Purpose To explore the clinicopathologic features,pathogenesis and differential diagnosis of Malaco-plakia.Methods The clinical features,imaging manifestations,cytopathologic features,histopathologic features,im-munohistochemistry,special staining and molecular pathological manifestations of 17 patients with Malacoplakia were analysed and the relevant literature was reviewed.Results Seventeen patients with Malacoplakia were mostly female,of which 13 lesions were located in the bladder,1 in the prostate,1 in the colon,1 in the right external auditory canal,and 1 in the retroperitoneum.Cytologic morphology varied depending on the site of the lesion,with phagocytes and MG-like microsomal analogues seen in renal puncture cytology,and small numbers of squamous epithelial cells and uroepi-thelial cells(NHGUC)seen in urinary cytology specimens.Histologic morphology showed a large number of foamy his-tiocytes and small numbers of neutrophils and eosinophils against a background of chronic inflammation dominated by lymphocytes and plasma cells;the cytoplasm of the histiocytes was eosinophilic and granular,with blue calcified vesi-cles scattered throughout,some of which were in the form of target-ring or concentric-circle-like structures,which are known as Michaelis-Gutmann bodies(MG bodies).Special stains showed PAS and iron staining(+);immunohisto-chemistry showed diffuse histiocyte CD68(+),CD163(+),CK(AE1/AE3)(-);molecular pathology showed TB-DNA(-).Conclusion Malacoplakia is a chronic granulomatous disease that can be cured.Imaging often shows occupancy,which is easily misdiagnosed as a tumour clinically,and confirming the diagnosis mainly relies on patholog-ical diagnosis,differential diagnosis includes xanthogranulomatous cystitis,xanthogranulomatous pyelonephritis,colon cancer,granulosa cell tumour and Langerhans histiocytosis.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

Purpose To explore the clinicopathologic features,pathogenesis and differential diagnosis of Malaco-plakia.Methods The clinical features,imaging manifestations,cytopathologic features,histopathologic features,im-munohistochemistry,special staining and molecular pathological manifestations of 17 patients with Malacoplakia were analysed and the relevant literature was reviewed.Results Seventeen patients with Malacoplakia were mostly female,of which 13 lesions were located in the bladder,1 in the prostate,1 in the colon,1 in the right external auditory canal,and 1 in the retroperitoneum.Cytologic morphology varied depending on the site of the lesion,with phagocytes and MG-like microsomal analogues seen in renal puncture cytology,and small numbers of squamous epithelial cells and uroepi-thelial cells(NHGUC)seen in urinary cytology specimens.Histologic morphology showed a large number of foamy his-tiocytes and small numbers of neutrophils and eosinophils against a background of chronic inflammation dominated by lymphocytes and plasma cells;the cytoplasm of the histiocytes was eosinophilic and granular,with blue calcified vesi-cles scattered throughout,some of which were in the form of target-ring or concentric-circle-like structures,which are known as Michaelis-Gutmann bodies(MG bodies).Special stains showed PAS and iron staining(+);immunohisto-chemistry showed diffuse histiocyte CD68(+),CD163(+),CK(AE1/AE3)(-);molecular pathology showed TB-DNA(-).Conclusion Malacoplakia is a chronic granulomatous disease that can be cured.Imaging often shows occupancy,which is easily misdiagnosed as a tumour clinically,and confirming the diagnosis mainly relies on patholog-ical diagnosis,differential diagnosis includes xanthogranulomatous cystitis,xanthogranulomatous pyelonephritis,colon cancer,granulosa cell tumour and Langerhans histiocytosis.

Paraplegia caused by spinal cord injury is a serious neurological complication, for which surgery is currently the main treatment method. Due to different surgical approaches, patients are usually expected to maintain a passive prone position for a long time or switch between the supine and prone positions. Affected by multiple factors such as neurogenic sensory disorders, pathological changes in muscle tone and operative duration, the risk of intraoperative acquired pressure injury (IAPI) is significantly increased. Current clinical prevention strategies for IAPI in these patients predominantly focus on localized pressure relief during positioning, lacking systematic, standardized comprehensive prevention protocols or evidence-based guidelines. To address it, Department of Nursing, Orthopedics Branch, China International Exchange and Promotive Association for Medical and Health Care, Spinal Trauma Professional Committee, Orthopedics Branch, Chinese Medical Doctor Association, Nursing Group of Spine and Spinal Cord Professional Committee of Chinese Association of Rehabilitation Medicine organized experts in relevant fields to formulate Guideline for the prevention of intraoperative acquired pressure injury in paraplegic patients with spinal cord injury ( version 2025), based on evidence-based medical evidence and latest research results and clinical practice at home and abroad. Eleven recommendations were put forward from the aspects of preoperative risk assessment, intraoperative prevention strategies, postoperative handover and monitoring, and supportive mechanisms for IAPI prevention, aiming to standardize the prevention measures and management strategies of IAPI in paraplegic patients with spinal cord injury and accelerate the recovery of patients and improve the therapeutic effect.

