Objective To analyze the efficacy, safety, and learning curve of the three-lobe holmium laser enucleation of the prostate(HoLEP)in the treatment of benign prostatic hyperplasia(BPH)in a county-level hospital.Methods A retrospective analysis was conducted on the clinical data of 65 BPH patients who underwent the three-lobe HoLEP performed by a single surgeon at the Department of Urology, Yining County People's Hospital, during Dec.2023 and Jun.2024.The enucleation efficiency was calculated by dividing the weight of the enucleated prostatic tissue by the enucleation time.A case scatter diagram of enucleation efficiency was plotted according to the chronological order of the operations, and the learning curve was analyzed after fitting.Based on the inflection points of the learning curve, the learning process was divided into the initial learning, mastery, and proficiency phases.The basic clinical data, perioperative indicators, postoperative complications, and follow-up indicators were compared among the different learning phases.Results All 65 procedures were successfully completed.Marked by the enucleation efficiency reaching a plateau, cases 1-20 were defined as the initial learning phase, cases 21-40 as the mastery phase, and cases 41 onwards as the proficiency phase.The prostate volume in the proficiency phase was significantly larger than that in the initial learning and mastery phases(both P＜0.05).There were no statistically significant differences in other baseline characteristics among the three groups(all P＞0.05).The operation time [(105.50±19.12)min vs.(85.25±26.92)min vs.(69.00±23.58)min] and enucleation time [(76.90±14.19)min vs.(63.70±22.24)min vs.(48.80±20.48)min] showed a decreasing trend across the three groups(all P＜0.05).The enucleation efficiency in both the mastery and proficiency phases was significantly higher than that in the initial learning phase [(1.16±0.44)g/min vs.(0.85 ±0.25)g/min, P＜0.05;(1.36±0.49)g/min vs.(0.85±0.25)g/min, P＜0.05].The enucleation efficiency in the proficiency phase was slightly higher than that in the mastery phase, but the difference was not statistically significant(P= 0.389).There was no significant difference in the incidence of perioperative complications among the three groups(all P＞0.05).At the 6-month follow-up, the international prostate symptom score(IPSS), post-void residual(PVR), and maximum urinary flow(Qmax)were significantly improved compared to preoperative values in all three groups(all P＜0.05);however, no significant differences were observed among the three groups(all P＞0.05).Conclusion The three-lobe HoLEP for the treatment of BPH is safe and effective in a county-level hospital setting.Surgeons with some experience in endoscopic surgery can preliminarily master this technique after a learning period of approximately 20 procedures.

Objective To explore the value of MRI quantitative parameters and free/total prostate-specific antigen ratio(f/tPSA)for diagnosing prostate imaging reporting and data system(PI-RADS)3-point clinically significant prostate cancer(csPCa).Methods Totally 57 patients with PI-RADS 3-point prostate lesions were retrospectively enrolled,including 18 prostate cancer(PCa)(PCa group)and 39 benign hyperplasia with chronic prostatitis(non-PCa group).The former included 12 cases of csPCa and 6 cases of clinically insignificant PCa(ciPCa).Taken non-PCa and ciPCa into non-csPCa group(n=45),laboratory and MRI parameters(apparent diffusion coefficient[ADC],T1,T2,proton density[PD]values)were compared between PCa and non-PCa groups,also between csPCa and non-csPCa groups.Based on laboratory and MRI parameters being statistically different between groups according to univariate analysis,combined models were established using logistic regression.The efficacy of laboratory,MRI parameters and combined models for differentiating PCa and non-PCa as well as csPCa and non-csPCa were evaluated.Results ADC,T1,T2,PD values in PCa group were all lower those in non-PCa group(all P＜0.05),and f/tPSA,ADC,T1,T2 and PD values in csPCa group were all lower than those in non-csPCa group(all P＜0.05).AUC of ADC,T1,T2 and PD values for differentiating PCa from non-PCa was 0.662,0.755,0.793 and 0.729 respectively,while of ADC-T1-T2-PD combined model was 0.839,higher than that of ADC alone(P＜0.05)but not significantly different with T1,T2 and PD values alone(all P＞0.05).AUC of f/tPSA,ADC,T1,T2 and PD values for differentiating csPCa from non-csPCa was 0.692,0.759,0.741,0.805 and 0.737,respectively,while of ADC-T1-T2-PD combined model was 0.889,higher than that of f/tPSA,ADC and T1 values alone(all P＜0.05)but not significantly different with that of T2 and PD value alone(both P＞0.05).AUC of f/tPSA-ADC-T1-T2-PD combined model was 0.898,higher than that of f/tPSA,ADC,T1 and PD values alone(all P＜0.05)but not significantly different with T2 value and ADC-T1-T2-PD combined model(both P＞0.05).Conclusion MRI quantitative parameters combined with f/tPSA could effectively diagnose PI-RADS 3-point csPCa.

