Objective To compare the efficacy of dual channel (intravenous channel and puncture needle channel) and single channel (puncture needle channel) of thrombin injection in reducing bleeding during low-dose CT-guided percutaneous lung biopsy, identify the optimal method, and develop a protocol with improved safety and efficacy while minimizing radiation exposure to patients. Methods Patients who underwent CT-guided percutaneous lung biopsy at Linyi Central Hospital between May 2024 and January 2025 were selected and divided into a dual channel group (observation group) and a single channel group (control group) according to the methods of thrombin injection. The baseline characteristics (sex, age, underlying lung disease, lesion diameter, distribution, proportion of solid lesions, enhancement degree, puncture depth and time, and benign or malignant) and the differences in CT images after lung puncture (bleeding, blood diffusion distance, and blood diffusion volume) were compared between the two groups of patients. Results There were no significant differences in baseline characteristics and bleeding incidence between the two groups of patients (P > 0.05). The diffusion distance and volume of blood in the dual channel group were significantly lower than those in the single channel group (P < 0.05). Conclusion The use of dual channel thrombin injection under low-dose CT guidance cannot reduce the incidence of bleeding in lung biopsy, but it can reduce the amount of bleeding, blood diffusion to surrounding lung tissues, and intraoperative radiation exposure to patients.

Background With the rapid industrialization, cadmium has become a primary heavy metal pollutant in cultivated land soil in China, which seriously affects human health. Previous studies have found that cadmium exposure associates with cognitive dysfunction in individuals, but there is a lack of research on the mechanism of cadmium exposure associated cognitive impairment in offspring in early life which is more vulnerable to various toxins and crucial for development of the neuro. Objective To explore the potential mechanism of brain-derived neurotrophic factor/tyrosine kinase receptor B (BDNF-TrkB) signaling pathway in cognitive dysfunction in mice after cadmium exposure in early-life. Methods Twelve 8-week-old C57BL/6 pregnant mice were randomly divided into 2 groups, namely control group and cadmium exposure group, with 6 mice in each group. The exposure period was from pregnancy day 4.5 to lactation day 21 (E4.5-P21), during which distilled water or cadmium chloride solution (2.5 mg·kg⁻¹·d⁻¹) was given. After lactation, the offspring of the control group and the cadmium exposure group were given distilled water until 8 weeks of age. Then the toxicity effects of cadmium exposure on mice were evaluated by body weight and selected biochemical indicators. The cadmium content in brain was detected and the learning and memory ability was tested by Y maze and Morris water maze to evaluate cognitive function of offspring mice. Histopathological changes of the hippocampus were observed after Nissl staining and Golgi staining. The mRNA and protein expression levels of the BDNF-TrkB pathway and synapse were detected by real-time quantitative PCR (qPCR) and Western blot. Results Compared with the control group, no significant change was found in body weight, liver or kidney function in the cadmium exposure group (P> 0.05). However, compared with the control group, the cadmium content in brain was increased in the cadmium exposure group (P<0.001). The behavioral changes associated with cognitive dysfunction were positive in the cadmium exposure group (all P<0.05). The histopathological observation after Nissl staining showed abnormal tissue structure, decreased number of neurons and increased karyopyknosis in the cadmium exposure group (P<0.01).The spine density of Golgi staining was decreased in the cadmium exposure group (P<0.001). The BDNF-TrkB pathway-related mRNA and the synapse-related mRNA in the hippocampus were reduced in the cadmium exposure group (all P<0.05). The expression levels of BDNF-TrkB pathway-related proteins and synapse-related proteins in the hippocampus were also reduced in the cadmium exposure group (P<0.05). Conclusion Early-life cadmium exposure may induce synaptic dysplasia and lead to cognitive dysfunction by down-regulating the BDNF-TrkB signaling pathway in mice.

Objective To explore the clinical features,diagnosis and treatment of liposarcoma of spermatic cord.Methods The clinical data of 1 case with multiple recurrence of liposarcoma of spermatic cord were retrospectively analyzed,and the clinical diagnosis and treatment were discussed in combination with relevant literature.Results The patient underwent the first operation to examine the adipocytes in the right spermatic cord area.Postoperative examination revealed highly differentiated liposarcoma.Within 1 year of follow-up,radical resection of both testis and retroperitoneal tumor were performed respectively due to recurrence.Conclusion liposarcoma of spermatic cord is an extremely rare disease,and currently there is no standard treatment protocol.Radical surgical resection of localized lesions is the key,and surgical treatment is still the first choice for local recurrence.As it is unable to achieve R0 resection,the recurrence rate is very high.Since liposarcoma is not sensitive to radiotherapy and chemotherapy,more precise adjuvant therapy is highly expected.

