[Objective] To compare the diagnostic accuracy of three imaging modalities, inlducing CT urography (CTU), contrast-enhanced MRI (CE-MRI), and contrast-enhanced ultrasound (CEUS) in the qualitative diagnosis of renal space-occupying lesions. [Methods] A retrospective analysis was performed on 542 patients with renal lesions confirmed by surgical pathology in our hospital during Jan.2019 and May 2024.The diagnostic results of CTU, CE-MRI and CEUS were compared and analyzed based on the patients' clinical and pathological data. [Results] The diagnostic accuracy rate of CTU, CE-MRI and CEUS were 84.50%, 83.14% and 86.14%, respectively.For the 161 patients who underwent all three examinations, CEUS was significantly more accurate than CTU (84.16% vs. 77.02%, P=0.018), while there was no significant difference between CTU or CEUS and CE-MRI (79.81%) (P>0.05). Further analysis found that for lesions ≤4 cm, the accuracy of the three examinations was as follows: CEUS=CTU 79.55%, CE-MRI 76.14%, with no significant difference (P>0.05). However, for lesions >4 cm, CEUS ranked the first, followed by CE-MRI and CTU (89.73% vs. 84.25% vs. 73.97%), and CEUS and CE-MRI were better than CTU (P<0.05). Additionally, for the diagnosis of clear cell renal carcinoma and benign renal space-occupying lesions, there was no statistically significant difference among the three imaging modalities (P>0.05), while for the qualitative diagnosis of non-clear cell renal carcinoma, CEUS ranked the first, followed by CE-MRI and CTU (83.87% vs. 74.19% vs. 56.45%), and CE-MRI and CEUS were better than CTU (P<0.05). [Conclusion] All of them have important diagnostic value, and the appropriate selection should be based on patients' specifc conditions.CEUS and CE-MRI are more accurate in the qualitative diagnosis of renal space-occupying lesions than CTU, especially for large lesions and non-clear cell carcinoma.

Objective:To summarize and evaluate the temporal trends of the burden of congenital heart disease (CHD) in China and globally from 1990 to 2021, and to predict the burden of the disease up to 2035.Methods:The Joinpoint regression method was used to study the time trend of congenital heart disease, and the Bayesian age-period-cohort method (BAPC) was used to predict the change in disease burden due to congenital heart disease in China and globally between 2022 and 2035. Results:From 1990 to 2021, the disability-adjusted life years and mortality burdens of congenital heart disease have decreased in China and globally. Although the disease burden is higher in men than in women, the difference is gradually decreasing. BAPC estimates that the burden of congenital heart disease is expected to continue to decline in China and globally in 2022-2035, but congenital heart disease remains a major health problem. China has made remarkable progress in reducing the burden of congenital heart disease, which reflects the positive impact of rapid advances in medical technology and improved public health policies.Conclusion:Although congenital heart disease will remain a significant disease burden over the past three decades and into 2035, it is critical to focus on disease-specific differences to develop more targeted interventions to further reduce the disease burden of congenital heart disease and improve the quality of life and living standards of patients.

Objective:To explore the advantages of individualized 3D-printed vaginal cylinder template-guided interstitial brachytherapy (3D-p-VC-ISBT) in locally advanced cervical cancer, aiming to provide reference for clinical adaptive brachytherapy.Methods:Clinical data of 20 patients with locally advanced cervical cancer admitted to Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from September, 2021 to August, 2023 were retrospectively analyzed. The median age was 54 years old (32-69 years). Among them, 3 patients were diagnosed with adenocarcinoma and 17 cases of squamous cell carcinoma. According to the treatment method, all patients were divided into intracavitary brachytherapy group (ICBT-plan group, n=10) and 3D-p-VC-ISBT group (3D-p-VC-ISBT treatment-plan group, n=10). A pretreatment plan was designed for each patient undergoing 3D-p-VC-ISBT. The pretreatment plans were formed as the pretreatment-plan group. Dose volume histogram was used to evaluate dose distribution of the targets and organs at risk (OAR). Comparison between two groups was analyzed by Mann-Whitney test and comparison among three treatment plans (ICBT, 3D-p-VC-ISBT treatment-plan and 3D-p-VC-ISBT pretreatment-plan) was analyzed by Kruskal-Wallis test. Results:The mean D 90rel (representing the dose received by 90% volume of the target area divided by the prescription dose) of high-risk clinical target volume (HR-CTV) in 3D-p-VC-ISBT, pretreatment-plan and ICBT-plan groups were 100.47%, 104.66% and 85.91%, respectively. The conformity indexes were 0.66, 0.72 and 0.68, respectively. There was no significant difference in D 0.01 cm3, D 2 cm3 and D 5 cm3 of bladder, rectum and sigmoid colon among the three groups (all P>0.05). For the 3D-p-VC-ISBT treatment-plan group, the D 2 cm3 values of the small intestine at 6 Gy and 7 Gy prescription doses were 169.51 cGy and 111.93 cGy respectively, which were superior to those of the ICBT-plan group (343.07 cGy at 6 Gy prescription, P<0.01). Conclusions:Individualized 3D-p-VC-ISBT is superior to ICBT in terms of dose distribution of HR-CTV, and it can adaptively adjust the insertion plan according to changes in tumor volume and position, making the operation safer and more efficient.

