite differences of B. balsamifera after sweating treatment. ConclusionSweating can reduce the content of endophytic mycotoxins in B. balsamifera and has a great impact on the synthesis and metabolic pathways of total flavonoids and auxin. This study can provide a reference for the process research on the sweating conditions of B. balsamifera.

Objective To systematically evaluate the efficacy and safety of dronedarone in preventing early recurrence of atrial fibrillation(AF)after ablation.Methods PubMed,Web of Science,Cochrane Library,Embase,CNKI,WanFang Data and VIP databases were electronically searched to collect the clinical studies on the efficacy and safety of dronedarone in preventing early recurrence of AF after ablation from the inception to April 16,2024.Two researchers independently screened the literature,extracted data,and assessed the risk of bias of the included studies.Meta-analysis was performed by using RevMan 5.3 software.Results A total of three randomized controlled trials and eight cohort studies were ultimately included,including 1 534 patients.The results of meta-analysis showed that there was no statistically significant difference in the early recurrence rate of AF after ablation between the dronedarone group and the amiodarone group(RR=1.15,95％CI 0.90 to 1.47,P=0.25).Compared with the amiodarone group,the dronedarone group had a higher incidence of bleeding(RR=2.28,95％CI 1.08 to 4.81,P＜0.05),a higher incidence of gastrointestinal adverse reactions(RR=3.87,95％CI 1.39 to 10.74,P=0.009)and a lower incidence of thyroid dysfunction(RR=0.15,95％CI 0.06 to 0.40,P＜0.001).There was no statistically significant difference in the incidence of postoperative bradycardia,liver and kidney dysfunction,and total adverse drug reactions between the two groups(P＞0.05).Compared with the propafenone group,the dronedarone group had a lower early recurrence rate of AF after ablation(RR=0.31,95％CI 0.17 to 0.57,P＜0.001).However,there was no statistically significant difference in the incidence of adverse reactions between them(P＞0.05).Conclusion Current evidence suggests that dronedarone is as effective in preventing early recurrence after AF ablation as amiodarone,but more effective than propafenone.In terms of safety,compared to amiodarone,dronedarone has a lower risk of thyroid dysfunction,but a higher risk of gastrointestinal adverse reactions and bleeding.Due to the limited quality and quantity of the included studies,more large sample,multi-center and high-quality studies are needed to verify the above conclusion.

Aim To investigate the impact of Cinobu-facini on the proliferation,invasion,and apoptosis of HepG2 cells and the underlying mechanism.Methods The proliferation of HepG2 cells was assessed using the CCK-8 method following treatment with Cinobufaci-ni.The invasion capability of HepG2 cells was evalua-ted through Transwell assay after exposure to Cinobufa-cini.The apoptosis rates of HepG2 cells post Cinobufa-cini intervention were measured using flow cytometry,and the expression levels of VEGF in the culture medi-um of HepG2 cells were determined using enzyme-linked immunoassay.Furthermore,qRT-PCR and Western blot analyses were conducted to assess the im-pact of Cinobufacini on mRNA and protein expression levels related to the CXCL5/FOXD1/VEGF pathway.The interaction between CXCL5 and FOXD1 was inves-tigated via co-immunoprecipitation.Results Cinobufa-cini treatment led to a gradual decrease in HepG2 cell viability in a dose-dependent manner compared to the control group(P＜0.05).Moreover,Cinobufacini sig-nificantly suppressed HepG2 cell invasion(P＜0.05)while enhancing cell apoptosis(P＜0.05).Notably,Cinobufacini exhibited inhibitory effects on the CX-CL5/FOXD1/VEGF pathway,as evidenced by re-duced expression of related mRNA and proteins(P＜0.05).FOXD1 was identified as the binding site of CXCL5.Overexpression of CXCL5 resulted in in-creased proliferation and VEGF secretion by HepG2 cells(P＜0.05),and increased expression of FOXD1 and VEGF(P＜0.05).However,Cinobufacini inter-vention effectively inhibited liver cancer cell prolifera-tion and invasion(P＜0.05),promoted apoptosis(P＜0.05),reduced VEGF secretion by HepG2 cells(P＜0.05),and downregulated the expression of CXCL5 and FOXD1 in HepG2 cells(P＜0.05);but com-pared with the unexpressed group of Cinobufacini,its ability to inhibit cell activity was weakened(P＜0.05),and its ability to inhibit the expression of CX-CL5,FOXD1,and VEGF was weakened(P＜0.05).Conclusion Cinobufacini may inhibit HepG2 cell pro-liferation and invasion and promote HepG2 cell apopto-sis by regulating the CXCL5/FOXD1/VEGF pathway.