With the progress of comprehensive treatment of breast cancer, the surgical treatment of axillary lymph nodes presents a degraded treatment mode under the guidance of evidence-based medicine. The indications and contraindications of sentinel lymph node biopsy for early breast cancer have been very clear, but there are still many specific problems in clinical practice that surgeons are concerned about. This article discusses the recently published research on sentinel lymph node biopsy in order to draw the attention of surgical colleagues to the new hot issues of sentinel lymph node biopsy in early breast cancer, and promote standardized surgery and the promotion of new treatment concepts.

Objective To investigate the efficacy and safety of intravenous thrombolysis with low-dose and standard-dose recombinant tissue plasminogen activator(rt-PA)in the elderly patients(aged over 80 years)with acute ischemic stroke(AIS).Methods A total of 201 elderly patients with AIS treated at Tianjin Fourth Central Hospital from February 2019 to February 2023 were prospectively included and randomly assigned to the rt-PA low-dose group(n=93,0.6 mg/kg)and rt-PA standard-dose group(n=108,0.9 mg/kg).The incidence of intra-cranial hemorrhage,symptomatic intracranial hemorrhage,fatal intracranial hemorrhage,neurologic deterioration within 7 days and mortality within 90 days were observed to evaluate the safety.The neurologic improvement rate and good prognosis rate at 90 days were used to evaluate the effectiveness.A stratified analysis of 90-day outcomes was performed based on stroke severity and age.Results The incidence of intracranial hemorrhage,symptomatic intracranial hemorrhage and fatal intracranial hemorrhage within 7 days in rt-PA low-dose group was lower than that in rt-PA standard-dose group(P＜0.05).There were no statistically significant differences between the two groups concerning the residual safety index and the effectiveness index.The 90-day good prognosis rate of moderate stroke sub-group and of≥90 years of age sub-group in rt-PA low-dose group were both higher than that of rt-PA standard-dose group(P＜0.05).Conclusions For AIS patients with moderate stroke and aged over 90 years,intravenous thrombolytic therapy with rt-PA 0.6 mg/kg is recommended.

Acute ischemic stroke (AIS) is a kind of central nervous system disease that seriously threatens human health and life. Current treatment for AIS is mainly reperfusion. However, the time-sensitive of reperfusion limits its clinical application, and a considerable part of patients within the time window cannot achieve the expected effect after reperfusion; related complications of reperfusion have not been completely solved. So far, some clinical trials have confirmed that neuroprotectants are useful supplements and adjuncts to reperfusion. This paper reviews the recent advance in neuroprotectants combined with reperfusion in AIS to provide references for AIS treatment.

Objective To investigate the effects of intrauterine perfusion with granulocyte colony-stimulating factor(G-CSF)on the endometrial thickness,volume,and blood flow parameters of patients with thin endometrium and their clinical outcomes.Methods We designed a prospective non-randomized synchronous controlled trial and recruited patients with thin endometrium who underwent frozen-thawed embryo transfer(FET)at Mianyang Central Hospital between September 1,2021 and September 1,2023.They were divided into two groups,an experimental group of patients who received the experimental treatment of intrauterine perfusion with G-CSF and a control group of patients who did not receive the experimental treatment.The general data and the clinical outcomes of the two groups were analyzed and compared.The endometrial thickness,volume and blood flow parameters of patients in the experimental group before and after intrauterine perfusion with G-CSF were analyzed.Results The clinical data of 83 patients were included in the study.The experimental group included 51 cases,while the control group included 31 cases.There were no significant differences in the baseline data between the two groups.The clinical pregnancy rate of the experimental group(56.86% )was higher than that of the control group(50.00% )and the rate of spontaneous abortion in the experimental group(27.59% )was lower than that in the control group(37.50% ),but the differences were not statistically significant(P>0.05).In the experimental group,the postperfusion endometrial thickness([0.67±0.1]cm)was greater than the preperfusion endometrial thickness([0.59±0.09]cm),the postperfusion([1.84±0.81]cm3)was greater than the preperfusion endometrial volume([1.54±0.69]cm3),and the postperfusion vascularization flow index(VFI)(1.97±2.82)was greater than the preperfusion VFI(0.99±1.04),with all the differences being statistically significant(P<0.05).Conclusion Intrauterine perfusion with G-CSF can enhance the endometrial thickness,volume,and some blood flow parameters in patients with thin endometrium.

