Objective: To investigate the efficacy and safety of intelligent temperature-pressure-controlled flexible ureteroscopy combined with negative-pressure suction sheath lithotripsy in the treatment of upper urinary tract stones ≤2.5 cm. Methods: The clinical data of 225 patients with ≤2.5 cm upper urinary tract stones treated with this surgical method in our department during Aug. 2023 and Jul. 2024 were retrospectively analyzed. The patients were divided into the dual-control group (n=36) and conventional group (n=189) according to whether or not the intelligent temperature and pressure control device was used during operation. In the dual-control group，the intraoperative temperature and pressure in the renal pelvis were monitored and controlled in real time by the temperature and pressure sensors distributed at the end of the ureteral soft lens. The perioperative parameters，stone-removal rate，complication rate and renal function were compared between the two groups. Results: All operations were successfully completed in both groups. The postoperative procalcitonin (PCT) level [(22.75±5.85) ng/L vs. (29.08±6.60) ng/L，P=0.001]，difference in the white blood cell (WBC) level [(0.24±2.12)×10 cells/L vs. (1.19±2.17)×10 cells/L，P=0.016]，incidence of fever (2.8% vs. 16.9%，P=0.028) and overall complication rate (5.6% vs. 19.6%，P=0.042) were significantly lower in the dual-control group than in the conventional group，while the stone-clearance rate was slightly higher (88.9% vs. 82.5%，P=0.346)，with no significant difference. Conclusion: For upper urinary tract stones ≤2.5 cm，intelligent temperature-pressure-controlled ureteroscopy combined with negative-pressure suction sheath lithotripsy has a satisfactory stone-removal rate and a low rate of complications，which is worthy of clinical promotion.

ObjectiveTo investigate the preventive and therapeutic effects of Tiaogan Huaxian pills combined with entecavir on hepatic fibrosis in chronic hepatitis B with liver Qi stagnation， spleen deficiency， and blood stasis syndrome and its effect on diffusion-weighted imaging （DWI）. MethodClinical data of 117 patients with liver disease who visited the Department of Hepatology at the First Affiliated Hospital of Guangxi University of Chinese Medicine from January 2021 to April 2022 were retrospectively analyzed. According to different treatment plans， they were divided into a control group （59 cases） and a treatment group （58 cases）. Both groups of patients received entecavir-based etiology treatment， and the treatment group added Tiaogan Huaxian pills on the basis of basic treatment. Both groups were treated for 24 weeks. Before and after treatment， the two groups were compared in terms of alanine aminotransferase （ALT）， advanced surgical technologies （AST）， total bilirubin （TBil）， hepatitis B virus （HBV）-DNA conversion rate， liver stiffness measurement （LSM）， four items of liver fibrosis （hyaluronidase， type Ⅲ pro-collagen， type Ⅳ collagen， and laminin）， the fibrosis index based on four factors （FIB-4）， the aspartate aminotransferase to platelet ratio index （APRI）， the apparent diffusion coefficient （ADC） value in magnetic resonance imaging （MRI）， and traditional Chinese medicine symptom scores， so as to analyze the efficacy of the two groups. ResultBefore treatment， there was no significant difference in ALT， AST， TBil， LSM， four items of liver fibrosis， FIB-4， APRI， HBV-DNA conversion rate， ADC value， and traditional Chinese medicine symptom scores between the two groups. After treatment， both groups of patients showed significant reductions in ALT， AST， TBil， LSM， hyaluronidase， type Ⅲ pro-collagen， type Ⅳ collagen， laminin， FIB-4， and APRI （P<0.05） and a significant increase in ADC value （P<0.05） and HBV-DNA conversion rate （P<0.01）. The traditional Chinese medicine symptom score of the treatment group decreased significantly （P<0.05）. Compared with the control group after treatment， the effective rate of clinical traditional Chinese medicine in the treatment group was 91.38% （53/58）， which was significantly higher than that of the control group （54.23%， 32/59） （Z=-4.325， P<0.01）. In the treatment group， ALT， AST， TBil， LSM， hyaluronidase， type Ⅲ pro-collagen， type Ⅳ collagen， laminin， FIB-4， APRI， and traditional Chinese medicine symptom scores all decreased significantly （P<0.05）， and the increase in ADC values was more significant （P<0.05）， while the difference in HBV-DNA conversion rate was not statistically significant. There were no serious adverse reactions or events in either group. ConclusionTiaogan Huaxian pills combined with entecavir have significant clinical efficacy in the treatment of hepatic fibrosis in chronic hepatitis B， which can reduce liver inflammation activity， delay hepatic fibrosis progression， and reduce traditional Chinese medicine symptom scores. It is worthy of clinical promotion and application.

