To improve the treatment success rate of retrograde ureteroscopy in patients with proximal ureteral stones without a preset stent during a single hospitalization.
Methods
A coping path was developed for the difficulties encountered in semi-rigid ureteroscopy （sURS） surgery， and the data of 148 patients （156 sides） with proximal ureteral calculi who met the inclusion criteria and underwent the surgery according to the coping path between 2022 and 2023 were reviewed.
Results
Of the 148 patients included，143 （96.6%） completed the first stage treatment and 5 （3.4%） completed the second stage treatment. Two（1.4%） patients had fever 24 hours after operation， but there was no sepsis or Traxer grade 4 ureteral injury.No hydronephrosis was observed during a follow-up period of 6 to 12 months. In this study， patients with proximal ureteral stones without a preset stent had a 73.7% success rate of initial 8/9.8 Fr sURS placement.This rate improved to 82.1% after coaxial dilatation. Switching to ultrafine （4.5/6.5 Fr） sURS still prevented access to stones due to difficulty in ascending in 9.6% of cases.
Conclusion
With the awareness of multilink "ureteral mucosal protection"， the path to cope with difficult ureteral calculi through a combination of techniques is effective and safe， and can help complete the treatment of patients within a single hospitalization to the greatest extent.
To explore the value of blood inflammatory biomarkers in diagnosing earlyonset colorectal cancer （EOCRC） and predicting its adverse outcomes.
Methods
The baseline information，laboratory test results， and other clinical data of adult patients under 50 years old who were diagnosed with colorectal tumors （including colorectal cancer and benign colorectal tumors） and completed their treatment at Beijing Friendship Hospital Affiliated to Capital Medical University from January 2016 to December 2022 were collected. The clinical and pathological characteristics of patients with early-onset colorectal tumors were analyzed， and the differences in inflammatory indicators were compared between EOCRC patients and colorectal benign tumor patients under 50 years old.
Results
Patients with early-onset colorectal tumors tended to be male， overweight， and often asymptomatic， and the most commonly affected site was left colon.Multiple logistic regression analysis showed that after adjusting for confounding factors， compared with patients with colorectal benign tumors， systemic immune-inflammation index （SII） and C-reactive protein（CRP）-to-albumin ratio （CAR） were significantly increased in EOCRC patients （P＜0.05）. SII had the best diagnostic performance for EOCRC， with an area under the receiver operating characteristic （ROC） curve（AUC） of 0.751 （95% confidence interval ［CI］： 0.685～0.817， P＜0.001）. When SII was 416.63， it had the best sensitivity （71.3%） and specificity （71.1%）. EOCRC patients with distant metastasis had higher SII， CAR， and inflammatory burden index （IBI）， and lower lymphocyte-to-CRP ratio （LCR）； after adjusting for confounding factors， platelet-to-lymphocyte ratio （PLR） was significantly associated with distant metastasis of EOCRC（P＜0.05）. CAR had the best prediction effect （AUC=0.765， 95%CI： 0.683～0.846， P＜0.001）. When CAR was 0.077， its sensitivity and specificity for predicting distant metastasis of EOCRC were 76.5% and 69.1%，respectively.
Conclusion
This study confirms the ability of inflammatory index ratios represented by SII and CAR to diagnose EOCRC and predict its distant metastasis， and provides new prospective for future screening and early detection of EOCRC.
To investigate the feasibility and safety of extramedullary reference with anterior femoral condyle pre-osteotomy technique in total knee arthroplasty （TKA）.
Methods
A total of 160 patients with advanced knee osteoarthritis （OA） who underwent primary TKA at Suqian Third Hospital from January 2022 to December 2022 were randomly divided into two groups： A and B. In group A， a new extramedullary reference technique was adopted while in group B， standard intramedullary femoral instruments were used. Excluding cases with a follow-up duration less than 12 months， there were 68 cases in group A and 67 cases in group B. Gender， age， body mass index （BMI）， affected side， preoperative Visual Analogue Scale （VAS） score， preoperative range of motion （ROM）， preoperative Western Ontario and McMaster Universities Osteoarthritis Index （WOMAC）， and preoperative Oxford Knee Score （OKS） were evaluated in the two groups. Operation time， postoperative drainage volume， incidence of notching of anterior femoral cortex， postoperative hip-knee-ankle （HKA）， tibiofemoral angle （TFA）， femoral flexion angle （FFA），posterior tibial slope （PTS）， and proximal tibia medial angle （MPTA）， and postoperative complication rate were compared between the two groups， and VAS score， knee ROM， and WOMAC and OKS at 1， 6， and 12 months after operation were analyzed.
Results
There were no significant differences in gender， age， BMI，sides， preoperative VAS score， preoperative ROM， and preoperative WOMAC and OKS between the two groups （P＞0.05）. The incidence of anterior femoral cortex notching in group A （5.9%） was significantly lower than that of group B （17.9%； P＜0.05）. The postoperative drainage volume of group A ［（248.9±49.8） ml］was significantly less than that of group B ［（378.9±43.7） ml； P＜0.05］. There were no significant differences in operation time， postoperative complication rate， HKA， TFA， FFA， PTS， and MPTA between the two groups （P＞0.05）. The VAS score， ROM， WOMAC， and OKS in group A were significantly better than those of group B at 1 month after operation （P＜0.05）. However， no significant differences were found between the two groups at 6 and 12 months of follow-up （P＞0.05）.
