Objective To explore the feasibility of peritoneal dialysis catheter placement assisted by flexible ureteroscope.Methods A retrospective analysis was conducted on clinical data of 54 cases of end-stage renal disease receiving peritoneal dialysis catheter placement from May 2019 to March 2023.The placement method was chosen by the patient.In the conventional group,23 cases were guided by a metal guide wire for insertion of the peritoneal dialysis catheter,while in the flexible ureteroscope group,31 cases were guided by flexible ureteroscope instead of guide wire for insertion of the peritoneal dialysis catheter.The success rate of catheterization,surgical time,use of postoperative analgesic,complications related to peritoneal dialysis catheter,and postoperative creatinine decrease were compared between the two groups.Results The catheter placement was successfully performed in both groups.The total incidence of complications related to peritoneal dialysis catheter in the flexible ureteroscope group was lower than that in the conventional group[6.5%(2/31)vs.30.4%(7/23),χ2 =3.878,P =0.049].Between the conventional group and the flexible ureteroscope group,there were no statistically significant differences in the surgical time,postoperative analgesic usage,and the decrease of creatinine at 2 weeks after surgery(P>0.05).The median postoperative follow-up period was10 months(range,3-24 months)in the two groups,and there were no complications such as peritoneal leakage,intestinal perforation,or intraperitoneal bleeding.Conclusion The placement of peritoneal dialysis catheter guided by the flexible ureteroscope instead of metal guide wire is a safe,visible,and accurate method,which can reduce complications related to peritoneal dialysis catheter,and detect and manage comorbidities in the abdominal cavity.

Objective:To retrospectively analyze the treatment status of tyrosine kinase inhibitors (TKI) in newly diagnosed patients with chronic myeloid leukemia (CML) in China.Methods:Data of chronic phase (CP) and accelerated phase (AP) CML patients diagnosed from January 2006 to December 2022 from 77 centers, ≥18 years old, and receiving initial imatinib, nilotinib, dasatinib or flumatinib-therapy within 6 months after diagnosis in China with complete data were retrospectively interrogated. The choice of initial TKI, current TKI medications, treatment switch and reasons, treatment responses and outcomes as well as the variables associated with them were analyzed.Results:6 893 patients in CP ( n=6 453, 93.6%) or AP ( n=440, 6.4%) receiving initial imatinib ( n=4 906, 71.2%), nilotinib ( n=1 157, 16.8%), dasatinib ( n=298, 4.3%) or flumatinib ( n=532, 7.2%) -therapy. With the median follow-up of 43 ( IQR 22-75) months, 1 581 (22.9%) patients switched TKI due to resistance ( n=1 055, 15.3%), intolerance ( n=248, 3.6%), pursuit of better efficacy ( n=168, 2.4%), economic or other reasons ( n=110, 1.6%). The frequency of switching TKI in AP patients was significantly-higher than that in CP patients (44.1% vs 21.5%, P<0.001), and more AP patients switched TKI due to resistance than CP patients (75.3% vs 66.1%, P=0.011). Multi-variable analyses showed that male, lower HGB concentration and ELTS intermediate/high-risk cohort were associated with lower cytogenetic and molecular responses rate and poor outcomes in CP patients; higher WBC count and initial the second-generation TKI treatment, the higher response rates; Ph + ACA at diagnosis, poor PFS. However, Sokal intermediate/high-risk cohort was only significantly-associated with lower CCyR and MMR rates and the poor PFS. Lower HGB concentration and larger spleen size were significantly-associated with the lower cytogenetic and molecular response rates in AP patients; initial the second-generation TKI treatment, the higher treatment response rates; lower PLT count, higher blasts and Ph + ACA, poorer TFS; Ph + ACA, poorer OS. Conclusion:At present, the vast majority of newly-diagnosed CML-CP or AP patients could benefit from TKI treatment in the long term with the good treatment responses and survival outcomes.

Objective To investigate the clinical experience of cochlear implantation(CI)in patients with postlingual hearing loss accompanied by cholesterol granuloma(CG)in the middle ear.Methods A retrospective study was conducted on the clinical data of 6 patients with postlingual hearing loss who underwent CI with middle ear CG at Fuyang hospital of Anhui Medical University from December 2018 to December 2022.The selection of surgical methods,surgical efficacy,and postoperative complications of patients undergoing CI surgery during the same period were summarized and analyzed.The categories of auditory performance(CAP)and speech intelligibility rating(SIR)were used to evaluate the effectiveness of auditory speech rehabilitation.Results Six patients were treated by individualized surgical methods based on preoperative CT findings and successfully completed cochlear im-plant surgery.According to the scope of the lesion,three patients were treated with canal wall up mastoidectomy(CWUM)and CI,the other three patients were treated with radical mastoidectomy(RM),CI and middle ear clo-sure(MEC).All patients did not experience complications such as incision infection,facial paralysis,labyrinthitis,intracranial infection,recurrence,or electrode exposure after surgery and during follow-up.The CAP and SIR scores of postoperative patients were significantly improved compared to preoperative with statistical significance(P＜0.05).Conclusion For patients with severe sensorineural hearing loss and middle ear CG,simultaneous cochlear implantation can achieve good auditory rehabilitation effects.However,appropriate surgical methods should be se-lected based on the lesion range,and the lesion must be completely removed to prevent postoperative complications.

