Objective: To explore the safety and feasibility of the disconnection of the left renal artery preferentially during robot-assisted inferior vena cava (IVC) thrombectomy for patients with left renal cell carcinoma and tumor emboli. Methods: Clinical data of 7 patients who underwent robot-assisted IVC thrombectomy and radical nephrectomy in the First Affiliated Hospital of Zhengzhou University during Dec.2021 and Oct.2024 were retrospectively analyzed.Thrombectomy was performed first，followed by nephrectomy. The “IVC-first, kidney-last”robotic technique was developed to minimize chances of IVC thrombus. When patients in left lateral decubitus position, the left renal artery was severed from the right side through the inferior vena cava and abdominal aorta. After removal of thrombus from IVC was completed, patients changed to the right lateral position to complete radical left nephrectomy. Results: Imaging examinations revealed that the median diameter of the renal cell carcinomas was 83(46-99) mm; the median length of the inferior vena cava cancerous emboli was 49(2-91) mm.According to the Mayo classification，the cancerous emboli were gradeⅠ in 2 cases，gradeⅡ in 4 cases，and grade Ⅲ in 1 case.All surgeries were successful.The median operation time was 248(201-331) minutes，blood loss 500(200-1000) mL，and 6 cases required intraoperative blood transfusion.The median time for transition into the intensive care unit was 1(1-4) days，and drainage tube removal 6(5-12) days.Serum creatinine increased significantly in 5 cases，4 of which returned to normal after 1 week，but 1 had renal insufficiency (creatinine 166 μmol/L).Chylous fistula occurred in 1 patient，and lower extremity venous thrombosis developed in 3 patients.Pathological examinations indicated 6 cases of renal cell carcinoma and 1 case of MiT family translocation renal cell carcinoma.During the median follow-up of 17(1-35) months，5 cases were tumor-free，while 2 had lung and retroperitoneal metastases.They received targeted therapy of axitinib combined immunotheraphy and lived with tumors. Conclusion: In the left lateral position for left renal cell carcinoma with cancerous emboli，robot-assisted laparoscopic thrombectomy by crossing the inferior vena cava and abdominal aorta and disconnecting the left renal artery first is safe and feasible.

OBJECTIVE To explore the practice pathway and evaluate the effectiveness of the resident pharmacists stationed in the Drug Clinical Trial Institution Office （hereinafter referred to as the “GCP resident pharmacist”） in the management of dermatological drug clinical trials. METHODS The practical approach of GCP resident pharmacists participating in dermatological drug clinical trials at our hospital was introduced. A retrospective analysis was conducted on the data of dermatological drug clinical trials from 2021 to 2024， comparing efficiency and quality indicators between dermatological clinical trials and those of other specialties. RESULTS With the involvement of our hospital’s GCP resident pharmacists throughout, the process for dermatology drug clinical trials was constructed and optimized， a dedicated quality control system was established， and the acceleration strategy for subject enrollment was optimized. The number of dermatological drug clinical trials at our hospital showed a compound annual growth rate of 69.56% from 2021 to 2023. In terms of efficiency indicators， the approval waiting time for dermatological drug clinical trials was （12.31±4.99） days， which was significantly shorter than that of other specialties （[ 19.68±6.09） days， P＜0.05]. Regarding quality indicators， the enrollment rate for dermatological drug clinical trials was 75.71%（50.00%，114.48%）， which was significantly higher than that of other specialties [51.00%（25.00%，174.17%）， P＜0.05]. The numbers of first quality control issues （[ 8.31±3.25）items vs.（ 11.68±4.49）items] and protocol deviations [5.5（2.0，11.0）times vs. 11.0（5.5，17.5）times] were significantly lower than those of other specialties （P＜0.05）. CONCLUSIONS GCP resident pharmacists significantly enhance the overall efficiency of dermatological drug clinical trials， playing a crucial role in ensuring the reliability and authenticity of drug clinical trials， as well as safeguarding the rights and safety of trial subjects.