Objective To investigate the application of pre-hemostatic suturing in adolescent circumcision with a stapler.Methods A total of 120 patients with long foreskin treated in our hospital were included,and they were divided into two groups by random number table method,among which the patients in the observation group received circumcision with a stapler after pre-hemostatic suturing of the foreskin vessels,and these in the control group received conventional circumcision with a stapler.The operation time,intraoperative blood loss,postoperative healing time and occurrence of postoperative hematoma of the two groups were analyzed.Results There was no significant difference in the operation time between the two groups(P＞0.05).The intraoperative blood loss in the observation group was less than that in the control group,the postoperative healing time was shorter than that in the control group,and the incidence of postoperative hematoma was lower than that in the control group,with statistically significant differences(P＜0.05).Conclusion The application of pre-hemostatic suturing in circumcision with a stapler can improve surgical safety,with ease of learning,which may increase the benefit of patients.

Objective:To investigate the effect of irisin on apoptosis of hyperbilirubinemia cells in neonatal rats. Method:Ninety-six newbom SD rats were randomly divided into the control group(N group)and the model group(M group).The model was established by intraperitoneal injection of bilirubin solution at age 7 and 10 days.After successful modeling,the M group was randomly divided into four groups:T0,T1,T2,T3.Groups T1,T2,and T3 received intracerebroventricular injections of 40,60,and 80 μg/kg irisin solution,re-spectively,while the other groups were injected with an equivalent volume of phosphate buffer saline(PBS)solution.After 24 hours,neurobehavioral assessments were conducted,hematoxylin-eosin(HE)staining,termi-nal-deoxynucleoitidyl transferase mediated Nick end labeling(Tunel)were used to detect the hippocampus pathological changes and apoptosis rate statistics,and Westem Blot was used to detect relative expression lev-els of Bcl-2,Bax and Caspase-3 proteins in hippocampus. Result:After irisin injection,the T3 group required less time needed for planar double positive reflection than the T0,T1,T2 and more than N group(P＜0.01);negative geotaxis reflex time was also less in T3 group compared to T0,T1,T2 groups(P＜0.01,P＜0.05).HE staining showed nuclear pyknosis,cleavage,and disor-dered arrangement of hippocampal neurons in the M group.The cell morphology was improved to varying de-grees in T1,T2 and T3 groups.Tunel staining showed increased Tunel+cells throughout the field in M group,sparse distribution in N group and lower apoptosis rates in T3 group compared to T0 and T1 groups(P＜0.05).Western Blot showed no significant difference in the relative expression of Bcl-2 protein among all groups(P＞0.05);T0 group had higher Bax protein levels compared to the rest of groups(P＜0.05),and lower in T3 group compared to T1 group(P＜0.05);The Bcl-2/Bax ratio was lower in T0 group compared to N and T3 group(P＜0.05),and lower in T1,T2 groups compared to T3 group(P＜0.05);The expression of Cas-pase-3 protein were higher in T0 group than that in other groups(P＜0.05),lower in N group than T1 group(P＜0.05),and higher in T1 group than T3 group(P＜0.05). Conclusion:Irisin may reduce the apoptosis of nerve cells by reducing the expression of Bax and Caspase-3 protein and increasing the Bcl-2/Bax ratio,with effects dependent on the injection dose of irisin.

Objective:To evaluate the efficacy of modified corporeal rotation technique in the treatment of congenital penile downward curvature.Methods:A retrospective analysis was conducted on the clinical data of 32 patients with congenital penile curvature who underwent surgical procedure in Beijing Hospital from June 2021 to December 2022. The patients' age was (25.3±5.4) years old, preoperative erect penile length was (14.0±1.4) cm, preoperative erect penile circumference was (12.3±0.6) cm, preoperative erect penile downward curvature angle was (41.8±9.3)°, and preoperative International Index of Erectile Function(IIEF-5) score was (19.6±2.8). All 32 cases underwent modified corporeal rotation technique with local anesthesia, while the surgical instruments and suturing techniques employed in this study aimed to minimize damage to the penile neurovascular bundle by utilizing plastic surgery instruments and magnifier. Additionally, the use of inverted horizontal mattress sutures, with knots embedded within the tissue, was implemented to reduce their impact on postoperative patient satisfaction. Surgical time, preoperative and immediate postoperative penile length, circumference, and curvature angle were recorded. Follow-ups were conducted at 1, 3, and 6 months postoperatively, and IIEF-5 scores, postoperative penile sensation scores, and surgery-related complications (wound pain, infection, poor incision healing, etc.)were recorded.Results:The immediate postoperative erect penile length was (13.9±1.4) cm, with no statistically significant difference compared to preoperative length( P=0.127).The immediate postoperative erect penile curvature angle was (2.1±1.1) °, with a statistically significant difference compared to preoperative angle, ( P<0.01). IIEF-5 scores at 1, 3, and 6 months postoperatively were (20.4±1.7), (22.0±1.0), and (22.3±0.8) respectively, compared with preoperative scores, the differences were statistically significant ( P<0.001). The proportions of patients with fully restored glans sensation at 1, 3, and 6 months postoperatively were 0, 31.2% (10/32), and 68.8% (22/32), respectively, with sensation scores of (1.1±0.8), (3.2±0.6), and (3.7±0.5). Three patients (9.0%) experienced poor ventral wound healing postoperatively, but fully recovered after regular wound dressing. Conclusions:The modified corporeal rotation technique effectively corrects congenital penile downward curvature without significant loss of penile length, no adverse effects on erectile function or neurological damage were found, presenting high surgical safety and clinical value.

