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 clinical value of a trinity strategy for the treatment of multiple orthopedic trauma.Methods:A retrospective case series study was conducted to analyze the clinical data of 1 267 patients with multiple orthopedic trauma admitted to Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine and the First Affiliated Hospital of Navy Medical University from June 2013 to May 2023, including 862 males and 405 females, aged 18-93 years [(55.2±19.8)years]. Associated injuries included hemorrhagic shock in 632 patients, traumatic wet lung in 274, cranial injuries in 135, abdominal and pelvic bleeding in 116, pneumothorax in 89, urinary injury in 13, and vesical rupture in 8. All the patients were treated with the trinity strategy and the treatment process was divided into the phases of first aid, remodeling, and rehabilitation. The first aid phase focused on stabilizing symptoms and saving lives; the remodeling phase centered on restoring the anatomical structure and alignment; the rehabilitation phase aimed for functional recovery through the integration of both Western and traditional Chinese medicine. The all-cause mortality within 30 days after surgery and fracture healing time were calculated; the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, Hospital for Special Surgery (HSS) knee score and the American Orthopedic Foot & Ankle Society (AOFAS) ankle-hindfoot score at the last follow-up and the overall excellent and good rate of all joint function scores were measured. The short form health survey (SF-36) scores were collected preoperatively and at 6 months postoperatively, including 8 aspects such as physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health. The incidence of postoperative complications was recorded.Results:All the patients were followed up for 6-18 months [(10.2±4.2)months]. The mortality rate during the acute phase (within 30 days after surgery) was 2.37% with 12 deaths due to hemorrhagic shock, 10 due to traumatic brain injury, 6 due to multiple organ dysfunction syndrome (MODS), and 2 due to pulmonary infection. The average fracture healing time averaged 3.8-18 months [(11.5±4.2)months], with 89.49% of the patients having bone union within 12 months after surgery, 8.93% having bone union within 18 months after surgery, and 1.58% undergoing reoperation. For the patients with internal fixation failure and nonunion, the average healing time was extended to (10.2±2.2)months and (13.7±3.3)months respectively. At the last follow-up, the excellent and good rates of Constant-Murley shoulder score, Mayo elbow score, Gartland-Werley wrist score, Harris hip score, HSS knee score, and AOFAS ankle-hindfoot score were 83.93%, 90.24%, 94.12%, 85.57%, 88.46%, and 92.31% respectively, with an overall excellent and good rate of 89.11%. At 6 months after surgery, the SF-36 scores of all the patients in the eight dimensions,including the physical functioning, physical role, bodily pain, general health, vitality, social functioning, emotional role, and mental health were (74.4±8.6)points, (44.7±14.4)points, (77.4±10.9)points, (68.4±18.2)points, (72.5±16.0)points, (76.8±8.7)points, (49.9±17.6)points, and (72.8±17.9)points, significantly improved compared with those before operation [(63.4±12.7)points, (30.9±17.4)points, (56.4±18.0)points, (55.4±24.7)points, (53.5±21.0)points, (55.8±24.3)points, (36.9±24.0)points, (58.8±21.6)points] ( P<0.01). Complications of different degrees occurred in 214 patients (16.89%), including lung infections in 118 patients (9.31%), lower extremity deep vein thrombosis in 50(3.95%), pressure injuries in 26(2.05%), internal fixation failure in 12(0.95%), and nonunion in 8(0.63%). Conclusions:The trinity strategy provides whole-process management, personalized treatment, and overall rehabilitation for multiple orthopedic trauma. It can decrease mortality, shorten fracture healing time, improve joint function and quality of life, and reduce the incidence of complications.