Objective:To compare the efficacy and safety of extended-field versus reduced-field radiotherapy in upper tract urothelial carcinoma (UTUC) patients after radical operation.Methods:A retrospective analysis was conducted on the data of 210 UTUC patients who underwent full-length nephrectomy and received postoperative adjuvant radiotherapy in Peking University First Hospital from January 2013 to November 2023, and follow-up continued until June 2024. According to the target area of postoperative radiotherapy, patients were divided into the extended-field radiotherapy group (127 cases) and the reduced-field radiotherapy group (83 cases). The overall survival (OS), distant metastasis free survival (DMFS), local recurrence free survival (LRFS) and adverse reactions were compared. In the same period, 114 patients with recurrent abdominal and pelvic lymph nodes who did not receive adjuvant therapy after surgery for UTUC in our center were prospectively collected, and the coverage of the reduced-field target area was analyzed. Chi square test was used to compare the clinical characteristics, Kaplan-Meier method was used to analyze survival outcomes, log-rank test was used to compare the survival rate, and Cox multivariate regression analysis was performed on the influencing factors of survival.Results:The median follow-up was 24.5 (range: 3-74) months. There were no significant differences between the extended-field and reduced-field radiotherapy groups in terms of 2-year LRFS (93.3% vs. 98.1%, P=0.156), 2-year DMFS (84.8% vs. 91.2%, P=0.176), and 2-year OS (90.4% vs. 90.7%, P=0.707). The most common toxicities of adjuvant radiotherapy were nausea and leukopenia, with significantly higher grade 1-2 incidence in the extended-field group compared to the reduced-field group ( P<0.05). According to the analysis of patients with retroperitoneal lymph node recurrence after surgery, the reduced-field target designed according to the location of the primary tumor can cover more than 90% of the postoperative metastatic lymph node area Multivariate analysis revealed that variant histology ( HR=2.180,95% CI: 1.021-4.658, P=0.044) was an independent predictor of worse DMFS, while variant histology ( HR=3.825,95% CI: 1.514-9.662, P=0.005) and T 3-4 stage ( HR=4.452,95% CI: 1.025-19.339, P=0.046) were independent predictors of poorer OS. Conclusions:Compared with extended-field radiotherapy, reduced-field radiotherapy designed based on primary tumor location significantly reduced treatment-related toxicities without compromising postoperative therapeutic efficacy, and the reduced-field can cover more than 90% of local recurrent lesions.

Objective:To summarize and evaluate the temporal trends of the burden of congenital heart disease (CHD) in China and globally from 1990 to 2021, and to predict the burden of the disease up to 2035.Methods:The Joinpoint regression method was used to study the time trend of congenital heart disease, and the Bayesian age-period-cohort method (BAPC) was used to predict the change in disease burden due to congenital heart disease in China and globally between 2022 and 2035. Results:From 1990 to 2021, the disability-adjusted life years and mortality burdens of congenital heart disease have decreased in China and globally. Although the disease burden is higher in men than in women, the difference is gradually decreasing. BAPC estimates that the burden of congenital heart disease is expected to continue to decline in China and globally in 2022-2035, but congenital heart disease remains a major health problem. China has made remarkable progress in reducing the burden of congenital heart disease, which reflects the positive impact of rapid advances in medical technology and improved public health policies.Conclusion:Although congenital heart disease will remain a significant disease burden over the past three decades and into 2035, it is critical to focus on disease-specific differences to develop more targeted interventions to further reduce the disease burden of congenital heart disease and improve the quality of life and living standards of patients.

