[Objective] To explore the safety and efficacy of submucosal injection of glycerol and fructose saline in bladder tumor endoscopic submucosal dissection (BT-ESD) with a 450 nm blue laser semiconductor treatment machine in the treatment of non-muscular invasive bladder cancer (NMIBC). [Methods] Clinical data of 20 patients with bladder tumor treated with submucosal injection of glycerol and fructose saline BT-ESD via a 450 nm blue laser semiconductor treatment machine at our hospital during Nov.2023 and Apr.2024 were retrospectively analyzed.The patients included 13 males and 7 females, aged (64.95±6.89) years, tumor diameter (1.02±0.24) cm, and preoperative hemoglobin (Hb) (130.55±4.36) g/L.The operation time, Hb the next day after operation, positive rate of tumor basal biopsy, postoperative bladder irrigation time, catheter indwelling time, postoperative hospital stay, complications and recurrence rate were recorded. [Results] All operations were successful, and 28 lesions were removed.The postoperative pathological results confirmed that all cases were NMIBC, and the basal mucosa biopsies were negative.The operation time was (9.40±3.14) min, postoperative Hb (130.15±4.59) g/L, bladder irrigation time (17.70±1.34) h, catheter indwelling time 1 day, and postoperative hospital stay 1 day.There were no complications such as obturator nerve reflex, bladder perforation.There were no need for blood transfusion, no conversion to open surgery, and no secondary bleeding after operation.No tumor recurrence was found during 6-month postoperative follow up. [Conclusion] Submucosal injection of glycerol and fructose saline BT-ESD with a 450 nm blue laser semiconductor treatment machine is a safe and effective method for the treatment of NMIBC.It has advantages of whole enucleation of bladder tumor, clear basal layer, small amount of bleeding, short operation time and few complications.It can be used as a day surgery and is worthy of clinical promotion.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective To explore the effect of Sangxing Zhike Formula in rats with cough vari-ant asthma(CVA)and its possible mechanism based on the cyclic adenosine monophosphate(cAMP)/cystic fibrosis transmembrane conductance regulator(CFTR)pathway.Methods SD rats were randomly divided into control group,model group,dexamethasone group(0.5 mg/kg)and low-,medium-,high-dose Sangxing Zhike Formula groups(9.6,19.2 and 38.4 g/kg)using a ran-dom number table method,with 9 rats in each group.Except for the control group,CVA rat models were established in the other groups.Rats in each group were administered the drug by gavage once a day for 14 consecutive days.The general conditions of rats in each group were observed.Enzyme-linked immunosorbent assay(ELISA)was used to detect the levels of interleukin-1β(IL-1β)and interleukin-18(IL-18)in rat serum.Hematoxylin-eosin(HE)staining and periodic acid-Schiff(PAS)staining were used to observe the pathological changes in rat lung and bronchial tissues,and the acid-base balance of airway surface liquid(ASL)was measured.Western blot and real-time fluorescence quantitative polymerase chain reaction(RT-qPCR)were used to detect the expression levels of pro-tein kinase A(PKA),CFTR protein and their mRNA in lung tissues of rats.Results Compared with the control group,rats in the model group showed listlessness,dull fur,slow weight gain,a significantly expanded area of alveolar septal consolidation,and a large number of inflammatory cell infiltrations around the bronchi.Compared with the model group,rats in each intervention group had better general conditions and reduced inflammatory infiltrations in lung tissues and bronchial lu-mens.Compared with the control group,the serum levels of IL-1 β and IL-18 in the model group were increased,and the pH values of ASL in the model group,low-dose Sangxing Zhike Formula group,medium-dose Sangxing Zhike Formula group,and high-dose Sangxing Zhike Formula group were all decreased,with statistically significant differences(P＜0.05).Compared with the model group,the serum levels of IL-1β and IL-18 in each intervention group were decreased,and the pH values of ASL in the dexamethasone group,medium-dose Sangxing Zhike Formula group,and high-dose Sangxing Zhike Formula group were increased,with statistically significant differences(P＜0.05).Compared with the control group,the expressions of PKA protein and PKA mRNA in the model group,low-dose Sangxing Zhike Formula group,and medium-dose Sangxing Zhike Formula group were all decreased,and the expressions of CFTR protein and CFTR mRNA in the model group and each intervention group were all decreased,with statistically significant differences(P＜0.05).Compared with the model group,the expressions of PKA protein and PKA mRNA in the dexametha-sone group and high-dose Sangxing Zhike Formula group were increased,and the expressions of CFTR protein and CFTR mRNA in the high-dose Sangxing Zhike Formula group were increased,with statistically significant differences(P＜0.05).Conclusion Sangxing Zhike Formula can im-prove the general conditions of CVA rats,regulate the acid-base balance of ASL,reduce airway in-flammatory cell infiltration andairway remodeling,and decrease the levels of inflammatory factors IL-1β and IL-18.Its mechanism may be related to the cAMP/CFTR pathway.