AIM To study the secondary metabolites from the endophytic fungi Candida sp.of Berberis atrocarpa Schneid.METHODS The ethyl acetate fraction and petroleum ether fraction from the secondary metabolites of Candida sp.fermentation extract were separated and purified by silica gel,Sephadex LH-20 and preparative liquid chromatography,then the structures of obtained compounds were identified by physicochemical properties and spectral data.RESULTS Eighteen compounds were isolated and identified as 1-phenyl-1,2-ethanediol(1),4-hydroxyphenethyl alcohol(2),4-hydroxybenzoic acid(3),4-hydroxyphenylacetic acid(4),3-hydroxyphenylacetic acid(5),3-methylsulfinyl propionic acid(6),phenylacetic acid(7),(S)-N-nitroso-1-amino-p-hydroxy phenylethanol(8),2-phenylacetamide(9),p-hydroxybenzaldehyde(10),ethyl 2-(4-hydroxyphenyl)acetate(11),dibutyl phthalate(12),5,5'-dimethoxybiphenyl-2,2'-diol(13),3-indolealdehyde(14),N-acetyl-L-phenylalanine(15),9-hydroxy-10E,12Z-octadecadienoic acid(16),9-hydroxy-10E,12E-octadecadienoic acid(17),(6E)-5-methylene-6-tetradecenoic acid(18).CONCLUSION Compounds 1,3-8 and 10-18 are isolated from Candida sp for the first time.

Pancreatic neuroendocrine neoplasm (pNEN) is highly heterogeneous, and the prognosis varies among tumors of different stages and grades. However, there is lacking high pro-gnostic predictors with sensitivity and specificity. Inflammation plays a pivotal role in the occurrence and development of different tumors, various inflammatory markers such as neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, lymphocyte-monocyte ratio are of great significance in the diagnosis, treat-ment, and prognosis of tumors. Several studies have demonstrated that inflammatory markers are associated with poor prognosis and can serve as predictive factors for tumor prognosis. The authors summarize recent advances in the researches focused on the prognostic value of inflamma-tory markers in pNEN, in order to provide novel insights for clinical decision-making of pNEN.

Objective:To retrospectively analyze the treatment status of tyrosine kinase inhibitors (TKI) in newly diagnosed patients with chronic myeloid leukemia (CML) in China.Methods:Data of chronic phase (CP) and accelerated phase (AP) CML patients diagnosed from January 2006 to December 2022 from 77 centers, ≥18 years old, and receiving initial imatinib, nilotinib, dasatinib or flumatinib-therapy within 6 months after diagnosis in China with complete data were retrospectively interrogated. The choice of initial TKI, current TKI medications, treatment switch and reasons, treatment responses and outcomes as well as the variables associated with them were analyzed.Results:6 893 patients in CP ( n=6 453, 93.6%) or AP ( n=440, 6.4%) receiving initial imatinib ( n=4 906, 71.2%), nilotinib ( n=1 157, 16.8%), dasatinib ( n=298, 4.3%) or flumatinib ( n=532, 7.2%) -therapy. With the median follow-up of 43 ( IQR 22-75) months, 1 581 (22.9%) patients switched TKI due to resistance ( n=1 055, 15.3%), intolerance ( n=248, 3.6%), pursuit of better efficacy ( n=168, 2.4%), economic or other reasons ( n=110, 1.6%). The frequency of switching TKI in AP patients was significantly-higher than that in CP patients (44.1% vs 21.5%, P<0.001), and more AP patients switched TKI due to resistance than CP patients (75.3% vs 66.1%, P=0.011). Multi-variable analyses showed that male, lower HGB concentration and ELTS intermediate/high-risk cohort were associated with lower cytogenetic and molecular responses rate and poor outcomes in CP patients; higher WBC count and initial the second-generation TKI treatment, the higher response rates; Ph + ACA at diagnosis, poor PFS. However, Sokal intermediate/high-risk cohort was only significantly-associated with lower CCyR and MMR rates and the poor PFS. Lower HGB concentration and larger spleen size were significantly-associated with the lower cytogenetic and molecular response rates in AP patients; initial the second-generation TKI treatment, the higher treatment response rates; lower PLT count, higher blasts and Ph + ACA, poorer TFS; Ph + ACA, poorer OS. Conclusion:At present, the vast majority of newly-diagnosed CML-CP or AP patients could benefit from TKI treatment in the long term with the good treatment responses and survival outcomes.