Objective:To explore the advantages of individualized 3D-printed vaginal cylinder template-guided interstitial brachytherapy (3D-p-VC-ISBT) in locally advanced cervical cancer, aiming to provide reference for clinical adaptive brachytherapy.Methods:Clinical data of 20 patients with locally advanced cervical cancer admitted to Renji Hospital affiliated to Shanghai Jiao Tong University School of Medicine from September, 2021 to August, 2023 were retrospectively analyzed. The median age was 54 years old (32-69 years). Among them, 3 patients were diagnosed with adenocarcinoma and 17 cases of squamous cell carcinoma. According to the treatment method, all patients were divided into intracavitary brachytherapy group (ICBT-plan group, n=10) and 3D-p-VC-ISBT group (3D-p-VC-ISBT treatment-plan group, n=10). A pretreatment plan was designed for each patient undergoing 3D-p-VC-ISBT. The pretreatment plans were formed as the pretreatment-plan group. Dose volume histogram was used to evaluate dose distribution of the targets and organs at risk (OAR). Comparison between two groups was analyzed by Mann-Whitney test and comparison among three treatment plans (ICBT, 3D-p-VC-ISBT treatment-plan and 3D-p-VC-ISBT pretreatment-plan) was analyzed by Kruskal-Wallis test. Results:The mean D 90rel (representing the dose received by 90% volume of the target area divided by the prescription dose) of high-risk clinical target volume (HR-CTV) in 3D-p-VC-ISBT, pretreatment-plan and ICBT-plan groups were 100.47%, 104.66% and 85.91%, respectively. The conformity indexes were 0.66, 0.72 and 0.68, respectively. There was no significant difference in D 0.01 cm3, D 2 cm3 and D 5 cm3 of bladder, rectum and sigmoid colon among the three groups (all P>0.05). For the 3D-p-VC-ISBT treatment-plan group, the D 2 cm3 values of the small intestine at 6 Gy and 7 Gy prescription doses were 169.51 cGy and 111.93 cGy respectively, which were superior to those of the ICBT-plan group (343.07 cGy at 6 Gy prescription, P<0.01). Conclusions:Individualized 3D-p-VC-ISBT is superior to ICBT in terms of dose distribution of HR-CTV, and it can adaptively adjust the insertion plan according to changes in tumor volume and position, making the operation safer and more efficient.

Objective:To compare the efficacy and safety of extended-field versus reduced-field radiotherapy in upper tract urothelial carcinoma (UTUC) patients after radical operation.Methods:A retrospective analysis was conducted on the data of 210 UTUC patients who underwent full-length nephrectomy and received postoperative adjuvant radiotherapy in Peking University First Hospital from January 2013 to November 2023, and follow-up continued until June 2024. According to the target area of postoperative radiotherapy, patients were divided into the extended-field radiotherapy group (127 cases) and the reduced-field radiotherapy group (83 cases). The overall survival (OS), distant metastasis free survival (DMFS), local recurrence free survival (LRFS) and adverse reactions were compared. In the same period, 114 patients with recurrent abdominal and pelvic lymph nodes who did not receive adjuvant therapy after surgery for UTUC in our center were prospectively collected, and the coverage of the reduced-field target area was analyzed. Chi square test was used to compare the clinical characteristics, Kaplan-Meier method was used to analyze survival outcomes, log-rank test was used to compare the survival rate, and Cox multivariate regression analysis was performed on the influencing factors of survival.Results:The median follow-up was 24.5 (range: 3-74) months. There were no significant differences between the extended-field and reduced-field radiotherapy groups in terms of 2-year LRFS (93.3% vs. 98.1%, P=0.156), 2-year DMFS (84.8% vs. 91.2%, P=0.176), and 2-year OS (90.4% vs. 90.7%, P=0.707). The most common toxicities of adjuvant radiotherapy were nausea and leukopenia, with significantly higher grade 1-2 incidence in the extended-field group compared to the reduced-field group ( P<0.05). According to the analysis of patients with retroperitoneal lymph node recurrence after surgery, the reduced-field target designed according to the location of the primary tumor can cover more than 90% of the postoperative metastatic lymph node area Multivariate analysis revealed that variant histology ( HR=2.180,95% CI: 1.021-4.658, P=0.044) was an independent predictor of worse DMFS, while variant histology ( HR=3.825,95% CI: 1.514-9.662, P=0.005) and T 3-4 stage ( HR=4.452,95% CI: 1.025-19.339, P=0.046) were independent predictors of poorer OS. Conclusions:Compared with extended-field radiotherapy, reduced-field radiotherapy designed based on primary tumor location significantly reduced treatment-related toxicities without compromising postoperative therapeutic efficacy, and the reduced-field can cover more than 90% of local recurrent lesions.

