Objective To explore the feasibility and reference value of allogeneic lung transplantation and postoperative monitoring in miniature pigs for lung transplantation research. Methods Two miniature pigs (R1 and R2) underwent left lung allogeneic transplantation. Complement-dependent cytotoxicity tests and blood cross-matching were performed before surgery. The main operative times and partial pressure of arterial oxygen (PaO₂) after opening the pulmonary artery were recorded during surgery. Postoperatively, routine blood tests, biochemical blood indicators and inflammatory factors were detected, and pathological examinations of multiple organs were conducted. Results The complement-dependent cytotoxicity test showed that the survival rate of lymphocytes between donors and recipients was 42.5%-47.3%, and no agglutination reaction occurred in the cross-matching. The first warm ischemia times of D1 and D2 were 17 min and 10 min, respectively, and the cold ischemia times were 246 min and 216 min, respectively. Ultimately, R1 and R2 survived for 1.5 h and 104 h, respectively. Postoperatively, in R1, albumin (ALB) and globulin (GLB) decreased, and alanine aminotransferase increased; in R2, ALB, GLB and aspartate aminotransferase all increased. Urea nitrogen and serum creatinine increased in both recipients. Pathological results showed that in R1, the transplanted lung had partial consolidation with inflammatory cell infiltration, and multiple organs were congested and damaged. In R2, the transplanted lung had severe necrosis with fibrosis, and multiple organs had mild to moderate damage. The expression levels of interleukin-1β and interleukin-6 increased in the transplanted lungs. Conclusions The allogeneic lung transplantation model in miniature pigs may systematically evaluate immunological compatibility, intraoperative function and postoperative organ damage. The data obtained may provide technical references for subsequent lung transplantation research.

Objective To evaluate the efficacy and safety of a novel intravascular lithotripsy(IVL)balloon—Vesscrack shockwave balloon—for vascular preparation before stent implantation in patients with severe coronary artery calcification(CAC).Methods This was a prospective,single-arm,multicenter study conducted in China from June 2022 to October 2022.Patients with severe CAC were treated with the Vesscrack shockwave balloon for lesion preparation,followed by drug-eluting stent(DES)implantation.Of these,33 patients underwent optical coherence tomography(OCT).The primary endpoint was procedural success,defined as successful stent implantation with residual stenosis≤30％and the absence of in-hospital major adverse events,including cardiac death,target vessel-related myocardial infarction,or target lesion revascularization.Results A total of 170 patients[mean age:(65.9±7.9)years,116 males]were enrolled.After treatment with IVL and DES,the minimum lumen diameter increased significantly compared to baseline[(2.34±0.40)mm vs.(0.95±0.33)mm,P＜0.001],the degree of stenosis was significantly reduced[(13.24±6.60)％vs.(65.18±10.59)％,P＜0.001].Procedural success was achieved in 100％of cases,and device success was 98.8％.The 30-day patient-related cardiovascular clinical composite endpoint(POCE)rate was 0.0,with no target lesion failure,no confirmed or potential thrombotic events were observed.The shockwave energy generator demonstrated excellent stability and ease of use.Among the 33 patients assessed with OCT,after IVL intervention,the maximum calcified area of the lumen[(3.51±1.51)mm2 vs.(2.85±1.80)mm2,P＜0.001],and the minimum lumen area within the target lesion[(3.08±1.04)mm2 vs.(2.02±0.75)mm2,P＜0.001],and after DES intervention,the luminal area of the largest calcified site[(6.59±1.64)mm2 vs.(2.85±1.80)mm2,P＜0.001]and the minimum luminal area within the target lesion[(6.19±1.45)mm2 vs.(2.02±0.75)mm2,P＜0.001]were significantly increased,and the differences were statistically significant.Conclusions The Vesscrack shockwave balloon is effective and safe for vascular preparation in patients with severe CAC prior to stent implantation.It achieves significant calcified plaque modification,high procedural success rates,and minimal complications.