Secondary organizing pneumonia after infection is a pathological condition characterized by connective tissue filling and obstructing the alveoli and bronchioles, in which following an infection in the lung, the inflammatory response is not controlled in a timely and effective manner. The pathogenesis and treatment of this condition can be interpreted through the Sanjiao membranous tube theory and the concept of stagnation within the pulmonary micro-membrane. Sanjiao is conceptualized as a four-way membranous tube that internally connects with the zangfu organs and externally with the skin and muscles, enabling the circulation of energy and fluids throughout the body. It also maintains communication with the zangfu micro-membranes. Within the lungs, the pulmonary micro-membrane is distributed and connected to the upper jiao membranous tube, facilitating the movement of qi and fluids and supporting nutrient distribution. External pathogens may invade the Sanjiao membranous system through the external membranous tube, travel internally along this system, and transform into latent pathogens that settle within the pulmonary micro-membrane. These latent pathogens can subsequently transform into heat or dampness, leading to the depletion of lung qi and impairing the lung′s ability to regulate and transport body fluids. Consequently, fluids may seep into the pulmonary micro-membrane, where they are transformed into dampness, turbidity, and phlegm. The accumulation of damp-turbidity and phlegm obstructs the flow of qi and blood, resulting in blood stasis in the pulmonary collaterals. This stagnation occurring within both the pulmonary micro-membrane and its associated collaterals underlies the development of secondary organizing pneumonia after infection. In severe cases, this condition may progress to pulmonary interstitial fibrosis. The therapeutic approach emphasizes expelling latent pathogens, regulating and dredging the pulmonary micro-membrane, tonifying the healthy qi, and supporting health. Regulating and dredging the pulmonary micro-membrane is a crucial step, with a focus on promoting the flow of lung qi, resolving dampness and phlegm, and activating blood circulation to remove stasis.

Objective:To study the changes in biliary fluid dynamics in patients with hepatolithiasis after cholecystectomy.Methods:The clinical data of 101 patients with hepatolithiasis who underwent percutaneous transhepatic scleroscopic choledochotomy for stone extraction at the First Hospital of Guangzhou Medical University from September 2021 to June 2024 were retrospectively analyzed, among which there were 47 males and 54 females with the age of (51.8±15.7) years. They were divided into two groups based on whether they had undergone previous cholecystectomy or not: cholecystectomy group ( n=53) and non-chole-cystectomy group ( n=48). The pressures in the left hepatic duct, right hepatic duct and lower end of the common bile duct were compared between the two groups, as well as the viscosity of bile at different rates of incision. Results:There were no significant differences in baseline characteristics such as gender, age, and liver function between the two groups (all P>0.05). Compared with the non-cholecystectomy group, the bile viscosity in the cholecystectomy group were significantly lower at shear rates of 1/s, 50/s, and 200/s [1/s: (8.96±1.15) mPa·s vs. (13.13±1.25) mPa·s; 50/s: (2.37±0.18) mPa·s vs. (3.59±0.34) mPa·s; 200/s: (1.82±0.13) mPa·s vs. (2.25±0.15) mPa·s], with statistically significant diffe-rences (all P<0.05). The biliary pressure in the left hepatic duct, right hepatic duct, and lower end of the common bile duct in the cholecystectomy group were significantly higher than that in the non-cholecystectomy group [left hepatic duct: (16.43±7.02) cmH 2O vs. (13.84±5.07) cmH 2O; right hepatic duct: (16.71±7.36) cmH 2O vs. (13.76±5.03) cmH 2O; lower end of the common bile duct: (14.60±6.73) cmH 2O vs. (10.58±4.84) cmH 2O] (1 cmH 2O=0.098 kPa), with statistically significant differences (all P<0.05). Conclusion:Bile viscosity decreases after cholecystectomy in patients with hepatolithiasis, whereas biliary pressure increases at the left and right hepatic ducts and at the lower end of the common bile duct, and these changes may be closely related to the mechanism of hepatolithiasis formation and recurrence.