Objective:To investigate the predictive value of differential distribution of peripheral lymphocyte subsets before and after the first 131I treatment on the therapeutic response to 131I treatment in patients with papillary thyroid cancer (PTC). Methods:A retrospective study was conducted on 46 PTC patients (16 males, 30 females, age 20-77 years) who underwent total thyroidectomy and received 131I treatment between January 2021 and August 2021 in First Hospital of Shanxi Medical University. Peripheral blood lymphocyte subsets (T, B, CD4 + T, CD8 + T, natural killer (NK), helper T (Th)1, Th2, Th17, and regulatory T (Treg) cells) were measured 1-2 d before and 30 d after 131I treatment. Based on serological and imaging evidence, therapeutic response at 6-12 months post- 131I therapy was categorized as either excellent response (ER) or non-excellent response (NER). Differences of preablative stimulated thyroglobulin (psTg) and clinical baseline characteristics between two groups were assessed by using independent-sample t test, paired t test, or Mann-Whitney U test. Predictive value of lymphocyte subsets before and after 131I treatment for therapeutic response was assessed through logistic regression analysis, ROC curve analysis, and decision curve analysis (DCA). Results:In ER group ( n=33) and NER group ( n=13), most lymphocyte subsets showed different degrees of reduction 30 d after 131I treatment compared to before 131I treatment, such as T, B, CD4 + T and Th1 cells in ER group, as well as T, B, CD4 + T, Th1, Th2, Th17, and Treg cells in NER group ( t values: 2.41-9.57, all P<0.05). Before 131I treatment, NER group had significantly higher levels of psTg, Th2, Th17, and Treg cells compared to the ER group ( t values: from -3.32 to -2.48, U=29.00, all P<0.05). After 131I treatment, most of lymphocyte subsets in NER group (T, B, CD4 + T, CD8 + T, Th1 and Treg cells) showed higher trend than those in ER group but without statistical significances ( t values: from -1.12 to -0.06, all P>0.05). Th2 cells before 131I treatment (odds ratio ( OR)=25.00, 95% CI: 1.36-459.10, P=0.030) was identified as a risk factor for NER. ROC curve analysis indicated that AUCs of psTg and Th2 cells for predicting therapeutic response were 0.932 and 0.790, respectively, which was 0.958 for the combined psTg and Th2 cells. DCA showed that within the threshold probability range of 10%-60%, the curves for psTg, Th2 cells, and the combined psTg and Th2 cells were all higher than the extreme curve, suggesting good effect. Conclusions:Most lymphocyte subsets decrease to varying degrees, and NER group shows a significant decrease 30 d after 131I treatment. Th2 cells may be a risk factor for poor response to 131I treatment, providing a certain value in predicting the therapeutic response to 131I treatment.

Objective To observe the clinical effect of neuroendoscopic minimal invasive surgery in treating the patients with intraventricular hemorrhage cast.Methods The prospective non-randomized con-trolled study was adopted.Sixty-eight inpatients with intraventricular hematoma cast receiving surgical treat-ment in the neurosurgery department of this hospital from January 2020 to January 2023 were selected as the study subjects;thirty-four cases adopting neuroendoscopic minimal invasive surgery served as the observation group and 34 cases adopting lateral ventricle drilling drainage served as the control group;the surgical time,in-traoperative bleeding volume,hospitalization duration,ICU duration,clearance time of postoperative ventricle hematoma,postoperative hydrocephalus occurrence,occurrence rate of recurrent bleeding in operating area and postoperative complications occurrence rate were observed in the two groups.The levels of serum TNF-α,L-6,CRP,GFAP,S100-β and NSE before operation and on postoperative 7 d were detected;the GCS scores,BI,NIHSS scores before operation and on postoperative 14 d were observed;the GOS scores in postoperative 6 months were observed.Results The surgical time and intraoperative bleeding amount in the control group were significantly less than those in the observation group(P＜0.05);the hospitalization duration,ICU dura-tion,clearance time of postoperative ventricular hematoma and incidence rate of hydrocephalus in the observa-tion group were significantly short or less than those in the control group(P＜0.05);there was no statistical-ly significant difference in postoperative rebleeding incidence rate between the two groups(P＞0.05);the in-cidence rates of pulmonary infection,urinary tract infection,deep venous thrombosis and surgical site infection in the observation group were significantly less than those in the control group(P＜0.05);there was no sta-tistically significant difference in organ dysfunction incidence rate between the two groups(P＞0.05);the lev-els of postoperative TNF-α,L-6,CRP,GFAP,S100-β and NSE in the both groups were significantly decreased compared with those before operation(P＜0.05);the observation group was significantly lower than the con-trol group(P＜0.05);the GCS,BI and NIHSS scores on postoperative 14 d in the two groups were signifi-cantly improved compared with before operation(P＜0.05);the observation group was significantly better than the control group(P＜0.05);the GOS score at postoperative 6 months in the observation group was bet-ter than that in the control group(P＜0.05).Conclusion Neuroendoscopic minimally invasive surgery is ef-fective in treating intraventricular hemorrhage cast with low incidence rate of postoperative complications,which is worthy of clinical promotion.

