Super-pulse thulium fiber laser (hereinafter referred to as thulium laser) has shown broad application prospects in medical research, especially in the treatment of urinary tract stones.Thulium laser has a thin fiber diameter, which reduces the occupation of the working channel and increases the irrigation water flow.Currently, the peak power reaches up to 500 W, the single pulse energy to 6 J, and the frequency to 2000 Hz.The stone-breaking mechanism of thulium laser is photothermal and photomechanical.Different combinations of energy and frequency will significantly affect the volume of stone fragments. "High energy and low frequency" is more suitable for "fragmentation" stone breaking, while "low energy and high frequency" is more suitable for "powderization" stone breaking.Some in vitro experiments have confirmed that thulium laser has higher stone-breaking efficiency, less stone displacement, and more obvious thermal effects compared to holmium laser.Clinically, thulium laser has been applied to ureteroscopic lithotripsy and percutaneous nephrolithotomy., and the stone free rate and safety are relatively high.This article reviews the stone-breaking principles, in vitro experiments, and clinical applications of thulium laser, aiming to provide better theoretical support and practical experience for the development and application of super-pulse thulium fiber laser in the future.

Background::Highly expressed in various human cancers, circular RNA Protein Kinase C Iota (circPRKCI) has been reported to play an important role in cancer development and progression. Herein, we sought to reveal the prognostic and clinical value of circPRKCI expression in diverse human cancers.Methods::We searched the Pubmed, Web of Science, and the Cochrane Library databases from inception until May 16, 2021. The relationship between circPRKCI expression and cancer patients’ survival, including overall survival (OS) and disease-free survival (DFS), was assessed by pooled hazard ratios (HR) with corresponding 95% confidence interval (CI). The correlation between circPRKCI expression and clinical outcomes was evaluated using odds ratios (OR) with corresponding 95% CI. The data were analyzed by STATA software (version 12.0) or Review Manager (RevMan 5.3).Results::A total of 15 studies with 1109 patients were incorporated into our meta-analysis. The results demonstrated that high circPRKCI expression was significantly related to poor OS (HR = 1.96, 95% CI: 1.61, 2.39, P <0.001) when compared with low circPRKCI expression in diverse human cancers. However, elevated circPRKCI expression was not associated with DFS (HR = 1.34, 95% CI: 0.93, 1.95, P = 0.121). Furthermore, the patient with a higher circPRKCI expression was prone to have a larger tumor size, advanced clinical stage, and lymph node metastasis, but it was not significantly correlated with age, gender, and distant metastasis. Conclusion::Elevated circPRKCI expression was correlated with worse OS and unfavorable clinical features, suggesting a novel prognostic and predictive role of circPRKCI in diverse human cancers.

Objective To observe the value of nomogram model based on clinical and ultrasonic characteristics for diagnosing lymphoma.Methods Data of 176 patients with suspected lymphoma due to enlarged superficial lymph nodes were retrospective analyzed.The patients were divided into lymphoma group(n=90,invasive subgroup[n=40]and non-invasive subgroup[n=50])or non-lymphoma group(n=86)based on pathological results.Clinical and ultrasonic data were compared between groups and subgroups.Multivariate logistic regression was used to screen the independent risk factors of lymphoma,and then a nomogram was constructed.Receiver operating characteristic curves were drawn to evaluate the efficacy of conventional ultrasound,conventional contrast-enhanced ultrasound(C-CEUS),high-frame-rate contrast-enhanced ultrasound(H-CEUS)and nomogram for diagnosing lymphoma.Results Multivariate logistic regression analysis revealed that age＞59 years,cortical stripe/reticular hyperecho of lymph nodes and"centrifugal firework"enhancement pattern showed with H-CEUS were all independent risk factors of lymphoma(all P＜0.05).Taken 59 years as the best cut-off value of patients'age,the sensitivity,specificity,accuracy and the area under the curve(AUC)for diagnosing lymphoma was 67.78%,58.10%,63.06%and 0.630,respectively.The sensitivity,specificity,accuracy and AUC of cortical stripe/reticular hyperecho of lymph nodes for diagnosing lymphoma was 73.33%,58.10%,65.91%and 0.657,respectively,while of"centrifugal firework"pattern enhancement in H-CEUS was 77.78%,69.80%,73.86%and 0.738,respectively.AUC of conventional ultrasound,C-CEUS,H-CEUS and nomogram for diagnosing lymphoma was 0.657,0.540,0.738 and 0.844,respectively.Conclusion Nomogram model based on clinical and ultrasonic characteristics had good diagnostic efficacy for lymphoma,and"centrifugal firework"pattern enhancement in H-CEUS could be regarded as the specific characteristic of lymphoma.