Objective To explore the correlation between lumbar spine bone mineral density and the occurrence of large rotator cuff tears. Methods A total of 109 patients with arthroscopic shoulder surgery in the Department of Arthroplasty Surgery in Kunshan Hospital of Traditional Chinese Medicine from January 2018 to October 2023 were selected and divided into large rotator cuff tear group (n=27) and small rotator cuff tear group (n=82) according to the severity of the rotator cuff tears. General materials of patients were collected, and multivariate Logistic regression analysis was used to investigate the correlation between lumbar spine bone mineral density and the occurrence of large rotator cuff tears. Results The large rotator cuff tear group had significant higher age and higher proportion of patients with a history of trauma compared to the small rotator cuff tear group (P < 0.05); additionally, the levels of total cholesterol, albumin, serum magnesium, total hip bone mineral density, and lumbar spine bone mineral density were significantly lower in the large rotator cuff tear group (P < 0.05). The results of multivariate Logistic regression analysis indicated that lumbar spine bone mineral density was associated with the occurrence of large rotator cuff tears. The prevalence of large rotator cuff tears across the four quartile intervals of lumbar spine bone mineral density named as Q1 (< 0.870 g/cm²), Q2 (0.870~ < 0.991 g/cm²), Q3 (0.991~1.137 g/cm²), and Q4 (>1.137 g/cm²) were 48.15%, 29.63%, 18.52% and 3.70% respectively, showing a gradual decreasing trend with significant differences (P < 0.05). Conclusion There is a correlation between lumbar spine bone mineral density and large rotator cuff tears. The lower the bone density of the lumbar spine is, the higher the risk of large rotator cuff tears will be.

Objective To analyze the application value of a Nomogram model established on clinical and ultrasound features of thyroid in modifying classification results of the Chinese Thyroid Imaging Reporting and Data System (C-TI-RADS) by ultrasound physicians. Methods The clinicopathological ultrasound materials of patients with surgical resection for thyroid nodules in Sichuan Provincial People's Hospital (training set, n=841) and Sichuan Mianyang 404 Hospital (external validation set, n=295) from January 2021 to December 2022 were retrospectively analyzed, and preoperative thyroid ultrasound was used to classify thyroid nodules by C-TI-RADS. Univariate and Multivariate Logistic regression analyses were used to screen independent predictors in the training set and a Nomogram model was constructed, and Bootstrap resampling was used for internal validation; ultrasound physicians in Sichuan Mianyang 404 Hospital were charged in external verification based on this Nomogram model. Receiver operating characteristic (ROC) curve and calibration curve were drawn to evaluate the efficacy of the model and its clinical value in modifying the classification results by C-TI-RADS. Results Univariate and Multivariate Logistic regression analyses showed that gender, age, maximum diameter of nodules, the number of nodules, ultrasound abnormalities of cervical lymph nodes and C-TI-RADS classification were the independent factors for predicting the modified classification results of C-TI-RADS by ultrasound physicians (P < 0.05). Consistency index of the Nomogram model constructed based on these factors was 0.842 (95%CI, 0.816 to 0.867), the area under the curve (AUC) was 0.842, sensitivity was 92.9%, specificity was 63.7%, and accuracy was 75.9%. The prediction results of the Nomogram model were in good agreement with the actual situation in both the training set and the external validation set. Conclusion Nomogram model based on clinical and ultrasound features of thyroid shows good predictive accuracy in modifying classification results of C-TI-RADS by ultrasound physicians, which has potential clinical application value.