Abstract: Objective To explore the clinical data of children with Talaromyces marneffei (TM) infection admitted to the pediatric intensive care unit (PICU) to improve the diagnosis and treatment of TM infection in children. Methods The clinical data of 23 children with TM infection treated in four PICUs in southern China from January 2013 to December 2022 were retrospectively analyzed, including clinical characteristics, laboratory tests, treatment regimens, and outcomes. Results Among the 23 children, there were 14 boys and 9 girls, with a median age of 24 months. The time from onset to admission was 15 (range 10-30) days, and one patient had immunodeficiency disease. Common symptoms included fever (91.3%, 21 cases), cough (78.3%, 18 cases), and hepatosplenomegaly (78.3%, 18 cases). Severe clinical complications included multiorgan dysfunction (69.6%, 16 cases), septic shock (65.2%, 15 cases), and acute respiratory distress syndrome (65.2%, 15 cases). All patients elevated CRP levels, and 69.2% (9/13) had a positive G test. Elevated IgE levels were observed in 53.3% (8/15) cases, CD4/CD8 inversion in 17.6% (3/17) cases, and reduced NK cells in 84.2% (16/19) cases. HIV tests were negative in all cases. TM was most frequently detected by blood and bone marrow cultures. Seven cases were diagnosed with immunodeficiency by genetic testing. With monotherapy or combination of amphotericin B or/and voriconazole, followed by oral medication, 13 (56.5%) children died. Conclusions TM infection is clinically atypical in HIV-negative children, and patients admitted to PICU have rapidly deteriorated, with severe complications and a high mortality rate. Early use of multiple samples, and multiple methods to detect TM, combined with immune function and genetic test, is helpful to early diagnosis. The antifungal treatment strategies still need further study.

【Objective】 To investigate the effects of lamellar surgical techniques with urethral plate to strengthen the tissue of glans penis to widen the two flanks of glans penis on the basis of Duckett method in the treatment of congenital hypospadias with small glans penis deformity. 【Methods】 A total of 22 patients admitted to our hospital during Jun.2017 and Oct.2020 were involved. Urethral plate was used to replace the glans penis tissue to widen the two flanks of glans penis based on Duckett method. Lamellar surgical techniques were adopted to fully dissociate the two flanks of glans penis and urethral plate for urethroplasty. 【Results】 Of the 22 operations, 19 were successful,with a success rate of 86.3%. The success rate of penile head urethroplasty reached 96.1%. 【Conclusion】 Widening the glans penis by using the urethral plate based on Duckett method combined with lamellar surgical techniques can improve the success rate of glans penis urethroplasty.

Objective:To improve the understanding of cervical papillary squamous cell carcinoma (PSCC), and to provide evidence for the diagnosis and treatment of PSCC.Methods:The clinicopathological and follow-up data of 18 patients diagnosed PSCC by preoperative cervical biopsy in Tangshan Gongren hospital were collected, the correlation of preoperative biopsy, liquid-based cells, and human papilloma virus (HPV) with postoperative pathology and prognosis was analyzed.Results:The concordance rate between preoperative biopsy and postoperative pathology was 50% (9/18). 4 patients showed the characteristic features of PSCC in their liquid-based cells of the 9 patients who were diagnosed as PSCC postoperatively (4/9), the HPV infection rate was 44.4% (4/9), the International Federation of Gynecology and Obstetrics stage were IA1-IB1, no lymph node metastasis, recurrence or death occurred in all patients.Conclusions:Cervical biopsy before operation has certain limitations in the diagnosis of PSCC, which requires a clear diagnosis by postoperative pathology. The HPV infection rate is lower, the stage is earlier and the prognosis is better in PSCC. Some patients can choose a less invasive surgical method than radical surgery.