Objective:To evaluate the clinical outcomes of posterior approach vertebral column resection (VCR) osteotomy combined with titanium mesh bone-graft fusion and internal fixation for the treatment of special type stage IIIb Kummell disease.Methods:Twelve patients (3 males, 9 females) diagnosed with special type stage IIIb Kummell disease at Zhengzhou Orthopedics Hospital between October 2015 and June 2021 were enrolled. The mean age was 59.1±5.6 years (range, 53-67 years). All patients underwent VCR osteotomy, pedicle screw fixation, and posterior bone-graft fusion using titanium mesh. Preoperative and postoperative outcomes were assessed using visual analogue scale (VAS) scores, Oswestry Disability Index (ODI), Japanese Orthopaedic Association (JOA) scores, American Spinal Injury Association (ASIA) grading, Cobb angle correction, and bone graft fusion rate. Intraoperative and postoperative complications were also recorded.Results:All surgeries were completed successfully. The average follow-up duration was 11.6±1.8 months (range, 10-13 months). Significant improvements were observed in VAS scores, ODI, JOA scores, and Cobb angles at both two weeks postoperatively and at the final follow-up ( P<0.05), with no significant differences between the two time points ( P>0.05). The final recovery rates were 79.5% for VAS score, 73.2% for ODI, 72.1% for JOA score, and 77.3% for Cobb angle correction. Neurological function showed marked improvement. One patient developed delayed incision healing due to fat liquefaction but recovered following physical therapy. The remaining 11 patients experienced uneventful wound healing without infection or internal fixation loosening. One patient developed postoperative deep venous thrombosis of the lower limbs, which resolved with drug therapy. Conclusion:Posterior approach VCR combined with titanium mesh bone-graft fusion and internal fixation provides an effective surgical option for stage IIIb Kummell disease characterized by fractured vertebral bodies with only the broken upper and lower endplates remaining.

Objective:To investigate the effect of nuclide distribution with time from the in vivo metabolism based on measurement of radioactive contamination using lung counting method. Methods:The distribution of nuclides in the body with time was calculated on a basis of a single inhalation of aerosols containing 235U and the International Commission of Radiological Protection(ICRP) nuclide metabolism compartment model. A passive efficiency calibration of the lung counter, was performed using the simulation and calculation software Geant4 to obtain the contribution of the tissue or organs of interest to the lung counter, and to investigate the effect of the nuclide distribution on the lung counting method. Results:The time elapsed after inhalation of radionuclides, as well as their physicochemical state, has the effect on their distribution in the body and on the detection efficiency of the lung counter. Radionuclides with smaller particulate sizes have a higher initial retention in the lungs, and those with an activity median aerodynamic diameter (ADAM) of 1 μm contributed more fraction to the lung counter than those with an ADAM of 5 μm. F-type compounds were metabolized more rapidly by the respiratory system, and after 8 h of ingestion, nuclides were distributed in the lungs. F-type compounds were metabolized in the respiratory system at a relatively fast rate, and 8 h after inhalation, the fraction of nuclides retained in the lung contributed no more than 30% to the lung counter. Within 3 d after ingestion of M-type and S-type compounds, radioactive particulats largely deposites in the nasopharyngeal region. With biological metabolization and clearance, the fraction contributed by lung to counter is in rising, and the fraction to the lung counter typically remained larger than 80% after 3 d.Conclusions:Radionuclide metabolization in the body varies with their physicochemical properties and measurement time and site. For estimating internal contamination, consideration should be given to the distribution of nuclides, in order to avoid the overestimation.

Objective To observe the value of MR mDixon-Quant sequence for differentiating chylous and non-chylous pleural effusions.Methods MR mDixon-Quant sequence data of 28 cases of chylous pleural effusion(chylous group)and 18 cases of non-chylous pleural effusion(non-chylous group)were retrospectively analyzed.The average fat fraction(FF)value of pleural effusion and the average FF value of lipid component aggregation area within pleural effusion were measured based on FF maps,respectively.Pearson correlation analysis was used to evaluate the relationships of laboratory indicators and FF values.Receiver operating characteristic curve was plotted,and the area under the curve(AUC)was calculated to evaluate the diagnostic efficacy of FF values measured using the above 2 methods for distinguishing chylous and non-chylous pleural effusions.Results The average FF value of pleural effusion showed moderate or weak positive correlations with triglyceride,total cholesterol and albumin(r=0.727,0.661,0.445,all P＜0.01).Taken 0.95％as the optimal cutoff value,the sensitivity,specificity and AUC of the average FF value of pleural effusion for distinguishing chylous from non-chylous pleural effusions was 85.71％,100％and 0.962,respectively.The average FF value of lipid component aggregation area in pleural effusion exhibited strong,moderate and weak positive correlations with triglyceride,total cholesterol and albumin,respectively(r=0.815,0.739,0.492,all P＜0.01).Taken 0.87％as the optimal cutoff value,the sensitivity,specificity and AUC of the average FF value of lipid component aggregation area in pleural effusion for distinguishing chylous from non-chylous pleural effusions was 92.86％,100％and 0.982,respectively.No significant difference of diagnostic performance was found between these 2 methods(P=0.203).Conclusion MR mDixon-Quant sequence enabled non-invasive discrimination of chylous and non-chylous pleural effusions.The average FF value of lipid component aggregation area could more accurately reflect the fat component of pleural effusion.