BACKGROUND:Knee replacement is a successful technology for treating severe knee diseases,but there are still problems such as low surgical precision,long operation time,and long postoperative recovery period.The clinical application of intelligent orthopedic robots can solve these problems and make knee replacement technology more optimized.OBJECTIVE:To compare the efficacy of MAKO robot-assisted knee replacement with navigation knee replacement.METHODS:Twenty-five patients treated with MAKO robot-assisted knee replacement in Xuzhou Renci Hospital from January to December 2022 were selected as observation group.100 patients treated with navigation knee replacement during the same period were selected as the control group.Perioperative related indexes of the two groups were compared,including planned and actual medial proximal tibial angle,distal lateral femoral angle,hip-knee-ankle angle,visual analog scale score,joint range of motion,American Knee Society functional score,and Western Ontario and McMaster University Osteoarthritis Index score before and 3 months after surgery.RESULTS AND CONCLUSION:(1)The operation time of observation group was significantly longer than that of the control group(P＜0.05),and the intraoperative blood loss was significantly less(P＜0.05).(2)The difference of medial proximal tibial angle,distal lateral femoral angle,and hip-knee-ankle angle in observation group was significantly lower than that in the control group(P＜0.05).(3)Three months after surgery,visual analog scale score in both groups was lower than that before surgery(P＜0.05);range of motion in both groups was higher than that before surgery(P＜0.05).Visual analog scale score in observation group was significantly lower than that in the control group,and range of motion in observation group was significantly higher than that in the control group(P＜0.05).(4)Three months after surgery,the clinical and functional scores of American Knee Society in both groups were higher than those before surgery(P＜0.05),and those in observation group were significantly higher than those in the control group(P＜0.05).(5)Three months after surgery,the scores of function,stiffness and pain of Western Ontario and McMaster University Osteoarthritis Index in both groups were lower than those before surgery(P＜0.05),and the scores in observation group were significantly lower than those in the control group(P＜0.05).(6)It is indicated that compared with navigational knee replacement,MAKO robot-assisted knee replacement can decrease intraoperative blood loss,reduce lower limb force line and prosthesis position error,help to accurately place prosthesis,achieve planned force line,diminish postoperative pain,improve knee motion,and promote the recovery of knee function.

Objective To investigate the clinical efficacy and safety of facilitated percutaneous coronary intervention(PCI)with half-dose recombinant staphylokinase(r-SAK)in patients with ST-segment elevation myocardial infarction(STEMI)who are expected to undergo PCI within 120 minutes.Methods From October 2021 to August 2022,a total of 200 STEMI patients in eight centers were included and randomly assigned in a 1﹕1 ratio to either r-SAK group or control group.Patients received loading doses of aspirin and ticagrelor and intravenous heparin and were randomized to receive an intravenous bolus of either 5 mg r-SAK or normal saline prior to PCI.The outcomes were set as ST-segment resolution(STR)at 60-90 minutes after PCI,the proportion and transition of pathological Q waves on the 5th day after PCI,and the proportion of high-sensitivity cardiac troponin T(hs-cTnT)peaking within 12 hours of onset.The safety outcome was major bleeding events defined as Bleeding Academic Research Consortium(BARC)≥type 3 bleeding during hospitalization.Results Compared with the control group,the r-SAK group had a higher proportion of STR≥70%within 60-90 minutes after PCI(58.3%vs.40.3%,P=0.009);a lower proportion of pathological Q waves(59.1%vs.74.1%,P=0.040);a lower rate of Q wave progression(14.8%vs.43.2%,P＜0.001);a higher rate of Q wave disappearance(12.5%vs.3.7%,P=0.027);and a higher proportion of hs-cTnT peaking within 12 hours of symptom onset[31/40(77.5%)vs.17/33(51.5%),P=0.027].Regarding the safety outcome,no significant difference in BARC≥type 3 bleeding was found between the two groups during hospitalization(P＞0.05).Conclusions For STEMI patients who were expected to undergo primary PCI within 120 minutes of symptom onset,the facilitated PCI with half-dose r-SAK significantly increased the proportion of STR≥70%at 60-90 minutes after PCI,reduced the formation of pathological Q waves,and shortened the time to peak hs-cTnT,without increasing the risk of bleeding,which should be an alternative reperfusion strategy worthy of further study.