Background/Aims: To evaluate the causal correlation between complement components and non-viral liver diseases and their potential use as druggable targets. Methods: We conducted Mendelian randomization (MR) to assess the causal role of circulating complements in the risk of non-viral liver diseases. A complement-centric protein interaction network was constructed to explore biological functions and identify potential therapeutic options. Results: In the MR analysis, genetically predicted levels of complement C1q C chain (C1QC) were positively associated with the risk of autoimmune hepatitis (odds ratio 1.125, 95% confidence interval 1.018–1.244), while complement factor H-related protein 5 (CFHR5) was positively associated with the risk of primary sclerosing cholangitis (PSC;1.193, 1.048– 1.357). On the other hand, CFHR1 (0.621, 0.497–0.776) and CFHR2 (0.824, 0.703–0.965) were inversely associated with the risk of alcohol-related cirrhosis. There were also significant inverse associations between C8 gamma chain (C8G) and PSC (0.832, 0.707–0.979), as well as the risk of metabolic dysfunction-associated steatotic liver disease (1.167, 1.036–1.314). Additionally, C1S (0.111, 0.018–0.672), C7 (1.631, 1.190–2.236), and CFHR2 (1.279, 1.059–1.546) were significantly associated with the risk of hepatocellular carcinoma. Proteins from the complement regulatory networks and various liver diseaserelated proteins share common biological processes. Furthermore, potential therapeutic drugs for various liver diseases were identified through drug repurposing based on the complement regulatory network. Conclusions Our study suggests that certain complement components, including C1S, C1QC, CFHR1, CFHR2, CFHR5, C7, and C8G, might play a role in non-viral liver diseases and could be potential targets for drug development.

【Objective】 The thermal effects of super-pulsed thulium fiber laser (TFL) at different powers,lithotripsy modes and irrigation rates were studied using a 3D kidney model to simulate ureteral lithotripsy in vivo. 【Methods】 A thermal effect model was established in vitro. Under the same conditions of laboratory temperature and equipment,the temperature around the optical fiber was measured and compared when different optical fiber diameters,powers,lithotripsy modes and irrigation rates were used to simulate lithotripsy by TFL. 【Results】 There was significant difference in the temperature around the optical fiber caused by two fibers with different diameters under the same conditions (P<0.05). Under the same conditions,different lithotripsic modes produced different temperatures,and the temperature of "high energy and low frequency" was lower than that of "low energy and high frequency" (P<0.05). When the power was 10 W and the minimum irrigation rate was 10 mL/min,the plateau temperature did not reach the safety threshold (43 ℃). When the power was 20 W and the minimum irrigation rate was 10 mL/min,the platform temperature exceeded the safety threshold. When the irrigation rate was 20 mL/min,the platform temperature did not reach the safety threshold. 【Conclusion】 In the study of ureteral lithotripsy in vitro,the power,mode,irrigation rate and optical fiber diameter are factors affecting the thermal effects of TFL. No matter what kind of lithotripsy mode and fiber diameter,the temperature around the fiber is safe when the lithotripsy power is ≤10 W and the irrigation rate is ≥10 mL/min;when the lithotripsy power is ≤20 W and the irrigation rate is ≥20 mL/min,the temperature around the fiber is safe.

Objective:To analyze the safety and efficacy of ultrasound-guided needle-perc assisted retrograde intrarenal surgery (RIRS) in the treatment of small but complex renal calculi, and summarize our clinical experience.Methods:The clinical data of 36 patients with small but complicated renal stones treated by ultrasound-guided needle-perc assisted RIRS in Beijing Tsinghua Changgung Hospital from January 2020 to April 2022, were retrospectively analyzed. There were 25 males and 11 females. The average age was (54.7±6.1) years, and the body mass index (BMI) was (26.3±3.1) kg/m 2. The maximum diameter of the calculi was (1.8±0.7) cm. There were 28 patients without renal hydronephrosis before operation, 8 patients with mild to moderate renal hydronephrosis, 4 patients with caliceal diverticular stones, 32 patients with lower pole stones, 10 patients with ureteral stones, 6 patients with previous surgical history of ipsilateral kidney stones, and 3 patients with stones in the solitary kidneys. Patients were placed in oblique supine lithotomy position or prone split leg position (female). For lower pole stones or diverticular stones that were difficult to be handled by flexible ureteroscope, the needle-perc was used to puncture the stones in target calyx under ultrasound guidance. Holmium laser was then used to pulverize or fragment the calculi, and the flexible ureteroscope was used to remove or further pulverize the stone fragments. Perioperative indexes and postoperative complications were recorded, and stone-free rate was analyzed. Results:All 36 cases were successfully operated. The median operation time was 61.5(59.0, 66.8)min, with a median decrease in hemoglobin on the first postoperative day of 1.6(0.8, 2.0)g/ L, a median postoperative hospital stay of 1.5(1.0, 2.0)days, and a median needle-perc tract of 1(1, 2). The complications were recorded in 4 patients (11.1%), all of which were Clavien-Dindo grade I, including postoperative fever in 2 patients and analgesic use in 2 patients. The primary stone-free rate was 83.3% (30/36). The 6 patients with residual stones were treated by external physical vibration lithecbole on the 3rd to 7th day after surgery. After 1 month follow-up, residual stone expulsion were seen in 3 patients. Three patients with residual stones were followed up regularly. The final stone-free rate was 91.7% (33/36).Conclusions:Ultrasound-guided needle-per assisted RIRS is safe and effective in the treatment of small but complex renal calculi, with high postoperative stone free rate and low complication rate.