Objective To study the changes of blood glutathione peroxidase (GSH-px),superoxide dis-mutase (SOD),malondialdehyde (MDA) and pathological tissues in the rat contrast-induced nephropathy (CIN) model,and to determine the role of oxidation mechanism in CIN.Methods A total of 40 adult male SD rats were selected and divided into three big groups and five small groups.After constructing the model,six rats with good status were taken from each group for conducting the experiment.The serum GSH-px,SOD and MDA levels were measured,the renal tissue biopsy was performed and the morphological changes of kid-ney cells were compared.Results There was no statistically significant difference in the baseline data among the blank control group,the control group and the experimental group (P>0.05).There was no statistically significant difference in serum GSH-px,SOD and MDA levels before model construction,at 24,48 h after model construction between the blank control group and the control group (P>0.05).There were statistical-ly significant differences in serum GSH-px,SOD and MDA levels of the experimental group between before model construction and after model construction (P<0.05).There was no statistically significant difference in serum GSH-px,SOD and MDA level in the experimental group between at 24 h after modelling and 48 h af-ter modeling (P>0.05).There was no statistically significant difference in serum GSH-px,SOD and MDA levels at 24 h after modeling among the three groups (P>0.05).There were statistically significant differ-ences in serum GSH-px,SOD and MDA levels at 48 h after modeling among the three groups and their pairs (P<0.05).The pathological sections of the blank control group and control group showed no obvious abnor-mal changes in glomeruli,renal tubule and renal interstitium.Renal interstitial fibrosis and inflammatory cell infiltration were seen after 24 h in the experimental group,but there was no obvious change in the renal tu-bules.After 48 h,moderate focal-like atrophy of renal tubules,epithelial cell granule degeneration and vacuolar changes were obviously seen.Conclusion The oxidative stress mechanism plays a role in CIN.The contrast a-gent acute renal injury mainly acts on the renal tubules and renal interstitium,and there is no obvious damage to the glomeruli.

Objective To evaluate effects of flush fluid of different temperatures on pain, comfort and adverse reactions in patients receiving choledochoscopy via T tube for residual bile duct stones. Methods Patients who underwent choledochoscopy were divided into the experimental group ( 36℃ saline was used as flush fluid) and control group ( room temperature saline was used as flush fluid) randomly. Pain degree, comfort degree, procedure time, the total amount of flush fluid, infusion speed and adverse reactions were recorded and analyzed. Results A total of 100 cases were included, 50 cases in each group. There was no significant difference between the two groups in their education level, working condition, operation methods, T-tube size, necessity for lithotripsy, procedure time, total amount of flush fluid and infusion speed (all P>0. 05). The pain scores were 1. 0(1. 00, 2. 00) and 2. 0(1. 00, 3. 25) (Z=-2. 158,P=0. 031) and the comfort scores were 6. 0(5. 00, 7. 25) and 5. 0(2. 00, 6. 00) (Z=-3. 384,P=0. 001) in the experimental group and the control group, respectively. There was significant difference in the change rate of heart rate during and before procedure between the two groups (-4. 07％± 10. 76％ VS 0. 30％± 10. 23％, P=0. 046) . The incidence of postoperative diarrhea in the experimental group and the control group was 6％( 3/50) and 22％ ( 11/50 ) , respectively (χ2=5. 316, P=0. 021 ) . Conclusion 36℃ saline flush can reduce pain scores, improve comfort degree and reduce the incidence of postoperative diarrhea after procedure in patients undergoing choledochoscopy via T tube.