Objective:To analyze the effect of alprostadil on renal hemodynamic parameters in patients with severe lupus nephritis (LN) complicated with acute kidney injury (AKI).Methods:The clinical data of 130 patients with severe LN complicated with AKI from August 2020 to August 2023 in Affiliated Hospital of Jining Medical University were retrospectively analyzed. Among them, 66 patients were treated with continuous renal replacement therapy (CRRT) (CRRT group), and 64 patients were treated with CRRT combined with alprostadil (combination group). All patients of both groups were treated 10 d. The efficacy, renal function (serum creatinine, blood urea nitrogen and 24 h urinary protein quantitation), renal hemodynamic parameters and serum inflammatory factors were compared between two groups. The renal hemodynamic parameters included peak systolic velocity (PSV), resistance index (RI) and end diastolic velocity (EDV)), serum inflammatory factors (procalcitonin (PCT); and the inflammatory factor included procalcitonin (PCT), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).Results:The total effective rate in combination group was significantly higher than that in CRRT group: 96.88% (62/64) vs. 81.82% (54/66), and there was statistical difference ( χ2 = 7.67, P<0.01). There were no statistical difference in the indexes before treatment between two groups ( P>0.05). The serum creatinine, blood urea nitrogen, 24 h urinary protein quantitation, RI, PCT, TNF-α and IL-6 after treatment in combination group were significantly lower than those in CRRT group: (82.16 ± 16.66) μmol/L vs. (128.55 ± 21.06) μmol/L, (6.15 ± 1.66) nmol/L vs. (10.28 ± 2.45) nmol/L, (1.21 ± 0.42) g vs. (2.06 ± 0.52) g, (0.51 ± 0.12) cm/s vs. (0.61 ± 0.24) cm/s, (0.65 ± 0.12) μg/L vs. (0.89 ± 0.18) μg/L, (3.26 ± 0.34) μg/L vs. (6.82 ± 1.14) μg/L and (26.62 ± 3.62) μg/L vs. (40.55 ± 8.14) μg/L, the PSV and EDV were significantly higher than those in CRRT group: (25.66 ± 3.62) cm/s vs. (22.05 ± 1.84) cm/s and (10.92 ± 1.85) cm/s vs. (8.34 ± 1.26) cm/s, and there were statistical differences ( P<0.01). Conclusions:Alprostadil combined with CRRT can effectively improve renal function and renal hemodynamic in patients with severe LN complicated with AKI, enhance therapeutic efficacy, and inhibit the release of proinflammatory cytokines such as PCT.

Cerebral venous sinus thrombosis(CVST)is a rare disease of the venous system and a major cause of cerebral venous stroke.Systemic anticoagulation remains the key to the treatment of CVST,with heparin-bridged vitamin K antagonists being the traditional treatment of choice in the acute phase with the wide application of vitamin K antagonists,the disadvantages of narrow therapeutic window,food-drug interactions,and the need for frequent monitoring of the internationalized normative ratio(INR)have been exposed,whereas direct oral anticoagulants do not have the above mentioned problems under the same efficacy,so whether direct oral anticoagulants can replace vitamin K antagonists has become a major research hotspot.This article mainly focuses on the research progress of direct oral anticoagulants in CVST and the research progress of vitamin K antagonists and direct oral anticoagulants in CVST anticoagulation therapy in terms of effectiveness and safety.

Objective:To analyze the effect of alprostadil on renal hemodynamic parameters in patients with severe lupus nephritis (LN) complicated with acute kidney injury (AKI).Methods:The clinical data of 130 patients with severe LN complicated with AKI from August 2020 to August 2023 in Affiliated Hospital of Jining Medical University were retrospectively analyzed. Among them, 66 patients were treated with continuous renal replacement therapy (CRRT) (CRRT group), and 64 patients were treated with CRRT combined with alprostadil (combination group). All patients of both groups were treated 10 d. The efficacy, renal function (serum creatinine, blood urea nitrogen and 24 h urinary protein quantitation), renal hemodynamic parameters and serum inflammatory factors were compared between two groups. The renal hemodynamic parameters included peak systolic velocity (PSV), resistance index (RI) and end diastolic velocity (EDV)), serum inflammatory factors (procalcitonin (PCT); and the inflammatory factor included procalcitonin (PCT), tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6).Results:The total effective rate in combination group was significantly higher than that in CRRT group: 96.88% (62/64) vs. 81.82% (54/66), and there was statistical difference ( χ2 = 7.67, P<0.01). There were no statistical difference in the indexes before treatment between two groups ( P>0.05). The serum creatinine, blood urea nitrogen, 24 h urinary protein quantitation, RI, PCT, TNF-α and IL-6 after treatment in combination group were significantly lower than those in CRRT group: (82.16 ± 16.66) μmol/L vs. (128.55 ± 21.06) μmol/L, (6.15 ± 1.66) nmol/L vs. (10.28 ± 2.45) nmol/L, (1.21 ± 0.42) g vs. (2.06 ± 0.52) g, (0.51 ± 0.12) cm/s vs. (0.61 ± 0.24) cm/s, (0.65 ± 0.12) μg/L vs. (0.89 ± 0.18) μg/L, (3.26 ± 0.34) μg/L vs. (6.82 ± 1.14) μg/L and (26.62 ± 3.62) μg/L vs. (40.55 ± 8.14) μg/L, the PSV and EDV were significantly higher than those in CRRT group: (25.66 ± 3.62) cm/s vs. (22.05 ± 1.84) cm/s and (10.92 ± 1.85) cm/s vs. (8.34 ± 1.26) cm/s, and there were statistical differences ( P<0.01). Conclusions:Alprostadil combined with CRRT can effectively improve renal function and renal hemodynamic in patients with severe LN complicated with AKI, enhance therapeutic efficacy, and inhibit the release of proinflammatory cytokines such as PCT.