AIM:To investigate the effect of hypoxia-preconditioned human umbilical cord mesenchymal stem cell-derived exosomes(hUCMSC-Exos)on pulmonary vascular endothelial-mesenchymal transition(EndMT)in hypoxic pulmonary hypertension(HPH).METHODS:(1)Primary hUCMSCs were isolated and cultured by tissue adhesion method,and hUCMSC-Exos were extracted by ultrafiltration and identified.(2)Twenty-four SPF male SD rats were ran-domly divided into normoxia(N)group,hypoxia(H)group,hypoxia+normoxic hUCMSC-Exos group and hypoxia+hypoxia-preconditioned hUCMSC-Exos group,with 6 rats in each group.The rats in H group and intervention groups were placed in a cabin that simulated the hypoxic environment at an altitude of 5 000 m,and normoxic hUCMSC-Exos,hypoxia-precon-ditioned hUCMSC-Exos or equivalent volume of PBS were injected through the tail vein on the 3rd,5th,7th,10th and 14th days in hypoxia environment.After 21 d of modeling,the right ventricular systolic pressure(RVSP)and right ven-tricular hypertrophy index(RVHI)of the rats were detected,and the pathological changes of lung tissues were observed by HE staining.(3)After starvation for 12 h,human pulmonary arteriole endothelial cells(HPAECs)were randomly di-vided into normoxic control(N-Con)group,hypoxic model(H-Con)group,hypoxia+normoxic hUCMSC-Exos group and hypoxia+hypoxia-preconditioned hUCMSC-Exos group.The migration ability and tube formation ability of HPAECs were detected by Transwell assay and tube formation experiment.The expression of CD31 and α-smooth muscle actin(α-SMA)in HPAECs was detected by immunofluorescence double-staining.The protein levels of CD31,VE-cadherin,α-SMA and vimentin in pulmonary vessels and HPAECs were assessed by Western blot.RESULTS:(1)The HPH rat model was suc-cessfully established after 21 d of hypoxia,and EndMT occurred in pulmonary vessels.Compared with N group,the levels of RVSP,RVHI,percentage of vascular wall area(WA%)and percentage of vascular wall thickness(WT%)in H group were significantly increased(P＜0.01),pulmonary vascular wall thickening and the protein levels of CD31 and VE-cad-herin were significantly decreased(P＜0.01),while the protein levels of α-SMA and vimentin were significantly increased in pulmonary vessels(P＜0.05 or P＜0.01).Compared with H group,the RVSP,RVHI,WA%and WT%(P＜0.01)were significantly decreased(P＜0.05 or P＜0.01),and pulmonary vascular remodeling was attenuated after normoxic or hypoxia-preconditioned hUCMSC-Exos intervention.After hypoxia-preconditioned hUCMSC-Exos intervention,HPH pul-monary vascular remodeling and EndMT formation were significantly inhibited.(2)After 48 h of hypoxic treatment,the migration,tubule formation and EndMT of HPAECs were induced.Compared with H-Con group,cell migration and tube formation were significantly decreased after hypoxia-preconditioned hUCMSC-Exos intervention(P＜0.01).The protein levels of CD31 and VE-cadherin were increased,while the protein levels of α-SMA and vimentin were decreased(P＜0.05 or P＜0.01).CONCLUSION:Hypoxia-preconditioned hUCMSC-Exos attenuate the formation of HPH pulmonary vascu-lar remodeling by inhibiting pulmonary vascular EndMT.

This article reviews the training model of orthopedic residents in the world's top orthopedic hospitals, such as Hospital for Special Surgery Affiliated to Cornell University and The Affiliated Hospital of Harvard University Medical School, and it is found that there are differences between China and the US in the training of orthopedic residents in the aspects of the admittance system of physicians, the setting of training contents , and the training model of orthopedic residents . The training of orthopedic residents in the US adheres to the concept of elite education and pays attention to the construction of tutors and learning atmosphere. The enlightenment to the training of orthopedic residents in China includes further clarification of the training objectives of orthopedic residents , improvement of the stage-based training system , integration of excellent medical teaching resources , and improvement of teaching methods and assessment systems.

Objective To evaluate the effect of emergent microsurgery in treatment of patients with hematoma-type anterior circulation ruptured aneurysm.Methods The clinical data and therapeutic effect of emergency microsurgery for 32 patients with hematoma-type anterior circulation ruptured aneurysm were analyzed retrospectively.Results Finally 32 patients underwent emergency craniotomy clipping and hematoma removal in 24 h.Among them,15 cases underwent decompressive craniectomy.One week after the operation,CTA revealed that all aneurysms were completely clipped.One patient with communicating hydrocephalus were treated with ventriculoperitoneal shunt,and 6 patients had different degrees of cerebral infarction.After 6 months of follow-up,the Glasgow outcome scale (GOS) showed that there were 5 cases of grade 5 (15.6％),12 cases of grade 4 (37.5 ％),12 cases of grade 3 (37.5％),2 cases of grade 2 (6.3％) and 1 case of grade 1 (6.3％).The prognosis satisfaction rate was 53.1％ (17/32).Conclusion Emergent microsurgery is effective in the treatment of patients with hematoma-type anterior circulation ruptured aneurysm.