Objective:To investigate the effect of internet-based perinatal nutrition clinic initiated management at different trimesters on pregnancy outcomes.Methods:Adopting a retrospective study design,1120 singleton pregnant women registered at Nanning Maternal and Child Health Hospital from March 2021 to March 2022 were included.Randomly divided into early pregnancy intervention group(single day randomized,n=551)and mid pregnancy intervention group(double day randomized,n=569)based on the registation date.Both groups received internet-based perinatal nutrition clinic initiated management.The general information,pre pregnancy BMI,weight gain during pregnancy and pregnancy outcomes between two groups were compared.The pregnancy outcomes of two different pre pregnancy weight classification groups were compared.Results:Compared of age and weight gain during pregnancy between early pregnancy intervention group and mid pregnancy intervention group,the difference was statistically significant(P＜0.05).Compared of delivery mode,hypertensive disorders of pregnancy(HDP),gestational diabetes mellitus(GDM)and macrosomia between the early pregnancy intervention group and the mid pregnancy intervention group,the difference was statistically significant(P＜0.05).Compared of low birth weight infants and weight gain during pregnancy in low body weight group between early intervention and mid intervention,the difference was statistically significant(P＜0.05).Compared of delivery mode,GDM and weight gain during pregnancy in normal weight group between early intervention and mid intervention,the difference was statistically significant(P＜0.05).Compared of delivery mode,HDP,GDM,postpartum hemorrhage,macrosomia and weight gain during pregnancy in overweight group between early intervention and mid intervention,the difference was statistically significant(P＜0.05).Compared of delivery mode,HDP,GDM and weight gain during pregnancy in obesity group between early intervention and mid intervention,the difference was statistically significant(P＜0.05).Conclusion:Early pregnancy nutrition weight management based on internet-based perinatal nutrition clinic can regulate the rate of weight gain during pregnancy,can effectively reduce the risk of HDP,GDM and cesarean section.

Objective:To explore the diagnostic value of shear wave elastography(SWE)for clinically significant prostate cancer(csPCa).Methods:We retrospectively analyzed the clinical data of 359 cases with suspected prostate cancer(PCa)in Baoji Central Hospital from June 2017 to July 2023.All the patients underwent the following examinations in the order of serum prostate-spe-cific antigen(PSA)testing,transrectal ultrasonography(TRUS),measurement of the stiffness of the entire prostate gland by SWE,and TRUS-guided prostate puncture biopsy.The stiffness of the entire prostate gland was defined as the average of Young's modulus at both sides of the base,middle,and apex of the prostate,including the maximum Young's modulus(Emax),mean Young's modulus(Emean),and minimum Young's modulus(Emin).We analyzed the correlation of the parameters of the stiffness of the entire prostate gland with the pathological results,focusing on their diagnostic performance for csPCa.Results:Of the 359 cases,189 were diag-nosed by pathological puncture biopsy as BPH,26 as non-csPCa,and 144 as csPCa.The PSA level,Emax,Emean and Emin were significantly higher in the csPCa than those in the BPH and non-csPCa groups(all P＜0.01),but showed no statistically significant difference between the BPH and non-csPCa groups(all P＞0.05).The area under the receiver operating characteristic curve(AUC),optimal cut-off value,sensitivity,specificity,positive predictive value(PPV),negative predictive value(NPV)and accura-cy of Emax in the diagnosis of csPCa were 0.852,143.92 kPa,72.22％,84.65％,75.91％,81.98％and 79.67％;those of Emean were 0.868,82.42 kPa,67.36％,91.16％,83.62％,80.66％and 81.62％;and those of Emin were 0.682,32.73 kPa,47.22％,89.30％,73.91％,71.54％and 72.14％,respectively.In the non-csPCa group,Emax,Emean and Emin were found be-low the optimal cut-off value in 73.08％(19/26),92.31％(24/26)and 88.46％(23/26),respectively.Conclusion:The stiff-ness of the entire prostate gland measured by SWE contributes to the diagnosis of csPCa,reduces unnecessary detection of non-csPCa,and provides some reference for its active surveillance.