Objective To explore the value of MRI quantitative parameters and free/total prostate-specific antigen ratio(f/tPSA)for diagnosing prostate imaging reporting and data system(PI-RADS)3-point clinically significant prostate cancer(csPCa).Methods Totally 57 patients with PI-RADS 3-point prostate lesions were retrospectively enrolled,including 18 prostate cancer(PCa)(PCa group)and 39 benign hyperplasia with chronic prostatitis(non-PCa group).The former included 12 cases of csPCa and 6 cases of clinically insignificant PCa(ciPCa).Taken non-PCa and ciPCa into non-csPCa group(n=45),laboratory and MRI parameters(apparent diffusion coefficient[ADC],T1,T2,proton density[PD]values)were compared between PCa and non-PCa groups,also between csPCa and non-csPCa groups.Based on laboratory and MRI parameters being statistically different between groups according to univariate analysis,combined models were established using logistic regression.The efficacy of laboratory,MRI parameters and combined models for differentiating PCa and non-PCa as well as csPCa and non-csPCa were evaluated.Results ADC,T1,T2,PD values in PCa group were all lower those in non-PCa group(all P＜0.05),and f/tPSA,ADC,T1,T2 and PD values in csPCa group were all lower than those in non-csPCa group(all P＜0.05).AUC of ADC,T1,T2 and PD values for differentiating PCa from non-PCa was 0.662,0.755,0.793 and 0.729 respectively,while of ADC-T1-T2-PD combined model was 0.839,higher than that of ADC alone(P＜0.05)but not significantly different with T1,T2 and PD values alone(all P＞0.05).AUC of f/tPSA,ADC,T1,T2 and PD values for differentiating csPCa from non-csPCa was 0.692,0.759,0.741,0.805 and 0.737,respectively,while of ADC-T1-T2-PD combined model was 0.889,higher than that of f/tPSA,ADC and T1 values alone(all P＜0.05)but not significantly different with that of T2 and PD value alone(both P＞0.05).AUC of f/tPSA-ADC-T1-T2-PD combined model was 0.898,higher than that of f/tPSA,ADC,T1 and PD values alone(all P＜0.05)but not significantly different with T2 value and ADC-T1-T2-PD combined model(both P＞0.05).Conclusion MRI quantitative parameters combined with f/tPSA could effectively diagnose PI-RADS 3-point csPCa.

Objective Explore the clinical and molecular genetic characteristics of children with epilepsy as the first symptom caused by mutations in the ATPase Na+/K+transporting subunit alpha-3(ATP1A3)gene.Methods Clinical data of 853 epilepsy patients who visited the Department of Pediatric Neurology at Northwest Women's and Children's Hospital from November 2021 to December 2023 were retrospectively collected.Among them,3 cases were diagnosed with ATP1A3 gene mutations.Next-generation sequencing(NGS)techniques was used to perform whole exome sequencing analysis on serum samples from ATP1A3 gene mutation patients,and Sanger sequencing method was used for mutation verification.Results The ATP1A3 gene mutation sites in three patients were c.2401(exo n17)G>A,c.1103C>T and c.2542+1G>A,all of which presented with epilepsy as the initial symptom,mainly manifested as seizures and loss of consciousness.Imaging examination shows no abnormalities or slight widening of the subarachnoid space in both frontal and temporal regions,with background slow waves appearing in the electroencephalogram.Seizure were relieved after treatment with antiepileptic drugs.Conclusion The heterozygous mutations c.1103C>T and c.2542+1G>A at the ATP1A3 gene locus are novel pathogenic variations in epilepsy,and further confirm that the c.2401(exon17)G>A heterozygous mutation can cause epilepsy symptoms in patients.The clinical phenotype of ATP1A3 gene mutation includes typical alternating hemiplegia and muscle tone disorders,as well as seizures and developmental delay.