Objective:To explore the surgical methods and treatment effects of adult anterior dislocation of the sacroiliac joint (AADSJ).Methods:A multi-center retrospective case series study was conducted to analyze the clinical data of 25 cases admitted in 5 clinical centers (affiliations of authors in this article) from January 2016 to January 2021. There were 18 males and 7 females, aged 38.8±15.5 years (range, 18-83 years). The AADSJ clinical classification system was formulated based on the radiographic morphology of anterior dislocation of the sacroiliac joint, which includes two types. Type I: complete anterior dislocation of the sacroiliac joint, and displacement of the entire iliac auricular surface to the front of the sacrum. Type II: fracture of the sacroiliac joint combined with anterior dislocation, subdivided into 3 subtypes. Type IIa: iliac fracture involves the anterior 1/3 of the sacroiliac joint, and dislocation of the ilium anterior to the sacrum. Type IIb: iliac fracture involves the posterior 2/3 of the sacroiliac joint, and dislocation of the ilium anterior to the sacrum. Type IIc: iliac fracture involves the posterior 2/3 of the sacroiliac joint, and dislocation of the ilium anteromedial to the sacrum. The reliability and repeatability of the clinical classification, Tile classification and Young-Burgess classification were performed based on the results of two-phase assessments in four observers. The operations were performed by the lateral-rectus approach and the ilioinguinal approach. The operation time and intraoperative bleeding were recorded. Pelvic X-ray and CT scan were rechecked after the operation. The quality of fracture reduction was evaluated according to Matta score. The postoperative functional rehabilitation was evaluated according to the Majeed rehabilitation standard at one-year follow-up.Results:Among 25 cases in this study, there were 3 cases of Type I, 5 cases of Type IIa, 9 cases of Type IIb and 8 cases of Type IIc according to the clinical classification system. The Kappa values of reliability tests for the clinical classification, Tile classification and Young-Burgess classification were 0.681, 0.328 and 0.383, respectively. The Kappa values of repeatability tests for the clinical classification, Tile classification and Young-Burgess classification were 0.690, 0.221 and 0.395, respectively. The reliability and repeatability of the AADSJ clinical classification were significantly better than other classifications. There were 14 cases underwent lateral rectus abdominis approach and 11 cases underwent ilioinguinal approach. The operative time for managing anterior dislocation of the sacroiliac joint was 122.0±50.7 min (range, 65-148 min) through the lateral rectus abdominis approach, and through the ilioinguinal approach was 178.0±49.9 min (range, 110-270 min), with a significant difference ( t=2.76, P=0.011). The amount of intraoperative blood loss through the lateral rectus approach was 680±330 ml (range, 350-2,120 ml), which was significantly less than that through the ilioinguinal approach (1,660±968 ml, 680-3,300 ml), with a significant difference ( t=3.55, P=0.002). The follow-up period was 1-3 years. At one week after surgery, the quality of fracture reduction evaluated by Matta score showed that the excellent and good reduction rate of the lateral-rectus approach was 79% (11/14), and that of the ilioinguinal approach was 73% (11/14), with no statistically significant difference ( P=1.000). At a one-year follow-up, according to Majeed's criteria, the overall excellent and good rate of the lateral-rectus approach was 64% (9/14), which is similar to 64% (7/11) of that of the ilioinguinal approach. No fracture reduction loss or internal fixation loosening failure occurred. Conclusion:The AADSJ clinical classification system can accurately describe the imaging features and clinical manifestations of AADSJ, with high reliability and repeatability. The AADSJ can be treated by the lateral-rectus approach or the ilioinguinal approach, with similar therapeutic effects but the former having less trauma.

Thyroid cancer is one of the common malignant tumors in the endocrine system, and its incidence is increasing year by year. At present, the main diagnostic methods for thyroid cancer are ultrasound and thyroid puncture cytology. However, due to low sensitivity and/or specificity, it is increasingly difficult to meet the current clinical diagnostic needs. The discovery of biomarkers in thyroid cancer provides important clues for the diagnosis, pathogenesis and prognosis of the disease. As one of the essential trace elements in human body, iodine is closely related to the thyroid gland. Clarifying the relationship between iodine nutritional status and biomarkers of thyroid cancer has important practical significance for the diagnosis, pathogenesis and prognosis of thyroid cancer. Based on the research of systems biology, this article analyzes the influence of iodine nutritional status on biomarkers of thyroid cancer from four aspects of gene, transcription, protein and metabolism,

Accurate classification of the acetabular injuries and appropriate treatment plan are great challenges for orthopedic surgeons because of the irregular anatomical structure of the acetabulum and aggregation of important vessels and nerves around it. Letournel-Judet classification system has been widely applied to classify acetabular fractures. However, there are several limitations, including incomplete inclusion of fracture types, difficulty in understanding and insufficient guidance for surgical treatment, etc. Serious complications such as traumatic arthritis are common due to wrong classification and diagnosis and improper selection of surgical strategy, which brings a heavy burden to the society and families. Three-column classification, based on anatomic characteristics, has advantages of containing more fracture types and being easy to understand, etc. To solve the problems existing in the diagnosis and treatment process based on Letournel-Judet classification, achieve accurate diagnosis and treatment of patients with acetabular fractures, and obtain satisfactory prognosis, the Orthopedic Trauma Emergency Center of Third Hospital of Hebei Medical University and the Trauma Orthopedic Branch of the Chinese Orthopedic Association organized experts from relevant fields to formulate the Expert consensus on the accurate diagnosis and treatment of acetabular fractures based on three-column classification ( version 2023) in terms of principles of evidence-based medicine. Based on the three-column classification, 15 recommendations were proposed, covering the diagnosis, treatment, complication prevention and management, etc, so as to provide reference for accurate diagnosis and treatment of acetabular fractures.