Conclusion
The new extramedullary reference technique with pre-osteotomy of anterior femoral condyle in TKA is safe and effective. Compared with the intramedullary alignment system， the new technique not only reduces postoperative drainage volume and the incidence of nothing of anterior femoral cortex， but it is also associated with more pain relief and better joint function and ROM within 1 month after operation.
To explore effective diagnostic methods for sarcopenia， its prevalence，and its impact on the prognosis of intensive care unit （ICU） patients receiving mechanical ventilation.
Methods
This study included 62 patients with respiratory failure who received mechanical ventilation in the ICU of Rudong Hospital Affiliated to Xinglin College， Nantong University between January 2021 and December 2023. The SARC-F questionnaire and the thoracic skeletal muscle index （SMI） to diagnose sarcopenia. Patients were divided into sarcopenia and non-sarcopenia groups based on the diagnosis results.Key variables， including age， gender， APACHE-II and SOFA scores at 24 and 72 hours after admission， NRS-2002 score at admission， 7-day gastrointestinal nutrition compliance rate， mechanical ventilation duration，ICU stay， and 28-day mortality rate， were compared between the two groups.
Results
Of the 62 patients，24 were diagnosed with sarcopenia， resulting in a prevalence rate of 38.7%. The sarcopenia group had significantly higher NRS-2002 score， 72-hour APACHE-II and SOFA scores， longer mechanical ventilation duration， extended ICU stay， and lower 7-day gastrointestinal nutrition compliance rate compared to the nonsarcopenia group （P＜0.05）.
Conclusion
The combination of the SARC-F questionnaire and thoracic SMI may help effectively diagnose sarcopenia in mechanically ventilated ICU patients. Sarcopenia is prevalent in this population and is associated with a poor prognosis， highlighting the need for early diagnosis， evaluation，and treatment to optimize patient outcomes.
To investigate the impact of preoperative chemotherapy on the prognosis of pseudomyxoma peritonei （PMP） treated by cytoreductive surgery （CRS） plus hyperthermic intraperitoneal chemotherapy （HIPEC）.
Methods
A literature search was conducted on cohort studies on the effects of preoperative chemotherapy on the prognosis of PMP from PubMed， Embase， Cochrane Library， CNKI，and Wanfang Database. The literature was screened according to the inclusion and exclusion criteria， and quality evaluation and data extraction were carried out. RevMan5.4 and Stata15.1 software were used for statistical analyses. The outcome indicators were overall survival （OS）， progression-free survival， and disease-free survival （DFS）.
Results
Seventeen articles were included in the meta-analysis. Fourteen articles reported the impact of preoperative chemotherapy on OS. The results of meta-analysis showed that the OS of the preoperative chemotherapy group was shorter than that of the non-preoperative chemotherapy group（hazard ratio ［HR］=1.58， P＜0.00001）. Stratified analysis showed that in patients with pathological types of high-grade tumors and high-grade tumors with signet ring cells， the OS of the preoperative chemotherapy group was shorter than that of the non-preoperative chemotherapy group （HR=1.62， P＜0.00001）. The OS of the preoperative chemotherapy group in Caucasian race was shorter than the non-chemotherapy group in Caucasian race （HR=1.65， P＜0.001）， but there was no statistically significant difference in the Asian race.Seven articles reported the impact of preoperative chemotherapy on PFS. The results showed that the PFS of the preoperative chemotherapy group was shorter than that of the non-chemotherapeutic group （HR=1.62，P＜0.001）. Stratified analysis showed that in patients with pathological types of high-grade tumors and highgrade tumors with signet ring cells， the PFS of the preoperative chemotherapy group was lower than that of the non-chemotherapeutic group， but the difference was not statistically significant （HR=1.24， P=0.31）. In both Asian and Caucasian races， the PFS of preoperative chemotherapy group was declined （HR=1.53 and 1.71，P=0.003 and 0.0002， respectively）. Sensitivity analysis and publication bias test both suggested stable results.
Conclusion
Preoperative chemotherapy has no OS and PFS benefit for PMP patients receiving CRS + HIPEC treatment. Because all the included studies are retrospective， and the possible important confounding factors such as baseline information， pathological types， and chemotherapy regimens had not been investigated in more detail， more stringent prospective studies are warranted for further verification.
To investigate and analyze the narrative ability of general practitioners，and to put forward specific and feasible suggestions and measures to improve the medical humanistic quality of general practitioners.
Methods
The self-developed 5-level scale “Narrative Ability Evaluation Scale for General Practitioners” was used to evaluate the narrative ability of 17 general practitioners.Based on the evaluation results， the narrative ability of general practitioners was analyzed and discussed.
