177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Objective:To explore the impact of early and late antibody-mediated rejection (AMR) on treatment options and allograft outcomes after kidney transplantation (KT).Methods:From January 2013 to December 2022, the study retrospectively enrolled 141 KT allograft recipients receiving allograft biopsy and diagnosed as AMR according to the Banff 2019 criteria. Recipients with a diagnosis of AMR within 30 days post-KT were classified into early AMR group (n=19) while the remainders assigned as late AMR group (n=122). The outcome endpoints included recipient survival rate, death-censored graft survival rate, follow-up estimated glomerular filtration rate (eGFR) and immunodominant donor-specific antibody (DSA) intensity. Wilcoxon's test was utilized for assessing the differences in eGFR and DSA intensity while Kaplan-Meier curve and Log-rank test were employed for evaluating graft survival impact. Treatment regimens for AMR were collected and categorized.Results:The median follow-up duration was 2.6(1.2, 5.2) year. No graft failure was noted in early AMR group while 44 recipients in late AMR group experienced graft failure, with 34 cases (77.2%) due to AMR progression. The 5-year death-censored graft survival rate was significantly better in early AMR group than that in late AMR group [100% vs 60.1%(50.5%, 71.6%), P=0.002]. The one-year change in eGFR for early AMR group was significantly superior to that of late AMR group [19.3(-2.6, 38.1) vs -3.3(-14.0, 5.4), P=0.001]. One-year mean fluorescent intensity (MFI) of early AMR group was 1 158(401.5, 3 126.5). It was significantly lower than that when diagnosed with early AMR [3 120.5(2 392.8, 9 340.0)] and one-year MFI of late AMR group [8 094(2 251.5, 13 560.5)] ( P=0.005, P<0.001). Early AMR group primarily received standard treatment (3/19, 15.8%) and regimens centered on rituximab and/or bortezomib (7/19, 43.8%). Late AMR group mainly received standard (16/122, 13.1%) or intensified regimens (9/122, 7.4%) and regimens focused upon rituximab and/or bortezomib (32/122, 26.2%) and MP monotherapy (21/122, 17.2%). Conclusion:The outcome for early AMR is significantly better than that for late AMR. For early AMR, early and robust immunosuppression is recommended. For late AMR, early detection and timely treatment are crucial and individualized strategies should be implemented.

Primary adrenal small cell neuroendocrine carcinoma is clinically rare. This article reported a patient, who was diagnosed as primary adrenal small cell neuroendocrine carcinoma complicated with renal vein cancer thrombus, and underwent laparoscopic left adrenal + left kidney + left renal vein tumor embolectomy.The carcinoma relapsed after 19 months of follow-up after surgery. The patient and his family refused further treatment.

Objective:To analyze the incidence and the related factors of umbilical vein catheter (UVC) tip migration within 7 d after umbilical vein catheterization.Methods:This prospective study involved neonates who were successfully indwelled with UVCs in the Department of Neonatology of Gansu Provincial Women and Child-care Hospital from June 2020 to December 2021. The position of the UVC tip, length of umbilical stump, body weight, and abdominal circumference were recorded after the UVCs were inserted successfully, and the changes in these four data at 2, 24, 48, 72 h, and 7 d after catheterization were analyzed and compared. All the subjects were divided into the non-migrate group, inward migration group, and outward migration group. Chi-square test, Mann-Whitney U test, or Kruskal Wallis H test were used for statistical analysis. Results:A total of 157 newborns were enrolled, with 51 cases in the inward migration group, 62 cases in the outward migration group, and 44 cases in the non-migrate group. There were no significant differences among the three groups regarding gestational age, birth weight, gender, born through cesarean section, age at the time of catheterization, use of sedation, and feeding modes (all P>0.05). The migration rates of UVCs tip at 2, 24, 48, 72 h, and 7 d after catheterization were 0, 27.4% (43/157), 27.2% (31/114), 25.3% (21/83), and 29.0% (18/62), respectively. The cumulative migration rates at 24, 48, 72 h, and 7 d were 27.4% (43/157), 47.1% (74/157), 60.1% (95/157), and 72.0% (113/157), respectively. Compared with the non-migrate group, the inward migration group had a shorter umbilical cord stump at 24 and 48 h [0.5 cm (0.4-0.5 cm) vs 0.6 cm (0.5-0.8 cm); 0.4 cm (0.3-0.5 cm) vs 0.5 cm (0.5-0.6 cm), Z=－5.55 and －3.69, both P<0.05], less abdominal circumference increment at 48 and 72 h [0.6 cm (0.5-1.0 cm) vs 0.9 cm (0.7-1.2 cm); 0.6 cm (0.3-0.9 cm) vs 0.9 cm (0.7- 1.3 cm), Z=－2.03 and －2.09, both P<0.05)], and more weight loss percentage [－4.7% (－6.0%-－3.6%) vs －3.1% (－3.7%-－2.2%); －6.0% (－7.5%-－5.0%) vs －3.9% (－5.1%-－2.4%), Z=－3.75 and －2.96, both P<0.05]. The abdominal circumference increased more in the outward migration group at 24, 48, 72 h, and 7 d than those in the non-migrate group [1.6 cm (0.9-1.9 cm) vs 0.7 cm (0.5-0.9 cm); 1.5 cm (1.2-1.8 cm) vs 0.9 cm (0.7-1.2 cm); 1.7 cm (1.3-1.9 cm) vs 0.9 cm (0.7-1.3 cm); 1.6 cm (1.1-1.9 cm) vs 0.9 cm (0.6-1.3 cm), Z=－4.82, －4.79, －3.74, and －3.09, all P<0.05]. Conclusion:The incidence of UVC tip migration is high, which could be affected by dryness and retraction of the umbilical cord stump and the change in neonatal abdominal circumference and body weight.