BACKGROUND:In vitro lymphocyte proliferation test is often used to detect the potential immunogenicity of medical devices,but no detailed extraction conditions and dose are given in the relevant standards. OBJECTIVE:To investigate the effects of different extraction conditions of the test product and different doses of the extract on in vitro human lymphocyte proliferation,and to consider the factors that need to be considered when selecting test conditions for in vitro lymphocyte proliferation test. METHODS:In the experiment,the homogenous bone repair material and heparin-modified intraocular lens were divided into the following 12 groups:(1)Experimental group 1:24-hour complete medium(RPMI modified medium containing 10%fetal bovine serum)extract of 200 μL + lymphocyte suspension of 50 μL;(2)negative control group 1:24-hour complete medium 200 μL + lymphocyte suspension 50 μL;(3)experimental group 2:24-hour complete medium extract 100 μL + lymphocyte suspension 100 μL;(4)negative control group 2:24-hour complete medium 100 μL + lymphocyte suspension 100 μL;(5)experimental group 3:72-hour RPMI modified medium extract(addition of 10%fetal bovine serum before experiment)200 μL + lymphocyte suspension 50 μL;(6)negative control group 3:72-hour RPMI modified medium(addition of 10%fetal bovine serum before experiment)200 μL + lymphocyte suspension 50 μL;(7)experimental group 4:72-hour RPMI modified medium extract(addition of 10%fetal bovine serum before experiment)100 μL + lymphocyte suspension 100 μL;(8)negative control group 4:72-hour RPMI modified medium(addition of 10%fetal bovine serum before experiment)100 μL + lymphocyte suspension 100 μL;(9)positive control group 1:complete medium containing 10 μg/mL plant hemagglutinin-M 200 μL + lymphocyte suspension 50 μL;(10)positive control group 2:complete medium containing 10 μg/mL plant hemagglutinin-M 100 μL + lymphocyte suspension 100 μL;(11)blank control group 1:250 μL complete medium;(12)control group 2:200 μL complete medium.After 3 days of culture,the proliferation of lymphocytes was detected by CCK-8 assay. RESULTS AND CONCLUSION:(1)Under different test conditions,the extracts of the allogeneic bone repair material could enhance the activity of human lymphocytes.Under the condition of 72-hour leaching in RPMI modified medium and the volume ratio of leaching solution and lymphocyte suspension was 4:1,the most significant effect was observed.Heparin-modified intraocular lens extract also had obvious inhibitory effect on lymphocyte activity under this condition;its inhibitory effect on lymphocyte activity may be related to the heparin in the extract.However,the activity of lymphocytes was slightly enhanced by heparin-modified intraocular lens extract under the experimental conditions of complete medium extraction for 24 hours and the volume ratio of extract to lymphocyte suspension was 4:1.(2)Under different extraction conditions and doses,the results of in vitro lymphocyte proliferation test may be quite different.The selection of test conditions should be combined with the clinical application of the product,and the inherent characteristics of the product should also be considered.

BACKGROUND:There is no consensus on the optimal bone tunnel position in the lateral clavicle,which guides coracoclavicular ligament reconstruction.Postoperative complications such as enlargement of the lateral clavicle bone tunnel,bone osteolysis,clavicle fracture,and failure of internal fixation are likely to occur.Bone mass density plays an important role in the strength and stability of endophytic fixation.Regional differences in the bone mass density of the distal clavicle should not be overlooked in the repair and reconstruction of acromioclavicular dislocation.Currently,there are no quantitative clinical studies in humans regarding the bone mass density of the distal clavicle. OBJECTIVE:To measure the magnitude of bone mass density in different regions of the distal clavicle by quantitative CT to provide a reference for surgeons to repair and reconstruct the coracoclavicular ligament. METHODS:101 patients undergoing quantitative CT checking in Fuyang People's Hospital Affiliated to Anhui Medical University from October to December 2022 were enrolled,from which 1 616 samples of subdivisional bone mass density of the distal clavicle were measured.For each of the quantitative CT samples,firstly,the distal clavicle was divided medially to laterally into the following four regions:conical nodal region(region A),inter-nodal region(region B),oblique crest region(region C)and distal clavicular region(region D).Secondly,each region was divided into the first half and the second half to determine eight subdivisions,then setting semiautomatic region of interest(ROI)in each subdivision:(ROI A1,A2,B1,B2,C1,C2,D1,and D2).Thirdly,each quantitative CT scan was transferred to the quantitative CT pro analysis workstation,and cancellous bone mass density was measured in the distal clavicle ROI.Finally,the clavicular cortex was avoided when measuring. RESULTS AND CONCLUSION:(1)There was no statistically significant difference in bone mineral density on the different sides of the shoulder(P＞0.05).(2)The analysis of bone mineral density in eight sub-areas of the distal clavicle A1,A2,B1,B2,C1,C2,D1,and D2 showed statistically significant differences(P＜0.05).It could be considered that there were differences in bone mineral density in different areas of the distal clavicle.After pairwise comparison,there was no statistically significant difference in bone mineral density between A1 and A2,D1 and D2,A2 and B1(P＞0.05),and there was a statistically significant difference in bone mineral density between the other sub-areas(P＜0.05).(3)The bone mineral density in the region A2 of the anatomical insertion of the conical ligament was significantly higher than that in the inter-nodular area(region B)(P＜0.05).The bone mineral density in the region A1 was higher than that in the region A2,but the difference was not statistically significant(P＞0.05).The bone mineral density in the region C1 of the anatomical insertion of the trapezium ligament was higher than that in regions C2,D1 and D2,and the bone mineral density in the inter-nodular area(region B)was significantly higher than that in regions C and D(P＜0.05).(4)These results have suggested that there are differences in bone mass density in different regions of the distal clavicle;regional differences in bone mass density in the distal clavicle during repair and reconstruction of acromioclavicular dislocation cannot be ignored.Consideration should be given not only to biomechanical factors but also to the placement of implants or bone tunnels in regions of higher bone mass density,which could improve the strength and stability of implant fixation and reduce the risk of complications such as bone tunnel enlargement,osteolysis,fracture and implant failure.

