Benign biliary strictures are frequently encountered after liver transplantation or as a result of iatrogenic injury, among others. Complex and refractory benign biliary obstructions refer to biliary strictures that persist or treatment fails despite multiple endoscopic therapies. Traditional endoscopic approaches demonstrate suboptimal therapeutic effects in treating such patients, with a high recurrence rate. Moreover, surgical operations are highly invasive, and the outcomes are also unsatisfactory. The magnetic dilation technology establishes an external drainage sinus tract via percutaneous transhepatic biliary drainage and positions a magnet above the obstructed biliary tract; through endoscopic retrograde cholangiopancreatography, another magnet is placed beneath the obstructed biliary tract. The two magnets mutually attract each other, exerting pressure on the scar tissue in the middle of the magnets, causing it to gradually become ischemic, necrotic, and detached, and subsequently discharged along with the magnets. The biliary epithelial cells surrounding the magnets gradually repair and heal, ultimately forming a new patent anastomosis. The magnetic dilation technology, through slow compression, realizes the concurrent process of “removing” scars and healing, avoiding severe local inflammatory responses and excessive tissue hyperplasia. Consequently, the magnetic dilation technology possesses advantages such as minimally invasiveness and reliable effects, gradually emerging as an effective modality for treating complex and refractory benign biliary stricture cases.

Objective To investigate the feasibility of non-ECG-gated scan using wide-body detector in left atrial computed tomo-graphy angiography(CTA)and to assess its value in evaluating left atrial appendage closure(LAAC)outcomes.Methods Patients who underwent LAAC and completed left atrial CTA were prospectively selected.Participants were randomly divided into groups A and B.In group A,the heart rate was measured using a finger clip oximeter before the examination,and the heart rate was set as the simula-ted heart rate.The simulated signal was generated by the CT equipment to complete the examination.In group B,the conventional ECG-gated scan was adopted.The residual leakage of left atrial appendage occluder,image quality,patient comfort and radiation dose of the two groups were compared,and statistical analysis was performed for these indicators.Results Both groups completed the evaluation of the endothelialization degree of the left atrial appendage occluder,and there was no significant difference in the objective image quality evaluation or subjective image score between the two groups(P＞0.05).The total scores of the physiological dimension,psy-chological dimension,social cultural dimension and environmental dimension of patients in group A were higher than those in group B(P＜0.001),and the volume CT dose index(CTDIvol)and dose length product(DLP)decreased by 25％and 25.36％respectively,with statistically significant differences(P＜0.001).Conclusion During the left atrial CTA examination,the wide-body detector with non-ECG-gated scan mode can provide good image quality for clinical use and observe the embolization of the left atrial appendage after LAAC surgery.At the same time,it can effectively reduce the radiation dose for patients and improve patient comfort dur-ing the examination,showing high clinical feasibility and appli-cation value.

To explore the protective effect of Angelica sinensis polysaccharide(ASP)on leptospiro-sis induced by pathogenic Leptospira infection,the golden hamster model of leptospirosis was se-lected for the experiment.The Leptospira and Leptospira+ASP groups were intraperitoneally injected with Leptospira interrogans serovar Lai strain 56601(1 × 10 6 per hamster).After infec-tion,the Leptospira+ASP group was injected intraperitoneally with ASP(50 mg/kg)for three consecutive days,while the Leptospira group was injected intraperitoneally with normal saline for three days.The experiment employed methods such as daily observation of the clinical symptoms of golden hamsters,statistics of the survival status of each group of golden hamsters,pathological damage of liver,kidney,and lung,bacterial load in organs,and the expression of inflammatory cy-tokines(IL-1β and TNF-α).The results indicated that ASP could effectively alleviate the clinical symptoms of the infected hamsters,enhance the survival rate,ameliorate the pathological damage of the body,reduce the bacterial load in various organs,and mitigate tissue inflammation.This study demonstrated for the first time that ASP has a protective effect on leptospirosis,providing medication guidance for the clinical treatment of leptospirosis.

Objective:To develop a simple and effective subretinal injection pipeline system to enhance the accuracy and precision of subretinal injection volume control.Methods:A retrospective case series study. From May to October 2023, 18 patients (18 eyes) with submacular hemorrhage (SMH) who continuously received modified subretinal injection treatment in Department of Ophthalmology of Peking Union Medical College Hospital were included in the study. Among them, there were 10 males and 8 females. The mean age was (60.00±7.41) years. The primary causes included polypoid choroidal vasculopathy (14 cases), retinal macroaneurysm (2 cases), traumatic retinopathy (1 case), and Valsalva retinopathy (1 case). Hemorrhage affected 14 eyes of the fovea centralis. All affected eyes underwent standard three-channel 25G vitrectomy via the flat part of the ciliary body combined with modified subretinal injection of recombinant tissue plasminogen activator. The improved injection system consisted of a 1 ml syringe, a Q-Syte TM connector, a 41G subretinal microinjection needle, a converter and a viscoelastic substance control pipeline. The drug preparation time for subretinal injection (i.e., the time consumed by the system connection step), the injection time, whether bubbles occur during the injection process, and the perioperative complications were recorded and analyzed. Results:The preparation time prior to drug injection ranged from 230 to 335 seconds, while the injection completion time varied between 43 and 75 seconds. Both times decreased progressively as operator proficiency improved. Among the treated eyes, five received a target injection dose of 0.05 ml and thirteen received 0.10 ml, with all eyes achieving the preset dose accurately. No subretinal bubbles were observed during the injection procedure. Additionally, no intraoperative complications such as retinal hemorrhage or tear secondary to mechanical trauma at the injection site were recorded. Postoperatively, one eye developed anterior chamber hemorrhage, which resolved following intraocular pressure-lowering treatment. No other postoperative complications, including hemorrhage, rhegmatogenous retinal detachment, or infection, were observed in the remaining eyes.Conclusion:The retinal drug injection system developed in this study has a simple structure, safe and stable operation, can achieve precise drug injection, and effectively avoid the formation of bubbles.