Objective To investigate and compare the epidemiological characteristics of common respiratory viruses among influenza-like illness(ILI)and severe acute respiratory infection(SARI)cases in Huzhou,Zhejiang Province before and after the COVID-19 pandemic,so as to provide a basis for formulating and adjusting the prevention and control strategies for viral respiratory infectious diseases.Methods ILI and SARI cases at two influenza surveillance sentinel hospitals in Huzhou and had throat swab samples collected during Nov 2017 to Feb 2020(pre-COVID-19 pandemic period)and Dec 2022 to Apr 2024(post-COVID-19 mitigation phase)were selected as the participants.Seven common viral respiratory pathogens were tested,including influenza A virus(H1N1 and H3N2 subtypes),influenza B virus(Victoria lineage,FluB),respiratory syncytial virus(RSV),rhinovirus(HRV),adenovirus(ADV),and severe acute respiratory syndrome coronavirus-2(SARS-CoV-2).The positive rates of respiratory pathogens before and after the COVID-19 pandemic were compared across different age groups and different time.Results A total of 7 948 ILI samples and 2 294 SARI samples were included.The overall positive rate of ILI samples increased from 33.6%to 47.1%,primarily due to the increase in influenza and COVID-19 infections;the overall positive rate of SARI samples decreased from 31.4%to 24.8%,mainly due to the reduction in HRV and ADV infections.During the post-COVID-19 mitigation phase,SARS-CoV-2(22.1%),H3N2(12.7%),and FluB(6.0%)were the primary pathogens in ILI samples,while RSV(7.1%),H3N2(5.3%),and HRV(4.5%)dominated in SARI samples.During the post-COVID-19 mitigation phase,the influenza virus circulation period was shortened.Before the COVID-19 pandemic,RSV was mainly detected in autumn and winter,while during the post-COVID-19 mitigation phase,out-of-season RSV epidemics were observed in spring and summer.Co-infection rate in ILI cases increased significantly in the post-COVID-19 mitigation phase,predominantly consisting of co-infections of COVID-19 and influenza A virus,while co-infection rate in SARI cases showed a decline.Conclusion We found important epidemiological changes in respiratory viruses in Huzhou during the post-COVID-19 mitigation phase compared to pre-COVID-19 period,including increased positive rates of influenza and COVID-19,and disruptions to the seasonal patterns of influenza and RSV.The prevention and control strategies should be adjusted in a timely manner based on the monitoring data.

BACKGROUND:Knee replacement is a successful technology for treating severe knee diseases,but there are still problems such as low surgical precision,long operation time,and long postoperative recovery period.The clinical application of intelligent orthopedic robots can solve these problems and make knee replacement technology more optimized.OBJECTIVE:To compare the efficacy of MAKO robot-assisted knee replacement with navigation knee replacement.METHODS:Twenty-five patients treated with MAKO robot-assisted knee replacement in Xuzhou Renci Hospital from January to December 2022 were selected as observation group.100 patients treated with navigation knee replacement during the same period were selected as the control group.Perioperative related indexes of the two groups were compared,including planned and actual medial proximal tibial angle,distal lateral femoral angle,hip-knee-ankle angle,visual analog scale score,joint range of motion,American Knee Society functional score,and Western Ontario and McMaster University Osteoarthritis Index score before and 3 months after surgery.RESULTS AND CONCLUSION:(1)The operation time of observation group was significantly longer than that of the control group(P＜0.05),and the intraoperative blood loss was significantly less(P＜0.05).(2)The difference of medial proximal tibial angle,distal lateral femoral angle,and hip-knee-ankle angle in observation group was significantly lower than that in the control group(P＜0.05).(3)Three months after surgery,visual analog scale score in both groups was lower than that before surgery(P＜0.05);range of motion in both groups was higher than that before surgery(P＜0.05).Visual analog scale score in observation group was significantly lower than that in the control group,and range of motion in observation group was significantly higher than that in the control group(P＜0.05).(4)Three months after surgery,the clinical and functional scores of American Knee Society in both groups were higher than those before surgery(P＜0.05),and those in observation group were significantly higher than those in the control group(P＜0.05).(5)Three months after surgery,the scores of function,stiffness and pain of Western Ontario and McMaster University Osteoarthritis Index in both groups were lower than those before surgery(P＜0.05),and the scores in observation group were significantly lower than those in the control group(P＜0.05).(6)It is indicated that compared with navigational knee replacement,MAKO robot-assisted knee replacement can decrease intraoperative blood loss,reduce lower limb force line and prosthesis position error,help to accurately place prosthesis,achieve planned force line,diminish postoperative pain,improve knee motion,and promote the recovery of knee function.