Knee osteoarthritis is a common joint disease within osteoarthritis,characterized by pain,swelling,and limited functionality as the main clinical manifestations.In severe cases,it affects daily life and falls under the category of"impediment syndrome"or"bone impediment"in TCM.The author believes that the theory of"bones,tendons,and muscles"is closely related to this disease.Treatment should focus on simultaneously nourishing the liver,spleen and kidneys,considering tendons,bones and muscles,while also dispelling wind,cold and dampness.The clinical application of Sanbi Decoction has shown good efficacy,and this discussion aimed to provide ideas for the diagnosis and treatment of knee osteoarthritis.

Objective:To design a special device for limiting position of boat-shape headrest of breast brackets,and explore its application value in radiotherapy post-radical mastectomy.Methods:1 cm plex glass plate was cut as T-shape base plate,and the top of the T-shape base plate was drilled to obtain four holes for limiting position.A 2 mm acrylic plate was cut as horse hoof-shape and strip-shape pieces for limiting position,which were adhered respectively to the top and bottom of the T-shape base plate to form a boat-shape headrest with groove structure for limiting position.Self-made pillars with limiting position were used to connect the T-shape base plate with the backplane of breast bracket,so as to realize rigid connection between conventional boat-shape headrest and breast bracket.A total of 60 female patients who received radiotherapy after radical mastectomy for breast cancer at Changzhou Cancer Hospital during January and December 2023 were selected.They were randomly divided into an observation group and a control group(with 30 cases in each group)by using a random number table.The observation group adopted breast bracket combined with self-made boat-shape headrest for limiting position device+boat-shape headrest to conduct fixation,while the control group adopted rotundity headrest of breast bracket to conduct fixation.Both groups adopted hybrid intensity-modulated radiotherapy(IMRT)technique to formulate plan,and the exposure dose was 50Gy/25 fractions,and patients received radiotherapy as 5 times per week,and the treatment course was 5 weeks.Cone-beam computed tomography(CBCT)was used to conduct verification for position before the first 3 treatments.During the treatment duration between the 2nd and the 5th week,CBCT verification for position was conducted in each week.The positioning error and positioning time on left-right direction(x),head-foot direction(y)and abdomen-back direction(z)at each time between two groups were compared.Results:The positioning errors on x,y,z direction of three dimension at each time in observation group were lower than those in control group,and the differences were significant(Z=-7.666,-11,672,-6.311,P<0.05).The average positioning time at first time and the total average positioning time were respectively(222.4±12.9)s and(212.2±15.1)s in observation group,all of which were lower than(262.9±12.5)s and(254.0±15.7)s in control group,and the differences were significant(t=12.364,27.783,P<0.05).Conclusion:The combination of breast bracket and self-made device with boat-shape for limiting position can increase precision and efficiency of positioning,and improve comfort through individually chooses the type of boat-shape headrest,and set the position of headrest,which has favorable clinically application value.

Knee osteoarthritis is a common joint disease within osteoarthritis,characterized by pain,swelling,and limited functionality as the main clinical manifestations.In severe cases,it affects daily life and falls under the category of"impediment syndrome"or"bone impediment"in TCM.The author believes that the theory of"bones,tendons,and muscles"is closely related to this disease.Treatment should focus on simultaneously nourishing the liver,spleen and kidneys,considering tendons,bones and muscles,while also dispelling wind,cold and dampness.The clinical application of Sanbi Decoction has shown good efficacy,and this discussion aimed to provide ideas for the diagnosis and treatment of knee osteoarthritis.