Objective To analyze the epidemiological patterns and pathogens of clusters of diarrhea in Xicheng Distract , Beijing during 2017-2022 , in order to update the policy of prevention. Mehods Between January 2017 and December 2022, stool samples of patients and partly cooks in clusters of diarrhea were collected and tested by Real-time PCR for Rotavirus, Norovirus, Adenovirus, Sapovirus and Astrovirus. Part of ORF1/ORF2 from Norovirus positive samples were amplified using RT-PCR. PCR products were sequenced and the genetypes were determined. Results Four hundreds and one clusters of diarrheas were reported. Among them , 369 were reported in kindergartens, primary schools and secondary schools. The morbidities were 4.14, 2.13 and 0.69 per thousand, respectively. Seventy four cooks in 15 clusters of diarrhea were Norovirus positive. The rate was 8.67%. Among these pathogens, Norovirus had the largest proportion , but the trend was declining. At least three kinds of genetype of GⅡ Norovirus were detected every year. Conclusion Clusters of diarrhea mainly occurred in kindergartens, primary schools and secondary schools. Result from the increasing proportions of unknown-cause clusters of diarrhea, the testing methods and scopes of pathogens should be extended. Diverse genetypes of Norovirus coexist and alternate in Beijing. So appearance of new genetypes and recombination of existed ones of Norovirus should be closely concerned.

Objective To investigate associations between three-dimensional(3D)morphology of cervical vertebrae and skeletal mat-uration by cone-beam computed tomography(CBCT)and establish corresponding regression models for quantitatively evaluating cervical vertebral maturation(CVM).Methods The analyzed sample consisted of 358 CBCT images(175 male,183 female),of which 277 images were randomly selected as the model development group and 81 as the performance test group.Twenty-one 3D morphological pa-rameters were defined and measured,incorporating all parts of the cervical vertebrae,including the cervical vertebral bodies,transverse processes,spinous processes,pedicles,lamina,and articular processes.The cervical vertebral maturation index(CVMI)was determined by experienced orthodontists as reference standard.Spearman's rank correlation coefficient and multivariable stepwise regression analysis were used to identify the associations and build regression models.The performance test group was employed to ex-amine each model's reliability.Paired-samples Wilcoxon signed-rank test compared the CVMI of the model prediction with the reference standard.Results Three-dimensional morphological changes in various parts of the cervical vertebrae correlated with CVMI(P＜0.05).Six 3D morphometric parameters were each recognized for male and female models,three of which were identical.The adjusted R2 was 0.899 for males and 0.902 for females,with corresponding accuracies of 85.0%and 85.4%,respectively.These models showed no difference as compared with the reference standard(P＞0.05).Con-clusion New associations were found between 3D morphology of cer-vical vertebrae and skeletal maturation.The 3D-driven morphometric CVM assessment method and corresponding regression models exhibited good credibility and high consistency with experts.