Objective:To investigate the effect of left colonic artery (LCA) preservation on rectal cancer patients' short-term postoperative anal function and quality of life.Methods:Two-hundred ninty-two patients with rectal cancer at the Department of Gastrointestinal Surgery of Peking University First Hospital between Jan 2022 and Dec 2023 were enrolled . The patients were divided into two groups according to whether the LCA was preserved during surgery or not. The LARS scale and EORTC QLQ-CR29 quality of life questionnaire were used to assess postoperative anal function and quality of life.Results:There were no significant differences between the two groups in terms of the amount of surgical blood loss and the number of lymph node dissections in the root No. 253 group and the time to postoperative voiding (all P>0.05). However, the LARS scores at 1 and 3 months postoperatively were significantly lower in the preserved LCA group than in the LCA nonpreserved group, especially for gas incontinence, loose stool leakage, and number of bowel movements (all P<0.05). The EORTC QLQ-CR29 scores showed that the LCA preserved group recovered significantly better than the non-preserved group in terms of postoperative voiding dysfunction ( P=0.007), urinary incontinence ( P=0.006), mucus discharge ( P=0.009), and fecal incontinence symptoms ( P<0.001). Male sexual dysfunction recovery was quicker in the preserved LCA group ( P=0.043), but there was no significant difference between the two groups at 3 months postoperatively( P>0.05). Conclusion:Preservation of the left colonic artery in low anterior resection of rectal cancer helps to reduce the incidence of postoperative low anterior resection syndrome, improve genitourinary symptoms, and improve patients' quality of life.

Objective:Analyze the risk factors of gastrointestinal perforation caused by foreign body and summarize the experience of surgical treatment of foreign bodies.Method:From Jan 2008 to Dec 2023, 89 patients with foreign bodies in the digestive tract were admitted to the Department of Gastrointestinal Surgery, Peking University First Hospital. Relevant data were collected and binary logistic regression was used to analyze the independent risk factors for intestinal perforation, resection and anastomosis of intestine or enterostomy/colostomy.Results:The mean age of 89 patients was (60.1±16.2) years old, 65 patients (73%) had unintentionally ingested foreign bodies. The most common foreign bodies were jujube pits (40 cases). Thirty-nine patients diagnosed with gastrointestinal perforation. Binary Logistic regression analysis showed that the total number of leukocytes ( OR=4.085, 95% CI: 1.214-13.745, P=0.023), sharp foreign body ( OR=26.124, 95% CI: 5.194-131.392, P<0.001), and the location of foreign body ( OR=3.980, 95% CI: 1.178-13.465, P=0.026) were the independent risk factors for gastrointestinal perforation. Thirty-three patients underwent gastrointestinal repair surgery, and 36 patients underwent resection and anastomosis of intestine or enterostomy/colostomy. Binary Logistic regression analysis showed that the foreign body located in the colorectum ( OR=71.928, 95% CI: 4.646-1 113.479, P=0.002) and the length of the foreign body ≤2.5 cm ( OR=5.791, 95% CI: 1.606-20.882, P=0.007) were the independent risk factors for resection and anastomosis of intestine or enterostomy/colostomy. Conclusions:Leukocyte count ≥10×10 9/L, sharp foreign body, and location of foreign body are independent risk factors for gastrointestinal perforation. Foreign body located in the colorectum and foreign body length ≤2.5 cm are risk factors for resection and anastomosis of intestine or enterostomy/colostomy.