Objective To explore the relationship between triglyceride-glucose index(TyG)and acute ischemic stroke with large vessel occlusion(AIS-LVO)of anterior circulation.Methods A retrospective study was conducted on patients with anterior circulation AIS-LVO who underwent emergency endovascular thrombectomy at Neurovascular Center of The First Affiliated Hospital of Naval Medical University from Jan.2018 to Dec.2019.According to modified Rankin scale(mRS)score 90 d after operation,the patients were assigned to favorable outcome group(mRS score 0-2)or unfavorable outcome group(mRS score 3-6),and the TyG was compared.According to the median of TyG,the patients were assigned to low-TyG group(TyG＜8.57)or high-TyG group(TyG ≥8.57),and the clinical data,laboratory indexes,and imaging characteristics were compared.Receiver operating characteristic curve was used to evaluate the predictive value of TyG for poor prognosis.Results A total of 135 patients were enrolled,with 72 in the favorable outcome group and 63 in the unfavorable outcome group.The TyG of the unfavorable outcome group was significantly higher than that of the favorable outcome group(8.82+0.63 vs 8.43+0.60,P＜0.001).There were 67 patients in the low-TyG group and 68 in the high-TyG group.Compared with the low-TyG group,the proportion of patients with hyperlipidemia history(P=0.003),systolic blood pressure at admission(P=0.018),fasting blood glucose level(P＜0.001),and triglyceride level(P＜0.001)were significantly higher in the high-TyG group,the infarct core volume was significantly larger(P=0.025),the high density lipoprotein-cholesterol level was significantly lower(P=0.013),and the mRS score 90 d after operation was significantly higher(3[1,5]vs 1[0,5],P=0.049).The TyG had certain predictive value for poor prognosis in anterior circulation AIS-LVO patients(area under curve value=0.662,95％confidence interval 0.571-0.753).Conclusion TyG is elevated in anterior circulation AIS-LVO patients with poor prognosis,and may be a potential prognostic indicator for anterior circulation AIS-LVO patients.

Objective To explore the clinical efficacy,safety and changes in sexual function of 450 nm blue laser vaporization resection of the prostate in the treatment of benign prostatic hyperplasia(BPH).Methods The clinical data of 132 BPH patients treated in Yingsheng Branch of Taian Central Hospital during Jan.and Oct.2023 were retrospectively analyzed.The perioperative related indicators,incidence of complications were recorded.The international prostate symptoms(IPSS)score,maximum urine flow rate(Qmax),post voiding residual(PVR),quality of life score(QoL),prostate-specific antigen(PSA)level,the Chinese index of premature ejaculation score(CIPE)and international erectile function index-5(IIEF-5)score before operation,and 1,3,6,and 12 months after operation were analyze.Results The operation time was(18.37±5.38)min,intraoperative blood loss(6.73±2.57)mL,postoperative hospital stay(4.31±1.54)d,catheter indwelling time(2.45±1.27)d,and bladder irrigation time(19.61±2.45)h.There were significant differences in Qmax,PVR,PSA level,QoL and IPSS before and after operation(P＜0.05).There was no statistically significant difference in IIEF-5 and CIPE before operation and 3,6 and 12 months after operation(P＞0.05).The retrograde ejaculation rate remained 6.25％3,6 and 12 months after operation.Conclusion The 450 nm blue laser vaporization resection of the prostate can relieve lower urinary tract symptoms,preserve the sexual function,and improve patients'quality of life.