Objective:To study the risk factors for retinopathy of prematurity (ROP) in very low birth weight infants (VLBWIs).Methods:From October 2020 to December 2021, VLBWIs with gestational age(GA) ≤32 weeks admitted to the neonatal department of our hospital were retrospectively studied. According to the occurrence of ROP, they were assigned into ROP group and non-ROP group. The clinical data of the two groups were compared and the risk factors of ROP in VLBWI were analyzed.Results:A total of 251 VLBWIs were enrolled, including 60 cases (23.9%) in ROP group and 191 (76.1%) in non-ROP group. The GA and birth weight (BW) of ROP group were significantly lower than non-ROP group [28(26,30) w vs. 29(28,31) w, 1 035(840,1 285) g vs. 1 260(1 110,1 380) g, respectively, all P<0.001]. The ROP group had longer duration of oxygen therapy [42.0(26.0, 53.5) d vs. 24.0(18.0, 34.0) d], higher incidences of blood transfusion [2.5(1.0, 3.0) times vs. 2.0 (1.0, 2.0) times] and hyperglycemia (80.0% vs. 16.8%), higher average [(5.6±0.5) mmol/L vs. (5.1±0.5) mmol/L] and peak [10.4(7.8,13.2) mmol/L vs. 6.5(6.1,6.8) mmol/L] blood glucose levels in the first week than the non-ROP group (all P<0.001). Multivariate analysis showed that longer duration of oxygen therapy ( OR=1.047, 95% CI 1.008-1.087, P=0.018) and higher peak blood glucose level in the first week ( OR=1.268, 95% CI 1.092-1.474, P=0.002) were the independent risk factors for ROP. Conclusions:Longer duration of oxygen therapy and higher peak of blood glucose level in the first week are risk factors for ROP in VLBWIs.

Objective:To study the risk factors of secondary hydrocephalus after severe intraventricular hemorrhage (IVH) in preterm infants for prevention and early identification of post-hemorrhagic hydrocephalus (PHH).Methods:From June 2013 to June 2021, preterm infants with severe IVH admitted to our hospital were retrospectively analyzed. They were assigned into PHH group and non-PHH group. Rank sum test or chi-square test was used for comparison between the two groups and multivariate logistic regression analysis was used to analyze the risk factors of PHH in preterm infants.Results:A total of 246 preterm infants with severe IVH were enrolled, including 68 cases (27.6%) in the PHH group and 178 cases (72.4%) in the non-PHH group. Multivariate logistic stepwise regression analysis showed that male gender ( OR=2.014, 95% CI 1.063-3.817), gestational age ≤30 week ( OR=2.240, 95% CI 1.210-4.146), 5-min Apgar score ≤5 ( OR=3.980, 95% CI 1.483-10.685), placental abruption ( OR=2.940, 95% CI 1.324-6.531) were independent risk factors for PHH in preterm infants and thrombocytopenia was the protective factor for PHH in preterm infants ( OR=0.305, 95% CI 0.147-0.632). The incidence of moderate thrombocytopenia in non-PHH group was significantly higher than PHH group ( P<0.05). No significant differences existed in the incidences of mild and severe thrombocytopenia between the two groups ( P>0.05). Conclusions:Male gender, gestational age ≤30 week, 5-min Apgar score ≤5, placental abruption are risk factors for PHH in premature infants with severe IVH and moderate thrombocytopenia has protective effects.