Objective:To investigate the distribution of CYP2C19 genotypes in Helicobacter pylori (Hp) infected children in Chongqing and the correlation of genotypes with gender, age and efficacy, and to provide a reasonable plan for Hp eradication in children in Chongqing. Methods:A prospective clinical cohort study was carried out on 156 children who were suspected of Hp infection and underwent gastroscopy in Children′s Hospital of Chongqing Medical University from March to July 2020. 13C-urea breath test ( 13C-UBT), rapid urease test (RUT) and histological examination were made for all the children included.Meanwhile, for Hp-positive children, the CYP2C19 genotypes were detected by using the polymerase chain reaction(PCR)-sequence-specific primer method, and their sensitivity to Clarithromycin and Amoxicillin was assessed.According to the genetic testing results, the CYP2C19 genotypes were divided into homozygous extensive metabolizer (HomEM), heterozygous extensive metabolizer (HetEM) and poor metabolizer (PM). The eradication outcomes of proton pump inhibitor combined with Amoxicillin and Clarithromycin (PAC) in different genotypes were observed.The measurement data that did not conform to the normal distribution were expressed with the median ( M), and the enumeration data were represented by the rate or the constituent ratio.The Chi- square test was used for comparison between groups, and P<0.05 indicated statistically significant difference. Results:(1)A total of 102 children were Hp positive.Positive rates of 13C-UBT, RUT and histologic results were 97.1% (99/102), 99.0% (101/102), and 90.2% (92/102), respectively.(2)Among the 102 Hp-infected children HomEM accounted for 45.1% (46/102), HetEM for 41.2% (42/102), and PM for 13.7% (14/102). (3)There were 50 males and 52 females in 102 Hp-infected children.The age range was 3 years to 17 years and 9 months (median: 9 years and 7 months). There was no significant difference in the distribution of CYP2C19 genotypes between females and males and among children of different ages (all P>0.05). (4)In 87 cases treated with PAC regimen, 36 cases failed to eradicated Hp in the initial treatment, including 18 cases of HomEM, 15 cases of HetEM, and 3 cases of PM.Hp was eradicated successfully in 51 cases, including 21 cases of HomEM, 21 cases of HetEM and 9 cases of PM.There was no statistically significant difference in the Hp eradication efficacy among children with different CYP2C19 genotypes treated by the PAC regimen ( P>0.05). (5) Among the 87 children, 45 children were sensitive to Clarithromycin, and 37 of them achieved successful Hp eradication.About 42 children were resistant to Clarithromycin, and Hp eradication was fulfilled in 14 of them.There was a statistically significant difference in the Hp eradication efficacy among Clarithromycin-resistant children treated by PAC regimen ( P<0.05). Conclusions:The CYP2C19 genotypes have no correlation with gender, age and Hp eradication efficacy of PAC in children with Hp infection in Chongqing.

The polymorphism of CYP2C19 gene constitutes the basis for the difference in enzyme activity and affects the metabolism of many drugs including proton pump inhibitors.The distribution of CYP2C19 gene varies by region and race.The study on the relationship between CYP2C19 genotype and proton pump inhibitors is of great significance for the individualized treatment of Helicobacter pylori (Hp) in children.This paper reviews the effects of CYP2C19 gene polymorphism on proton pump inhibitors and the efficacy of Hp eradication in children.

The 13C-urea breath test is the most widely applied non-invasive test to diagnose Helicobacter pylori (Hp) infection in children.The fasting time, dose and formulation of labeled urea, type of test meal, time of breath collection, device to detect breath samples, cut-off value of exhaled 13CO 2/ 12CO 2 breath delta value and the interpretation of results have been modified to improve the accuracy.The 13C-urea breath test possesses a good perfor-mance in diagnosing Hp infection and evaluating the eradication of infection after treatment in children.However, the high false-positive results in young children are caused by oral flora, endogenous CO 2 and fixed dose of labeled urea.In addition, taking proton pump inhibitors, antibiotics and bismuth before test, low bacterial density and peptic ulcer bleeding will lead to false negative results.This study aims to review the influencing factors of 13C-urea breath test in the diagnosis of Hp infection in children.

Gastrointestinal tuberculosis(GITB)is defined as Mycobacterium tuberculosis involving any region of gastrointestinal tract, mostly in the distal ileum and cecum.Clinical features include abdominal pain, fever and palpable mass in the ileocecal area and so on.China is one of the countries with high tuberculosis burden, and the incidence of GITB remains high.However, the manifestation isn′t specific, so it′s still difficult to diagnose, which causes misdiagnosis and mistreatment.Diagnosis and treatment of GITB in children are more difficult than in adults.It′s often misdiagnosed as Crohn′s disease, increasing treatment expense, leading to unnecessary adverse drug reactions and affecting the physical and mental health of children.Therefore, it′s vital to understand the characteristics and make correct diagnosis, which improves patient′s prognosis and life quality, and reduces tuberculosis transmission.