Background Although current evidence suggests a link between outdoor air pollution and depressive symptoms, the effect of solid fuel use (a significant indoor air pollutant) on depressive symptoms in China's rural middle-aged and elderly population remains poorly understood. Objective To explore the association between solid fuel use for cooking and depressive symptoms among middle-aged and elderly people in rural areas of China, and to provide a basis for the prevention and control of depressive symptoms among residents in rural areas. Methods Data were obtained from the 2020 China Family Panel Studies (CFPS), depressive symptoms were assessed using 8-item Center for Epidemiologic Studies Depression Scale (CES-D), and cooking fuel type was self-reported. Subsequently, two-level binary unconditional logistic regression models were fitted to assess the impact of solid fuel use for cooking on depressive symptoms. Results A total of 7991 participants aged 45 years and older [mean age (58.52±9.18) years] were included in the study, with a mean CES-D score of 6.07±4.48 and a mean positive depressive symptoms rate of 34% (40.54% in the solid fuel group and 30.81% in the clean fuel group, χ²=74.40, P<0.001). After controlling for potential confounding covariates, rural middle-aged and elderly residents in the solid fuel group had a higher risk of reporting depressive symptoms than those in the clean fuel group (OR=1.36, 95%CI: 1.20-1.54), an association that was unaffected by participant characteristics and was positive across age and gender groups. Conclusion There is a positive association between solid fuel use for cooking and depressive symptoms in middle-aged and elderly people in rural areas of China. It is recommended that rural areas promote the upgrading of stoves through the installation of ventilation equipment or the switch from solid cooking fuel to clean fuel. This approach is directed toward reducing exposure to household air pollution, alleviating the prevalence of depression among middle-aged and elderly residents in vast rural areas, and enhancing their mental health.

Objective To propose a novel mechanical method and index to in-vivo characterize the health status of cancellous bone during the percutaneous kyphoplasty(PKP),and validate its feasibility and consistency.Methods According to the theory of elasticity,the expression and physical significance of the mechanical index K were given.Then using clinical images of the lumbar spine L4,three-dimensional finite element simulations were conducted to verify the validity of the theoretical results,as well as the consistency of the methodology and the indexes were verified for studies of different balloon shapes and puncture routes.Results The internal pressure of the balloon linearly varied with the injected fluid volume.The mechanical index K was closely related to the bone shear modulus and could well reflect the health status of cancellous bones.The balloon shape had a trivial influence on the Kresults,and the relative difference between the cylindrical and ellipsoidal shapes was less than 2％.The influence of surgical access route on the K results was also very small,and the relative difference between the routes by vertebral pedicle and by lateral margin of vertebral pedicle was less than 0.5％.Conclusions The in-vivo mechanical method and the mechanical index K can characterize the bone health of patients with good consistency.This study has a great significance for providing guidelines of the optimization of PKP operation plan and postoperative rehabilitation,collecting in vivo data of bone mechanical properties,and improving the diagnosis and treatment of osteoporosis in clinic.