Objective:To explore the effect of umbilical vein catheterization (UVC) on portal vein blood flow velocity (PBFVe) and its relationship with gastrointestinal (GI) complications in neonates.Methods:A prospective study was conducted on neonates with indications for UVC and achieving one-time successful catheterization at Gansu Provincial Women and Child-care Hospital from March 2019 to March 2021. Successful UVC was defined as the umbilical catheter reaching the entrance of the inferior vena cava and right atrium through the ductus venosus. PBFVe was measured by bedside ultrasound before and after UVC. All subjects were divided into two groups as those with GI complications anytime from insertion to withdrawal (complication group), and those with no GI complications (no complication group) to compare the PBFVe value before UVC and the percentage of decrease in PBFVe after UVC. Multivariate logistic regression analysis and receiver operating characteristic (ROC) curve were used to analyze the risk factors of GI complications and the predictive value of the percentage of decrease in PBFVe after UVC.Results:Of 91 subjects included, 59.3% (54/91) had no GI complications, and 40.7% (37/91) had. After UVC, PBFVe was decreased than before in neonates both with and without GI complications [(11.3±1.8) vs (14.7±2.4) cm/s; (12.4±1.7) vs (14.2±1.8) cm/s, t=－16.92 and－17.62, respectively, both P<0.05]. PBFVe before UVC were similar between the two groups. However, the complications group had a lower PBFVe after UVC ( t=－2.98, P=0.004) and a higher percentage of decrease in PBFVe [(22.5±6.0)% vs (12.6±4.9)%, t=8.65, P<0.001] when compared with the no complications group. Multivariate logistic regression analysis showed that the body weight was the protector of GI complications ( OR=0.294, 95% CI:0.089-0.974, P=0.045), and the percentage of decrease in PBFVe was the risk factor ( OR=1.478, 95% CI:1.249-1.749, P<0.001). The area under the curve of the percentage of decrease in PBFVe for predicting GI complications was 0.919 (95% CI:0.843-0.966, P<0.001). The cut-off value was 16.9% with a sensitivity of 89.2% and a specificity of 85.2%. Conclusions:UVC can reduce the PBFVe of neonates. The more the PBFVe decreases, the greater the possibility of GI complications.

Blast injury of the chest injury is the most common wound in modern war trauma and terrorist attacks, and is also the most fatal type of whole body explosion injury. Most patients with severe blast injury of the chest die in the early stage before hospitalization or during transportation, so first aid is critically important. At present, there exist widespread problems such as non-standard treatment and large difference in curative effect, while there lacks clinical treatment standards for blast injury of the chest. According to the principles of scientificity, practicality and advancement, the Trauma Society of Chinese Medical Association has formulated the guidance of classification, pre-hospital first aid, in-hospital treatment and major injury management strategies for blast injury of the chest, aiming to provide reference for clinical diagnosis and treatment.

Objective: To investigate changes in the three⁃dimensional position of the maxillary canine during the distal movement of the maxillary first molar by a mini⁃implant combined with a CD appliance. Methods: Ten typodont models of class II malocclusion were selected, and one side was randomly chosen as the experimental group. The CD ap⁃ pliance was bonded to the maxillary canine and first molar of the experimental group, and 1.2 mm stainless steel wire was bent as the anchorage, which was fixed on the model to simulate mini⁃implants implanted in the zygomatic alveolar ridge. Then, 180 g orthodontic force was applied to the canine of the experimental group; the other side was recognized as the control group and was not used for strengthening. Six mini⁃implants were implanted in different parts of the mod⁃ el and used as a reference before and after the experiment. The models were placed in an incubator and heated at 56 ℃ in a water bath for 2 min. The models were scanned before and after thermostatic water bath treatment with a 3⁃shape scanner. Then, the digital models were overlapped through the reference points, and the positions of the canines and first molars were measured before and after the experiment. Results: The sagittal movement distance of the first molar in the experimental group was ( 0.25 ± 0.33) mm, and the vertical movement distance was (0.25 ± 0.28 )mm, which was significantly different from the control group (P < 0.05), while the transverse change was not significantly different (P > 0.05). There was no significant difference in the root position of the first molar in the experimental group (P > 0.05). The lateral and vertical displacement distances of the maxillary canine crown in the experimental group were (4.03 ± 2.11) mm and (1.86 ± 1.01) mm, respectively, which were significantly different from those in the control group (P < 0.001), while the sagittal changes showed no significant differences (P > 0.05). In the experimental group, there was no significant difference in the position of the apex of the maxillary cusp (P > 0.05). Conclusion Our in vitro study showed that the maxillary canines inclined buccally accompanied by a small amount of intrusion during molar distaliza⁃ tion by a mini⁃implant combined with a CD appliance.

Medical ethics has a long history and rich connotations.It has developed from the simple "medical morality" of ancient times to the modem medical ethics.The basic principles of medical ethics include autonomy,non-maleficence,beneficence,justice,and so on.Researchers often conduct clinical researches in the balance between achievements and ethical norms.Clinical researchers of surgery should have a deep understanding of medical ethical principles and strictly abide by medical ethics.Ethics committee should strictly perform their duties and play the role of inspection and supervision.Modem medical knowledges should be popularized throughout the society to make clinical research correctly understood.Adhering principles of ethics first,people orientation and cooperation practice,with patients' benefit as evaluation criteria,balance of surgical "Dao" and "Shu" can be achieved.