Objective:To design a special device for limiting position of boat-shape headrest of breast brackets,and explore its application value in radiotherapy post-radical mastectomy.Methods:1 cm plex glass plate was cut as T-shape base plate,and the top of the T-shape base plate was drilled to obtain four holes for limiting position.A 2 mm acrylic plate was cut as horse hoof-shape and strip-shape pieces for limiting position,which were adhered respectively to the top and bottom of the T-shape base plate to form a boat-shape headrest with groove structure for limiting position.Self-made pillars with limiting position were used to connect the T-shape base plate with the backplane of breast bracket,so as to realize rigid connection between conventional boat-shape headrest and breast bracket.A total of 60 female patients who received radiotherapy after radical mastectomy for breast cancer at Changzhou Cancer Hospital during January and December 2023 were selected.They were randomly divided into an observation group and a control group(with 30 cases in each group)by using a random number table.The observation group adopted breast bracket combined with self-made boat-shape headrest for limiting position device+boat-shape headrest to conduct fixation,while the control group adopted rotundity headrest of breast bracket to conduct fixation.Both groups adopted hybrid intensity-modulated radiotherapy(IMRT)technique to formulate plan,and the exposure dose was 50Gy/25 fractions,and patients received radiotherapy as 5 times per week,and the treatment course was 5 weeks.Cone-beam computed tomography(CBCT)was used to conduct verification for position before the first 3 treatments.During the treatment duration between the 2nd and the 5th week,CBCT verification for position was conducted in each week.The positioning error and positioning time on left-right direction(x),head-foot direction(y)and abdomen-back direction(z)at each time between two groups were compared.Results:The positioning errors on x,y,z direction of three dimension at each time in observation group were lower than those in control group,and the differences were significant(Z=-7.666,-11,672,-6.311,P<0.05).The average positioning time at first time and the total average positioning time were respectively(222.4±12.9)s and(212.2±15.1)s in observation group,all of which were lower than(262.9±12.5)s and(254.0±15.7)s in control group,and the differences were significant(t=12.364,27.783,P<0.05).Conclusion:The combination of breast bracket and self-made device with boat-shape for limiting position can increase precision and efficiency of positioning,and improve comfort through individually chooses the type of boat-shape headrest,and set the position of headrest,which has favorable clinically application value.

Cerebral venous sinus thrombosis(CVST)is a rare disease of the venous system and a major cause of cerebral venous stroke.Systemic anticoagulation remains the key to the treatment of CVST,with heparin-bridged vitamin K antagonists being the traditional treatment of choice in the acute phase with the wide application of vitamin K antagonists,the disadvantages of narrow therapeutic window,food-drug interactions,and the need for frequent monitoring of the internationalized normative ratio(INR)have been exposed,whereas direct oral anticoagulants do not have the above mentioned problems under the same efficacy,so whether direct oral anticoagulants can replace vitamin K antagonists has become a major research hotspot.This article mainly focuses on the research progress of direct oral anticoagulants in CVST and the research progress of vitamin K antagonists and direct oral anticoagulants in CVST anticoagulation therapy in terms of effectiveness and safety.

Objective:To investigate the influencing factors associated with the difficulty in endoscopic submucosal dissection (ESD) for early esophageal cancer and precancerous lesions.Methods:The retrospective case-control study was conducted. The clinicopathological data of 331 patients with early esophageal cancer and precancerous lesions who were admitted to Xinxiang Central Hospital from December 2011 to December 2021 were collected. There were 229 males and 102 females, aged (72.6±2.7)years. All patients underwent ESD. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. The univariate analysis was performed using statistical methods appropriate to the data type. Multivariate analysis was conducted using the Logistic stepwise regre-ssion model. Results:(1) Surgical situations of ESD. The operation time of 331 patients was (67±8)minutes. There were 327 patients with en bloc resection, and 4 patients with piecemeal resection. Of the 331 patients, adverse events included bleeding in 1 case, pneumomediastinum in 2 cases, esophageal stenosis in 2 cases, and esophageal perforation in 3 cases. All of these adverse events were treated conservatively without surgical intervention. Of the 331 patients, the depth of tumor invasion was epithelial layer in 109 cases, lamina propria in 155 cases, muscularis mucosa in 9 cases, submucosal layer (<0.2 mm) in 12 cases, and submucosal layer (≥0.2 mm) in 42 cases. Of the 331 pati-ents, there were squamous cell carcinoma in 302 cases and adenocarcinoma in 29 cases. Of the 331 pati-ents, 57 cases had difficulties in ESD. (2)Analysis of Influencing factors associated with difficulty in ESD for early esophageal cancer and precancerous lesions. Results of multivariate analysis showed that esophageal cancer located in the left wall, longitudinal tumor diameter>30 mm, and tumor circumference exceeding half of the esophageal circumference were independent risk factors for difficulty in ESD for early esophageal cancer and precancerous lesions ( odds ratio=3.903, 6.699, 5.387, 95% confidence interval as 1.423-10.702, 1.222-36.735, 1.492-19.468, P<0.05). Conclusion:Esophageal cancer located in the left wall, tumor size greater than 30 mm and tumor circumference exceeding half of the esophageal circumference are independent risk factors for difficulty in ESD for early esophageal cancer and precancerous lesions.

As a new hypoglycemic drug,Dapagliflozin has attracted much attention because of its unique hypoglycemic mechanism. It has been used in many studies on type 2 diabetes mellitus,but the application of type 1 diabetes mellitus(T1DM)in the eastern population is rare. This article uses Dapagliflozin through a case of obese T1DM to provide new ideas for the treatment of T1DM.