ObjectiveTo observe the clinical efficacy and safety of Bushen Ruyan Formulation （补肾乳岩方， BRF） in treating premenopausal breast cancer patients of disharmony of the chong （冲） and ren （任） meridian type under endocrine intensive therapy. MethodsA total of 88 premenopausal breast cancer patients who received endocrine intensive therapy and were diagnosed with disharmony of the chong and ren meridian by traditional Chinese medicine （TCM） were included and randomly divided into a control group and a treatment group， with 44 cases in each group. The control group received ovarian function suppression （OFS） combined with endocrine therapy， while the treatment group was given oral BRF additionally. Both groups were treated for three months. The clinical efficacy was evaluated by comparing the pre- and post-treatment results of the Functional Assessment of Cancer Therapy-Breast （FACT-B）， modified Kupperman score， T cell subsets （CD3⁺， CD4⁺， CD8⁺， CD4⁺/CD8⁺）， sex hormone levels， including estradiol （E₂）， luteinizing hormone （LH）， follicle-stimulating hormone （FSH）， progesterone （P）， testosterone （T）， and prolactin （PRL）， tumor markers， such as carcinoembryonic antigen （CEA）， carbohydrate antigen 125 （CA125）， and carbohydrate antigen 153 （CA153）， TCM syndrome score， and TCM syndrome efficacy. Blood routine tests， liver function and kidney function were monitored to assess safety. ResultsThe FACT-B scores of each domains and the total scores of the treatment group increased， while the social/family status score of the control group decreased. The treatment group had significantly higher scores in all domains and total score compared to the control group （P＜0.05 or P＜0.01）. The modified Kupperman score and TCM syndrome score of the treatment group decreased， and were lower than those of the control group （P＜0.01）. The levels of CD3⁺ and CD4⁺ in the treatment group increased， and were higher than those of the control group （P＜0.05）. Serum testosterone levels in the treatment group were lower than those in the control group （P＜0.05）. The total effective rate of TCM syndrome efficacy in the treatment group was 67.44%， significantly higher than the 23.26% in the control group （P＜0.05）. No significant abnormalities were observed in the blood routine tests or liver/kidney function indicators in either group before or after treatment. ConclusionBRF can effectively improve quality of life， alleviate symptoms， increase serum CD3⁺ and CD4⁺ levels， and enhance clinical efficacy in premenopausal breast cancer patients undergoing endocrine intensive endocrine therapy. It is also safe with no significant adverse effects.

Objective:To carry out a systematic review of the development, introduction or validation of drug literacy assessment tools for adults at home and abroad, and to summarize and analyze the characteristics of the assessment tools.Methods:The research framework of the scoping review was used to systematically search 8 Chinese and English databases, such as China National Knowledge Infrastructure, China Biology Medicine disc, PubMed, Web of Science, and Embase. The search period was from database establishment to October 31, 2023. Studies on adult drug literacy assessment tools were screened and included, tool characteristics were extracted and analyzed, and ultimately the extracts were standardized for reporting.Results:A total of 31 articles that met the criteria were included, of which 26 were on the development and validation of assessment tools, three were on the localization and application of assessment tools, and two were on the revision of assessment tools, covering 33 assessment tools.Conclusions:It is needed to recognize the importance of drug literacy assessment, actively explore the diversity of drug literacy assessment tools, clarify the limitations of existing drug literacy assessment tools, further improve the reliability and validity of existing tools, continue to develop and introduce assessment tools suitable for China's national conditions, so as to increase the accuracy of drug literacy assessment.

Objective To investigate the feasibility of non-ECG-gated scan using wide-body detector in left atrial computed tomo-graphy angiography(CTA)and to assess its value in evaluating left atrial appendage closure(LAAC)outcomes.Methods Patients who underwent LAAC and completed left atrial CTA were prospectively selected.Participants were randomly divided into groups A and B.In group A,the heart rate was measured using a finger clip oximeter before the examination,and the heart rate was set as the simula-ted heart rate.The simulated signal was generated by the CT equipment to complete the examination.In group B,the conventional ECG-gated scan was adopted.The residual leakage of left atrial appendage occluder,image quality,patient comfort and radiation dose of the two groups were compared,and statistical analysis was performed for these indicators.Results Both groups completed the evaluation of the endothelialization degree of the left atrial appendage occluder,and there was no significant difference in the objective image quality evaluation or subjective image score between the two groups(P＞0.05).The total scores of the physiological dimension,psy-chological dimension,social cultural dimension and environmental dimension of patients in group A were higher than those in group B(P＜0.001),and the volume CT dose index(CTDIvol)and dose length product(DLP)decreased by 25％and 25.36％respectively,with statistically significant differences(P＜0.001).Conclusion During the left atrial CTA examination,the wide-body detector with non-ECG-gated scan mode can provide good image quality for clinical use and observe the embolization of the left atrial appendage after LAAC surgery.At the same time,it can effectively reduce the radiation dose for patients and improve patient comfort dur-ing the examination,showing high clinical feasibility and appli-cation value.

To explore the protective effect of Angelica sinensis polysaccharide(ASP)on leptospiro-sis induced by pathogenic Leptospira infection,the golden hamster model of leptospirosis was se-lected for the experiment.The Leptospira and Leptospira+ASP groups were intraperitoneally injected with Leptospira interrogans serovar Lai strain 56601(1 × 10 6 per hamster).After infec-tion,the Leptospira+ASP group was injected intraperitoneally with ASP(50 mg/kg)for three consecutive days,while the Leptospira group was injected intraperitoneally with normal saline for three days.The experiment employed methods such as daily observation of the clinical symptoms of golden hamsters,statistics of the survival status of each group of golden hamsters,pathological damage of liver,kidney,and lung,bacterial load in organs,and the expression of inflammatory cy-tokines(IL-1β and TNF-α).The results indicated that ASP could effectively alleviate the clinical symptoms of the infected hamsters,enhance the survival rate,ameliorate the pathological damage of the body,reduce the bacterial load in various organs,and mitigate tissue inflammation.This study demonstrated for the first time that ASP has a protective effect on leptospirosis,providing medication guidance for the clinical treatment of leptospirosis.