3 cases with dental implant entered into the maxillary sinus by accident during posterior maxillary dental implant surgery were reported in this work.The implants were localized by CBCT scanning and removed by endoscope assisted extraction through the refined Cald-well-Luc approach under local anesthesia.The results showed that all 3 implants were successfully removed,highlighting the efficacy of en-doscopic-assisted techniques in minimizing trauma,ensuring accurate positioning and providing a clear surgical field of vision.

Despite exciting achievements with some malignancies, immunotherapy for hypoimmunogenic cancers, especially glioblastoma (GBM), remains a formidable clinical challenge. Poor immunogenicity and deficient immune infiltrates are two major limitations to an effective cancer-specific immune response. Herein, we propose that an injectable signal-amplifying nanocomposite/hydrogel system consisting of granulocyte-macrophage colony-stimulating factor and imiquimod-loaded antigen-capturing nanoparticles can simultaneously amplify the chemotactic signal of antigen-presenting cells and the "danger" signal of GBM. We demonstrated the feasibility of this strategy in two scenarios of GBM. In the first scenario, we showed that this simultaneous amplification system, in conjunction with local chemotherapy, enhanced both the immunogenicity and immune infiltrates in a recurrent GBM model; thus, ultimately making a cold GBM hot and suppressing postoperative relapse. Encouraged by excellent efficacy, we further exploited this signal-amplifying system to improve the efficiency of vaccine lysate in the treatment of refractory multiple GBM, a disease with limited clinical treatment options. In general, this biomaterial-based immune signal amplification system represents a unique approach to restore GBM-specific immunity and may provide a beneficial preliminary treatment for other clinically refractory malignancies.

The condition of patients with severe traumatic brain injury (sTBI) complicated by corona virus 2019 disease (COVID-19) is complex. sTBI can significantly increase the probability of COVID-19 developing into severe or critical stage, while COVID-19 can also increase the surgical risk of sTBI and the severity of postoperative lung lesions. There are many contradictions in the treatment process, which brings difficulties to the clinical treatment of such patients. Up to now, there are few clinical studies and therapeutic norms relevant to sTBI complicated by COVID-19. In order to standardize the clinical treatment of such patients, Critical Care Medicine Branch of China International Exchange and Promotive Association for Medical and Healthcare and Editorial Board of Chinese Journal of Trauma organized relevant experts to formulate the Chinese expert consensus on clinical treatment of adult patients with severe traumatic brain injury complicated by corona virus infection 2019 ( version 2023) based on the joint prevention and control mechanism scheme of the State Council and domestic and foreign literatures on sTBI and COVID-19 in the past 3 years of the international epidemic. Fifteen recommendations focused on emergency treatment, emergency surgery and comprehensive management were put forward to provide a guidance for the diagnosis and treatment of sTBI complicated by COVID-19.