Anthracyclines(ANT),serving as a broad-spectrum antitumor medication,play a pivotal role in the treatment of various malignant tumors such as breast cancer,lymphoma,and soft tissue tumors.Nevertheless,their profound cardiotoxicity not only imposes limitations on the clinical application of these drugs,but also has significant impacts on patients'quality of life and long-term prognosis.In recent years,with the continuous advancement of detection technology,methods for detecting an-thracycline-induced cardiotoxicity have been constantly updated and developed.This review mainly aims to provide crucial in-sights into current methods for detecting anthracycline-induced cardiotoxicity in order to facilitate early detection and clinical management while reducing the risk of severe cardiac injury in cancer patients.

Objective Explore the clinical and molecular genetic characteristics of children with epilepsy as the first symptom caused by mutations in the ATPase Na+/K+transporting subunit alpha-3(ATP1A3)gene.Methods Clinical data of 853 epilepsy patients who visited the Department of Pediatric Neurology at Northwest Women's and Children's Hospital from November 2021 to December 2023 were retrospectively collected.Among them,3 cases were diagnosed with ATP1A3 gene mutations.Next-generation sequencing(NGS)techniques was used to perform whole exome sequencing analysis on serum samples from ATP1A3 gene mutation patients,and Sanger sequencing method was used for mutation verification.Results The ATP1A3 gene mutation sites in three patients were c.2401(exo n17)G>A,c.1103C>T and c.2542+1G>A,all of which presented with epilepsy as the initial symptom,mainly manifested as seizures and loss of consciousness.Imaging examination shows no abnormalities or slight widening of the subarachnoid space in both frontal and temporal regions,with background slow waves appearing in the electroencephalogram.Seizure were relieved after treatment with antiepileptic drugs.Conclusion The heterozygous mutations c.1103C>T and c.2542+1G>A at the ATP1A3 gene locus are novel pathogenic variations in epilepsy,and further confirm that the c.2401(exon17)G>A heterozygous mutation can cause epilepsy symptoms in patients.The clinical phenotype of ATP1A3 gene mutation includes typical alternating hemiplegia and muscle tone disorders,as well as seizures and developmental delay.

Anthracyclines(ANT),serving as a broad-spectrum antitumor medication,play a pivotal role in the treatment of various malignant tumors such as breast cancer,lymphoma,and soft tissue tumors.Nevertheless,their profound cardiotoxicity not only imposes limitations on the clinical application of these drugs,but also has significant impacts on patients'quality of life and long-term prognosis.In recent years,with the continuous advancement of detection technology,methods for detecting an-thracycline-induced cardiotoxicity have been constantly updated and developed.This review mainly aims to provide crucial in-sights into current methods for detecting anthracycline-induced cardiotoxicity in order to facilitate early detection and clinical management while reducing the risk of severe cardiac injury in cancer patients.

Digital technologies have become an integral part of complete denture restoration. With advancement in computer-aided design and computer-aided manufacturing (CAD/CAM), tools such as intraoral scanning, facial scanning, 3D printing, and numerical control machining are reshaping the workflow of complete denture restoration. Unlike conventional methods that rely heavily on clinical experience and manual techniques, digital technologies offer greater precision, predictability, and efficacy. They also streamline the process by reducing the number of patient visits and improving overall comfort. Despite these improvements, the clinical application of digital complete denture restoration still faces challenges that require further standardization. The major issues include appropriate case selection, establishing consistent digital workflows, and evaluating long-term outcomes. To address these challenges and provide clinical guidance for practitioners, this expert consensus outlines the principles, advantages, and limitations of digital complete denture technology. The aim of this review was to offer practical recommendations on indications, clinical procedures and precautions, evaluation metrics, and outcome assessment to support digital restoration of complete denture in clinical practice.
Humans ; Denture, Complete ; Computer-Aided Design ; Denture Design/methods* ; Consensus ; Printing, Three-Dimensional