Objective To develop a GPU-based Monte Carlo dose calculation module for helical tomotherapy(TOMO),and integrate it into the commercial software ArcherQA to achieve fast and accurate dose verification in clinic.Methods The TOMO treatment head was modeled using TOPAS to obtain phase space files,and a fast weight tuning algorithm was used to simulate particle transport in multi-leaf collimator for improving computational efficiency,and finally,GPU-based Monte Carlo algorithms in ArcherQA were used to simulate particle transport in patients.To verify the model accuracy,the ArcherQA calculated results in water tank were compared with measured data for different open fields.In addition,multiple comparisons among ArcherQA results,TPS results and ArcCHECK results were conducted on 15 clinical cases(5 cases in the head and neck,5 cases in the chest and abdomen,and 5 cases in the whole body).Results In the water tank tests for 40 cm×5.0 cm,40 cm×2.5 cm and 40 cm× 1.0 cm radiation fields,the average global relative errors of the percentage depth dose,transverse dose distribution,and longitudinal dose distribution calculated by ArcherQA with the corresponding measured values were 0.72％,0.66％,and 0.54％,respectively.Over 98％of the voxels had a global relative error of less than 1％.As for 15 clinical cases,in 2％/2 mm criteria,the mean Gamma passing rate was 98.1％between ArcherQA and TPS,99.1％between TPS and ArcCHECK,and 99.4％between ArcherQA and ArcCHECK.The uncertainty of the simulation maintained less than 1％,and the average time taken for calculation based on patient CT vs ArcCHECK phantom was 87 s vs 64 s.Conclusion ArcherQA can be used for independent dose validation for TOMO plans for it can provide fast and accurate dose calculations.

Objective:To explore the characteristics of early postural control disorders in elderly patients with Parkinson's disease(PD). Method:The sensory organization test(SOT),limits of stability(LOS),and adaptation test(ADT)were performed on 15 patients with early-stage PD and 10 healthy elderly patients using a dynamic and static balance training system. Result:Compared with the healthy group,in the SOT,early PD patients showed no significant differences in the comprehensive score of sensory organization,proprioceptive,visual,and visual dependence(P＞0.05).How-ever,there was a significant difference in vestibular balance control(P＜0.05).In the LOS,early PD patients exhibited decreased forward and backward max excursions(MXE)(P＜0.05),increased reaction time(RT)(P＜0.05),and decreased backward directional contro1(DCL)(P＜0.05).There were no significant differences in for-ward DCL,left and right MXE,RT,DCL(P＞0.05).In the ADT,there were no significant differences in the incidence of the first fall and the incidence of the last four falls in PD patients and healthy groups in the for-ward and backward tilt tests(P＞0.05). Conclusion:Early PD elderly patients already have postural control disorders,particularly with decreased limits of stability in forward and backward directions and reduced ability to maintain balance using vestibular input.

Objective:To explore the application effect of Wenyang Jiangu Bao combined with Baduanjin in osteoporosis (OP) patients with kidney-yang deficiency.Methods:A total of 100 OP patients with kidney-yang deficiency who were initially hospitalized in Traumatology Department of the Second Affiliated Hospital of Hunan University of Chinese Medicine from January 2021 to May 2022 were selected by the convenient sampling method and they were randomly divided into the routine group, the packet group, Baduanjin group and the combined the Baduanjin group was treated with Baduanjin exercise on the basis of routine group, and the combined group was treated with Wenyang Jiangu Bao and Baduanjin combination measures on the basis of routine group. The intervention time was 12 weeks. The clinical curative effects, TCM syndrome score, lumbar bone density, the MOS Item Short from Health Survey (SF-36) score and Visual Analogue Scale (VAS) score of all groups before and after intervention were compared.Results:After intervention, the clinical curative effects of the combined group was better than that of the routine group and Baduanjin group, VAS score and TCM syndrome score were lower than those of other 3 groups, lumbar bone density and SF-36 score were higher than those of other 3 groups, and the differences were all statistically significant ( P<0.05) . Conclusions:Wenyang Jiangu Bao combined with simplified Baduanjin in treatment of osteoporosis patients with kidney-yang deficiency has a good clinical effect, which can improve the symptoms of lumbar pain and leg pain and traditional Chinese medicine symptoms of osteoporosis patients, increase the lumbar bone density of patients and improve the quality of life of them.

Objective:To explore the application effect of multidisciplinary team (MDT) nursing model in enteral nutrition support for patients in intensive care unit (ICU) .Methods:The convenient sampling method was used to select 76 patients undergoing enteral nutrition in ICU of Taizhou Hospital in Zhejiang Province from August 2020 to August 2022 as the research objects. A total of 37 patients admitted from August 2020 to August 2021 were set as the control group, and 39 patients admitted from September 2021 to August 2022 were set as the intervention group. Patients in the control group received routine nursing, while patients in the intervention group received MDT nursing model. The start time of enteral nutrition after admission to ICU, the compliance rate of enteral nutrition at 7 days after feeding, the rate of feeding interruption and the incidence of complications were compared between the two groups.Results:After intervention, the start time of enteral nutrition after admission to ICU in the intervention group was shorter than that in the control group, the compliance rate of enteral nutrition at 7 days after feeding was higher than that in the control group, and the feeding interruption rate and incidence of aspiration, nausea, vomiting and diarrhea were lower than those in the control group ( P<0.05) . Conclusions:The MDT nursing model can improve the effect of enteral nutrition support for ICU patients and reduce the incidence of enteral nutrition complications.