Objective:To investigate the association of interpectoral lymph nodes (IPNs) with clinicopathological characteristics in breast cancer and to evaluate their prognostic significance.Method:Data from 117 primary breast cancer specimens with complete clinical and follow-up information who underwent IPNs clearance from Feb. 2016 to Jun. 2024 in Shanghai Second People’s Hospital were collected, including patient age, tumor location, pathological type, histological grade, TNM stage, lymphovascular invasion (LVI) , molecular typing, Ki67, detection rate of IPNs, metastasis rate of IPNs, and patient follow-up information. SPSS18.0 was used to analyze the risk factors and impact on prognosis of IPNs metastasis. In addition, the data of 117 patients with primary breast cancer who did not undergo IPNs in the same period were collected and compared with those who underwent IPNs.Results:In 117 primary breast cancer specimens, the detection rate of IPNs was 28.2% (33/117) , and the metastasis rate was 4.3% (5/117) . There was no statistical difference in patient age ( χ2=0.59, P=1.000) , tumor location ( χ2=2.13, P=0.813) , pathological type ( χ2=1.86, P=0.500) , histological grade ( χ2=0.47, P=0.643) , T stage ( χ2=4.18, P=0.247) , N stage ( χ2=4.89, P=0.127) , TNM stage ( χ2=2.23, P=0.336) , LVI ( χ2=1.05, P=0.360) , molecular typing ( χ2=1.17, P=0.901) , or Ki67 ( χ2=0.01, P=1.000) between IPNs metastasis group and no IPNs metastasis group. However, the data showed that patients with advanced TNM stage and axillary lymph node metastasis were more likely to develop IPNs metastasis. During a median follow-up period of 29 months, IPNs metastasis had no significant effect on the invasive disease-free survival (iDFS) or overall survival (OS) of patients. Meanwhile, there was no significant difference in iDFs or OS between the IPNs non cleaning group and the IPNs cleaning group. Conclusions:The metastasis rate of IPNs in breast cancer patients is not high, mainly occurring in patients with advanced TNM staging and axillary lymph node metastasis. The metastasis of IPNs has no significant impact on the short-term recurrence survival of patients. Moreover, whether IPNs cleaning or not has no significant impact on the recurrence or survival of for the general patients with breast cancer. However, its value in predicting prognosis needs to be verified through larger samples and longer follow-up periods.

Severe open tibiofibular fractures account for approximately 28.1% of all open fractures. Among them, Gustilo-Anderson type IIIB/C fractures present significant clinical challenges due to associated bone and soft tissue defects, high infection rates, and risk of amputation. Inadequate preoperative assessment may lead to suboptimal emergency surgical planning or intraoperative complications. Historically, external fixation was often preferred, but this approach has been associated with limitations such as restricted joint mobility, delayed bone union, joint stiffness, and disuse osteoporosis, resulting in poor functional recovery. With advancements of debridement techniques, standardization of antibiotic use, and popularization of early soft tissue coverage, early internal fixation has gained broader acceptance. Nevertheless, controversies persist regarding the choice of fixation method, timing of definitive fixation, use of reamed versus unreamed intramedullary nailing, and necessity of fibular fixation. To standardize the diagnosis and early management of severe open tibiofibular fractures, reduce complication rates, and improve functional recovery, the Society of Microsurgery of the Chinese Medical Association organized a panel of domestic experts to develop the Evidence-based guideline for the diagnosis and early fixation of severe open tibiofibular fractures ( version 2025), using evidence-based methodology. The guidelines provided 12 recommendations covering diagnostic and early fixation strategies of severe open tibiofibular fractures, aiming to provide clinicians with scientifically grounded and standardized guidance.

Objective:To explore the clinical characteristics and sputum antibacterial protein levels of patients with cough-variant asthma (CVA) due to deficiency of different Zang-Fu organs.Methods:A total of 109 patients with CVA admitted to the Department of Respiratory, Affiliated Hospital of Traditional Chinese Medicine, Xinjiang Medical University from January 2023 to June 2024 were selected. According to the deficiency and damage of the internal organs of the patients, they were divided into 45 cases in the lung qi deficiency group, 39 cases in the lung and spleen deficiency group, and 25 cases in the lung and kidney deficiency group. Thirty healthy individuals were taken as the normal control group. The general information of the subjects was collected. The disease course of CVA patients, the number of acute exacerbations and hospitalizations, the Asthma Control Test (ACT) score, the Traditional Chinese Medicine (TCM) syndrome score, and the results of pulmonary function tests [forced vital capacity (FVC), forced expiratory volume in one second (FEV 1), FEV 1/FVC, early peak expiratory flow rate (MEF 25), mid-peak expiratory flow rate (MEF 50), late peak expiratory flow rate (MEF 75)], and the levels of antibacterial proteins [β -defensin (β-DF), antimicrobial peptide LL-37, lysozyme (LZM), lactoferrin (LTF)] in the sputum of the subjects were detected by enzyme-linked immunosorbent assay. Results:There were no statistically significant differences in the disease course, the number of acute exacerbations and the number of hospitalizations among the three groups of CVA patients (all P>0.05). There were statistically significant differences in the ACT scores and TCM syndrome scores among the three groups of CVA patients ( F=82.221, 194.577, all P<0.05). Among them, the ACT score was in the order of lung Qi deficiency group>lung and spleen deficiency group>lung and kidney deficiency group, and the TCM syndrome score was in the order of lung qi deficiency group0.05), while there was a statistically significant difference in MEF 25 ( Z=53.896, P<0.05). Among them, the MEF 25 in the lung and kidney deficiency group was significantly lower than that in the lung qi deficiency group and the lung and spleen deficiency group (all P<0.05). The contents of β-DF, antimicrobial peptide LL-37, LZM and LTF in the sputum of the three groups of CVA patients were all higher than those in the normal control group (all P<0.05). Among them, the content of LZM in sputum of the lung and kidney deficiency group was higher than that of the lung and spleen deficiency group, and the content of antimicrobial peptide LL-37 was lower than that of the lung and spleen deficiency group. The differences were statistically significant (all P<0.05). Conclusions:The clinical characteristics of patients with CVA due to deficiency of different Zang-Fu organs are different, providing a theoretical basis for the syndrome differentiation and treatment of CVA by Zang-Fu organs. The level of antibacterial protein in sputum of the CVA group was higher than that of the normal control group. This might be because the onset of CVA is often induced by infection.