Objective:To analyze the factors associated with non-radiographic bone erosion in gout pa-tients,to improve the understanding of bone erosion in gout,and to promote the early detection of bone erosion.Methods:A retrospective analysis was conducted on the medical records of gout patients treated at Beijing Jishuitan Hospital from January 2018 to January 2022.Bone erosion was detectable by ultra-sound but not detected by X-ray as non-radiographic bone erosion;no bone erosion was detected by both ultrasound and joint X-ray as undetected bone erosion.A case-control study was used,and the two groups were matched 1∶2 according to age and sex.The differences between the two groups were com-pared in terms of general information,joint involvement characteristics,laboratory indicators and compli-cations.In the univariate analysis,P＜0.1 was included in the multivariate analysis,and the conditional Logistic regression was used for the multivariate analysis.P＜0.05 was considered to have statistically significant differences.Results:Among the 41 patients with non-radiographic bone erosion,the top three joints with bone erosion before its occurrence were metatarsophalangeal joint(12 cases),ankle(10 ca-ses),and knee(7 cases).There were 82 patients undetected with bone erosion.There were no signifi-cant differences in general information between the two groups(P＞0.05),including age,gender,body mass index,and alcohol consumption history.The characteristics of affected joints in the non-radio-graphic bone erosion group were compared with those in the no bone erosion detected,and the former had more affected joints(P=0.02),and a higher proportion of patients with at least 3 attacks of gout per year(P＜0.001).There were no significant differences in serum uric acid,fasting blood glucose,cholesterol,triglycerides,low-density lipoprotein,high-density lipoprotein,creatinine,homocysteine,white blood cell count,and urine pH between the two groups(P＞0.05).The results of multivariate analysis showed that at least 3 flares of gout per year was an independent risk factor for radiologically negative bone erosion in patients with gout,with an OR(95％CI)of 5.139(1.529-17.271).Conclusion:At least 3 flares of gout per year predicts the occurrence of radiologically negative bone erosion,and these patients should be given more attention to achieving treatment targets.

Objective:To evaluate the clinical efficacy of endoscopic treatment of superficial non-ampullary duodenal adenoma.Methods:A retrospective analysis was performed on the clinical data and follow-up information of patients diagnosed with superficial duodenal non-ampullary adenomas via preoperative endoscopy and treated endoscopically at Peking University First Hospital between January 2013 and January 2024. The overall en bloc resection rate, complete resection rate of the lesion, perioperative complications, and recurrence rates were evaluated. Patients were categorized into three groups based on their treatment modality: endoscopic mucosal resection (EMR)（ n=46）, endoscopic submucosal dissection (ESD)（ n=16）, and modified ESD (ESD with snare, ESD-S)（ n=24）. Comparative analyses were conducted to evaluate operative time, en bloc resection rate, and complete resection rate among the three groups. Results:Among 86 patients, the overall en bloc and complete resection rates were 87.2% (75/86) and 86.0% (74/86), respectively. No case of delayed bleeding was observed during the perioperative period. Intraoperative perforation occurred in two patients, both of whom improved following conservative management. Delayed perforation was noted in four patients, and three of them were successfully managed with surgical intervention, while one case was resolved after conservative treatment. During the follow-up period, local recurrence was identified in two patients. Following re-treatment with endoscopy and continuous surveillance, no further recurrence was observed. The operative times for the EMR group, ESD-S group, and ESD group were 4 (1-36) minutes, 25 (5-190) minutes, and 46 (5-150) minutes, respectively. Significant differences were observed in operative times among the three groups ( Hc=49.892, P<0.001). The en bloc resection rates for the EMR, ESD-S, and ESD groups were 80.4% (37/46), 91.7% (22/24), and 100.0% (16/16), respectively. The complete resection rates were 80.4% (37/46), 91.7% (22/24), and 93.8% (15/16) for the respective groups. Conclusion:Endoscopic treatment demonstrates favorable efficacy and safety for superficial non-ampullary duodenal adenoma. In addition to traditional EMR and ESD, ESD-S is also an effective procedure for endoscopic treatment of non-ampullary duodenal adenoma.