Objective:To explore the clinical safety and efficacy of transurethral oral mucosa urethroplasty for urethral meatus and navicular fossa stricture reconstruction.Methods:Retrospective analysis of 9 patients who underwent transurethral repair of urethral meatus and navicular fossa stricture by oral mucosa in our hospital from October 2021 to December 2022. The average age was (58.4±10.4) years old. 5 patients had a history of transurethral endoscopic surgery, 2 had penile lichen sclerosis, and 2 had no obvious causes. Nine patients were diagnosed with urethral meatus and navicular fossa stricture through retrograde urethrography before surgery. The average maximum preoperative urine flow rate was(3.2±0.7)ml/s. Surgical procedure: The incision was firstly made at 6 o'clock using ophthalmic scalpel, the entire layer of urethral scar was opened, and gradually penetrated into the urethral cavity until it reached the normal mucosa of the urethra. A fan-shaped wound was obtained by cutting the scar of 4 to 8 o'clock. The enlarged urethral lumen could smoothly pass through the F24 urethral probe. Measure the stricture length and width, and trim the oral mucosa to the appropriate shape. One arm of the 5-0 absorbable suture passed through the tip of the oral mucosal flap and the normal urethral mucosa outside the apex of the urethral fan-shaped wound, and then passed through the skin on the ventral side of the penis. The other arm of the suture passed through the apex of the fan-shaped wound and passes through the skin on the ventral side of the penis. Tighten the suture to bring the oral mucosa into the urethral cavity and cover the wound surface. If the narrow length was longer, we could suture three stitches to fix the oral mucosa with the V-shaped apex of the fan-shaped wound in a similar way, and the rest could be sutured and fixed with the urethral wound edge in direct vision. The actual measured average length of urethral stricture during the surgery was(1.6±0.5) cm. The appearance of the glans penis, stricture recurrence, maximum urine flow rate, and patient's urination symptoms were recorded after surgery 1 to 3 months. Functional success was defined as the lack of patient reported obstructive voiding symptoms, satisfaction with the appearance of the glans penis, and a slit like external urethral orifice.Results:All 9 patients successfully completed the surgery and the average maximum urine flow rate was(21.5±3.7)ml/s after 3 months of follow up. The overall successful rate was 100%.One patient experienced spraying urination 1 month later after removing the catheter. Examination revealed that protrusion and separation were found at the urethral anastomosis, and symptoms disappeared after urethral dilation. The other patients did not have any obvious complications, satisfactory with the appearance of the penis head and urination.Conclusions:Transurethral oral mucosal repair of urethral meatus and navicular fossa stricture could be a safe, and effective surgical method. It not only solves the problem of urination, but also takes into account the cosmetic effect of penis.

Objective: To explore the treatment effects of domestic auricular orthosis on children born with congenital auricular deformity. Methods: Children born with congenital auricle deformity were treated by "Yi Er" auricle orthosis, included 42 ears of 29 cases.These children were divided into three groups according to the birth age. The age less than 7 days was divided into group 1, 7-42 days for group 2, and more than 42 days for group 3. Compare the therapeutic effect of children in different ages. Results: The therapeutic effect was divided into three grades: markedly effective and cured (basically return to normal appearance); effective (improved, but not reached the normal appearance); invalid (no improvement after treatment). The markedly effective and cured rate in group 1, group 2 and group 3 were 100%, 85.7% and 45.0%, the difference was statistically significant(P<0.05), and the average correction time was(20.75±6.50)d, (32.64±15.40)d, (48.23±17.32) d, the difference was statistically significant(P<0.05). Conclusions The domestic auricle orthosis has a significant effect on the correction of children born with congenital auricular deformity. The better treatment effect and the shorter wearing time can be acquired in the early correction.

Abnormal liver function in pregnancy is a common clinical problem in the department of obstetrics and liver disease, but its severity can cause danger to the life of the mother and fetus. Therefore, the different cause of abnormal liver function in pregnancy should be assessed accurately in order to take early intervention measures. Moreover, it is necessary to comprehensively evaluate the situation of both mother and fetus to obtain the optimal treatment effect for abnormal liver function caused by different types of pregnancy-related liver diseases.

Objective: To investigate the changes of accumulated dose in target area and organs at risk (OARs) for radiotherapy of left breast cancer by deformable and rigid image registration. Methods: A total of 16 left breast cancer patients treated with 6 MV X-ray IMRT were analyzed retrospectively. All targets included the lymph node drainage area and the chest wall. All patients underwent simulation of the primary positioning and repositioning to obtain CT images. Primary and secondary treatment plans were developed using primary positioning CT (CT1) and repositioning CT (CT2), denoted as Plan1 and Plan2 respectively. The dose distribution of Plan2 was mapped to CT1 with rigid and deformable registration from CT2 to CT1 and then added to the dose distribution of Plan1 to obtain Plan-rigid and Plan-deform, respectively. The dosimetric differences between targets and the OARs of the four plans were compared. Results: The CTV volume on CT2 was reduced by 6.64% from that on CT1. The homogeneity index (HI) increased by 23.05% after deformation-based accumulation. The Dice similarity coefficients (DSCs) of the heart, left lung and right lung were lower than those before deformable registration (0.94±0.01 vs. 0.89±0.05, 0.96±0.01 vs. 0.91±0.03, and 0.96±0.01 vs. 0.92±0.03, respectively), and the differences were statistically significant (Z=-3.208, -3.533, -3.535, P<0.05). There were no significant differences in dose-volume indices of heart and left lung between Plan1 with other plans(P>0.05), while the dose-volume indices in Plan-rigid were higher than that in Plan-deform. Conclusions Rigid registration is recommended in patients undergoing radical resection of left breast cancer with little change in the volume and dose-volume index of the target area and organs at risk. The dose-volume index of the initial intensity modulation plan can basically reflect the dose-volume statistics of both lungs and heart.