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

Objective:To compare the efficacy of O-arm navigation-assisted and freehand posterior pedicle screw fixation in the treatment of ankylosing spondylitis (AS) associated with lower cervical fractures in adults.Methods:A retrospective cohort study was conducted to analyze the clinical data of 29 adult AS patients with lower cervical fractures admitted to Zhengzhou Orthopedic Hospital from June 2020 to September 2024, including 22 males and 7 females, aged 35-72 years [(52.3±11.1)years]. Injured segments involved C 5~6 in 6 patients, C 6 in 8, C 6~7 in 8, and C 7 in 7. Accirdubg to AO classification, the fracture was classified as type B3 in 22 patients and type C in 7. All the patients underwent posterior cervical pedicle screw fixation, among whom 15 patients were treated with navigation-assisted screw placement (navigation screw placement group, with 120 screws) and 14 with freehand technique (freehand screw placement group, with 112 screws). The two groups were compared in terms of the operative time, intraoperative blood loss, and postoperative drainage volume. The accuracy of screw placement, penetration rate of the pedicle cortex and fracture healing time were evaluated in the two groups. The Cobb angle before surgery and at 3 days after surgery and American Spinal Injury Association (ASIA) classification before surgery and at the last follow-up were recorded in the two groups. The visual analogue scale (VAS) score, Japanese Orthopedic Association (JOA) score and neck dysfunction index (NDI) before surgery, at 1 week, 3 months after surgery and at the last follow-up were compared between the two groups. The incidence of postoperative complications was also investigated. Results:All the patients were followed up for 6-57 months [(29.3±14.1)months]. The operation duration, intraoperative blood loss, and postoperative drainage volume were (166.0±31.4)minutes, (256.7±70.7)ml, and (91.0±14.4)ml in the navigation screw placement group, which were shorter or less than (219.29±31.7)minutes, (342.1±60.7)ml, and (123.2±20.7)ml in the freehand screw placement group ( P<0.01). The accuracy of screw placement in the navigation screw placement group was 98.3% (118/120) and penetration rate of the pedicle cortex was 5.8% (7/120), which were both superior to 89.3% (100/112) and 18.8% (21/112) in the freehand screw placement group ( P<0.01). No significant difference was detected in fracture healing time between the two groups ( P>0.05). There were no significant differences in the Cobb angle before surgery and at 3 days after surgery, as well as in the ASIA grading before surgery and at the last follow-up between the two groups ( P>0.05). The Cobb angle and ASIA classification at 3 days after surgery and at the last follow-up were improved compared with those before surgery ( P<0.05). Before surgery, at 1 week, 3 months after surgery, and at the last follow-up, the VAS scores were 8.0(7.0, 9.0)points, 4.0(3.0, 4.0)points, 2.0(1.0, 2.0)points, and 0.0(0.0, 1.0)points in the navigation screw placement group, which were not significantly different from 8.0(7.0, 9.0)points, 4.0(3.0, 4.0)points, 1.5(1.0, 2.0)points, and 0.0(0.0, 1.0)points in the freehand screw placement group ( P>0.05); the JOA scores were (7.5±1.4)points, (10.9±1.2)points, (13.2±1.5)points, and (15.7±1.0)points in the navigation screw placement group, which were not significantly different from (7.2±2.8)points, (10.1±3.2)points, (11.8±3.8)points, and (14.1±4.3)points in the freehand screw placement group ( P>0.05); the NDI were 48.0(44.0, 56.0)%, 30.0(30.0, 34.0)%, 18.0(16.0, 22.0)%, 8.0(6.0, 10.0)% in the navigation screw placement group, which were not significantly different from 44.0(40.0, 52.0)%, 30.0(29.0, 34.5)%, 17.0(16.0, 20.0)%, and 8.0(5.5, 10.0)% in the freehand screw placement group ( P>0.05). The VAS scores, JOA scores, and NDI were improved at 1 week, 3 months after surgery, and at the last follow-up in both groups, compared to those before surgery and they were gradually improved with the passage of the follow-up time ( P<0.05). One patient in the navigation screw placement group developed postoperative pulmonary infection and recovered after symptomatic treatment, with an incidence of complications 7% (1/15). Two patients in the freehand screw placement group had postoperative cerebrospinal fluid leakage and dural rupture and recovered after symptomatic treatment, with an incidence of complications 14% (2/14). Throughout the follow-up period, no complications such as screw breakage, implant loosening, or loss of correction were found in either group. Conclusion:Compared with freehand screw placement, the O-arm navigation system-assisted posterior pedicle screw fixation in the treatment of AS associated with lower cervical fractures in adults demonstrates significant advantages, including reduced operative time, decreased intraoperative blood loss and postoperative drainage volume, improved accuracy of screw placement, and reduced penetration rate of the pedicle cortex.