Objective To evaluate the effect of emergent microsurgery in treatment of patients with hematoma-type anterior circulation ruptured aneurysm.Methods The clinical data and therapeutic effect of emergency microsurgery for 32 patients with hematoma-type anterior circulation ruptured aneurysm were analyzed retrospectively.Results Finally 32 patients underwent emergency craniotomy clipping and hematoma removal in 24 h.Among them,15 cases underwent decompressive craniectomy.One week after the operation,CTA revealed that all aneurysms were completely clipped.One patient with communicating hydrocephalus were treated with ventriculoperitoneal shunt,and 6 patients had different degrees of cerebral infarction.After 6 months of follow-up,the Glasgow outcome scale (GOS) showed that there were 5 cases of grade 5 (15.6％),12 cases of grade 4 (37.5 ％),12 cases of grade 3 (37.5％),2 cases of grade 2 (6.3％) and 1 case of grade 1 (6.3％).The prognosis satisfaction rate was 53.1％ (17/32).Conclusion Emergent microsurgery is effective in the treatment of patients with hematoma-type anterior circulation ruptured aneurysm.

Objective To investigate regional cerebral blood flow (rCBF) in hypodense areas of the brain after severe traumatic brain injury (sTBI). Methods CT perfusion (CTP) was performed in 42 patients with sTBI during the period of 2011 to 2013. According to the findings of CT scans , hypodense lesions were divided into contusion- or infarction-associated regions. Regional cerebral blood volume (rCBV) of < 15 mL/(100 g·min) was used as the threshold of severe ischemia; rCBF, rCBV, and regional mean transit time (MTT) for the hypodense lesions were analyzed, and the incidence of severe ischemia was compared between the two groups. Results A total of 62 hypodense lesions were identified in the patients. 45 of the 62 hypodense lesions were associated with contusion, and 17 of the lesions were associated with infarction. The mean CT density was significantly lower in the hypodense regions than in the contralateral mirror regions (P<0.05), and there was no significant difference in the mean CT density between the two types of lesions (P > 0.05). Cerebral perfusion was significantly lower in the contusion-associated hypodense regions than in the contralateral mirror regions (P<0.05). In the contrast, cerebral perfusion in the hypodense areas associated with infarction did not significantly differ from that in the contralateral mirror regions (P>0.05). A reduction in rCBF<15 mL/(100 g·min) was found in 25 of the hypodense regions associated with contusion, but only one of those associated with infarction. Conclusions Cerebral perfusion in contusion-associated hypodense areas decreases significantly , but not in infarction-associated hypodense areas. Correct identification of cerebral perfusion in the hypodense areas is helpful for developing therapeutic strategies.

OBJECTIVEDiscuss the trade-off between vegetative growth and reproductive growth.

METHODVegetative modules and reproductive modules by large sampling were separated and quantitative charecters of organs and pattern of reproductive allocation were analysed of reproductive allocation were analysed.

RESULTThe phenotype plasticity of quantitative charecters were significant. Reproductive biomass was increasing at different stages. The mass of reproductive investment increased significantly with increasing individual size, the opposite of reproductive allocation. There were all significant positive correlations between the seeds weight and height, total biomass, vegetative biomass, reproductive biomass, fruit numbers, fruit weight.

CONCLUSIONThe significance of phenotype plasticity is the cause of multiple elements. In the process of transferring from vegetative growth to reproductive growth, there was a trade-off between organs. Under individual growth and reproductive strategy, the variation of biomass was allocated coordinately.

Objective To identify the Banna viruses isolated in northwestern part of Yunnan prov-ince in order to make the difference clear between the isolates and other Banna viruses isolated in other parts of Yunnan. Methods Three isolates of Banna vires isolated in 2005 and 2006 were identified by morpholo-gy, RNA-PAGE profile and molecular biologic method. Nueleotide and amino acid sequences of segment 12 of the 3 isolates were sequenced and analyzed. Results Three Banna viruses were isolated from mosquitoes collected in northwestern part of Yunnan during 2005 and 2006. Electron microscopy study showed that they are spherical with a diameter of 70 nm, no envelope but two layers of eapsid. It was found that the genome of the 3 isolates composes of 12 segments presenting band profile of 6-6 in RNA-PAGE. Nueleotide acid se-quence analysis about segment 12 showed that the identity was 99% between the 3 new isolates, 98% and 90% between the 3 isolates and the strains isolated in other parts of Yunnan, China and Indonesia, respec-tively. Phylogenetie analysis based on segment 12 gene showed that 3 new isolates clnstered in the same branch with the viruses isolated in other parts of Yunnan. The same difference of amino acids was found between Banna viruses isolated in China and Indonesia strains in the analysis of segment 12. Conclusion Banna virus strains were firstly isolated from mosquitoes collected in northwestern part of Yunnan province. Nueleotide acid sequence analysis of the 3 new isolates showed higher identity with strains isolated in other parts of Yunnan.