Objective To compare the clinical efficacy and safety of transurethral 450 nm semiconductor blue laser vaporization enucleation and transurethral resection of bladder tumor(TURBT)in the treatment of non-muscle invasive bladder cancer(NMIBC).Methods The clinical data of 85 NMIBC patients undergoing surgical treatment at Yingsheng Branch of Taian Central Hospital during Dec.2022 and Feb.2024 were retrospectively collected.The patients were divided into the blue laser group(n=40)and TURBT group(n=45).The operation time,intraoperative blood loss,postoperative bladder irrigation time,postoperative catheter indwelling time,postoperative hospital stay,intraoperative complications,wound healing 3 and 6 months after operation,and tumor recurrence 1 year after operation were compared between the two groups.Results Patients in both groups successfully completed the operation without blood transfusion or conversion to open surgery.Compared with the TURBT group,the blue laser group had shorter operation time[(23.68±9.98)min vs.(29.11±14.27)min],less blood loss[(1.43±0.87)g/L vs.(3.27±0.96)g/L],and shorter postoperative bladder irrigation time[0.5(0.5,0.5)d vs.0.5(0.5,1.5)d](P＜0.05).No cases developed obturator nerve reflexes in the blue laser group,but 7 cases in the TURBT group(P＜0.05).Three months after operation,the bladder wounds healed in 24 cases in the blue laser group,but only in 7 cases in the TURBT group(P＜0.01).Conclusion Compared with TURBT,transurethral 450 nm semiconductor blue laser vaporization enucleation for the treatment of NMIBC can shorten the operation time,reduce the amount of bleeding,shorten the postoperative healing time,and cause fewer complications.It is a safe and efficient minimally invasive surgery.

Objective:To investigate the association of interpectoral lymph nodes (IPNs) with clinicopathological characteristics in breast cancer and to evaluate their prognostic significance.Method:Data from 117 primary breast cancer specimens with complete clinical and follow-up information who underwent IPNs clearance from Feb. 2016 to Jun. 2024 in Shanghai Second People’s Hospital were collected, including patient age, tumor location, pathological type, histological grade, TNM stage, lymphovascular invasion (LVI) , molecular typing, Ki67, detection rate of IPNs, metastasis rate of IPNs, and patient follow-up information. SPSS18.0 was used to analyze the risk factors and impact on prognosis of IPNs metastasis. In addition, the data of 117 patients with primary breast cancer who did not undergo IPNs in the same period were collected and compared with those who underwent IPNs.Results:In 117 primary breast cancer specimens, the detection rate of IPNs was 28.2% (33/117) , and the metastasis rate was 4.3% (5/117) . There was no statistical difference in patient age ( χ2=0.59, P=1.000) , tumor location ( χ2=2.13, P=0.813) , pathological type ( χ2=1.86, P=0.500) , histological grade ( χ2=0.47, P=0.643) , T stage ( χ2=4.18, P=0.247) , N stage ( χ2=4.89, P=0.127) , TNM stage ( χ2=2.23, P=0.336) , LVI ( χ2=1.05, P=0.360) , molecular typing ( χ2=1.17, P=0.901) , or Ki67 ( χ2=0.01, P=1.000) between IPNs metastasis group and no IPNs metastasis group. However, the data showed that patients with advanced TNM stage and axillary lymph node metastasis were more likely to develop IPNs metastasis. During a median follow-up period of 29 months, IPNs metastasis had no significant effect on the invasive disease-free survival (iDFS) or overall survival (OS) of patients. Meanwhile, there was no significant difference in iDFs or OS between the IPNs non cleaning group and the IPNs cleaning group. Conclusions:The metastasis rate of IPNs in breast cancer patients is not high, mainly occurring in patients with advanced TNM staging and axillary lymph node metastasis. The metastasis of IPNs has no significant impact on the short-term recurrence survival of patients. Moreover, whether IPNs cleaning or not has no significant impact on the recurrence or survival of for the general patients with breast cancer. However, its value in predicting prognosis needs to be verified through larger samples and longer follow-up periods.