Results
The mean score of the participants was （90.61±4.94； full score 130）. The item with the highest score was “establishing a good trust relationship with patients” （4.0±0.36）， and that with the lowest score was “analyzing the main contradiction” in “scene reproduction” （3.55±0.27）. The item with the second lowest score was “reflect on the advantages， disadvantages and improvement methods in the process of general practice” （3.56±0.26）.
Conclusion
The narrative ability of general practitioners still has some room for improvement， especially in the comprehensive and in-depth analysis of the main contradictions of patients. Medical colleges and grassroots medical institutions should take corresponding measures to promote general practitioners to integrate narrative medicine into clinical diagnosis and treatment.
The intratumoral microbiome refers to the microbial community residing within tumors，forming a crucial part of the tumor microenvironment. With advancements in metagenomic technologies，there has been a deeper understanding of the composition and functions of these microbial communities.Growing evidence suggests that microorganisms， such as bacteria， can indeed survive within various tumor tissues， including breast cancer， and are associated with tumorigenesis， disease progression， and drug resistance. This review summarizes the intratumoral microbiota related to the initiation， progression， and recurrence of breast cancer， elucidating their mechanisms of action. Additionally， this paper also explores the potential clinical applications of targeting the tumor micro-ecosystem for precision treatment of breast cancer.
Lumbar paravertebral muscles， which play an important role in stabilizing the spine，have been observed to exhibit an increase in fat infiltration with age and lumbar degeneration. Magnetic resonance imaging （MRI） has emerged as a valuable tool for studying the morphology of paravertebral muscles and the degree of fat infiltration. A variety of measurement methods have been proposed by scholars for evaluating paravertebral muscles， including semi-quantitative （Goutallier grading system）， quantitative（muscle fat index MFI）， and functional evaluations （Ito test）. All of these methods have been demonstrated to have good reliability. Paravertebral muscle atrophy has been demonstrated to be associated with chronic low back pain， exhibiting a significant correlation with lumbar degenerative diseases such as lumbar disc herniation and lumbar spondylolisthesis. Additionally， it has been linked to osteoporosis and the number of spinal fractures. Furthermore， imaging studies have demonstrated that paravertebral muscle atrophy is associated with disc degeneration， endplate abnormalities， increased disc vacuum sign， increased osteoarthritis of the facet joints， decreased lumbar lordosis， and increased pelvic tilt. The surgical prognosis of patients is affected by alterations in paravertebral muscles. The fat infiltration index of paraspinal muscles correlates with poorer Oswestry Disability Index scores in postoperative patients. Furthermore， it is an independent risk factor for severe cage subsidence in men， an independent risk factor for postoperative proximal junctional kyphosis （PJK） in adult spinal deformities， and a potential risk factor for the occurrence of re-fracture after vertebroplasty and residual low back pain. A gene expression profiling study of paravertebral muscles revealed that increased COL3A1 expression was associated with a reduction in the fat infiltration in these muscles， while decreased mTOR expression was associated with an increase in the functional cross-sectional area of paravertebral muscles.
Atherosclerosis is a chronic inflammatory arterial disease characterized by the accumulation of lipids， inflammation， and endothelial dysfunction， and it is one of the main causes of metabolic diseases such as diabetes and coronary heart disease. Its pathogenesis is complex and variable，and has not yet been fully elucidated. Research has found that under pathological conditions such as obesity and inflammation， perivascular adipose tissue undergoes adipocyte phenotypic transformation， leading to the release of adipokines and inflammatory cytokines， and regulates various inflammatory cells， thereby regulating the progression of atherosclerosis "from outside to inside". Studies have found that traditional Chinese medicine can prevent and treat atherosclerosis by regulating the proportion and function of perivascular adipose tissue. This article reviews the mechanism of action of single Chinese herbs， single herb constituents， and Chinese herbal formulas in preventing and treating atherosclerosis by regulating the browning of perivascular adipose tissue， aiming to provide new methods and ideas for clinical treatment.
With the advent of an aging society， the incidence of chronic diseases is increasing year by year. The development of the economy has continuously improved people's living standards， and as a result， people's demands for quality of life are gradually increasing. More and more studies have shown that cardiopulmonary rehabilitation plays an important role in cardiovascular diseases， shortening patients' hospital stay， improving their cardiovascular endurance， and enhancing their quality of life. This article reviews the application of cardiopulmonary rehabilitation in common cardiovascular diseases， aiming to enhance people's understanding of cardiopulmonary rehabilitation.
Chronic liver disease can be caused by a variety of factors， such as viral disease，alcohol and non-alcoholic fatty liver disease， autoimmune disorder， drug-induced liver injury， and genetic factors. Liver fibrosis is an important pathological repair reaction to various chronic liver diseases， which is closely related to the development of liver tumors and death. Although liver biopsy is the gold standard for the diagnosis of liver fibrosis， it is invasive and has limited use. The current histopathological fibrosis staging system is not sensitive enough to fibrosis monitoring. Therefore， early and non-invasive diagnosis and accurate staging of liver fibrosis are the key to treating and controlling the progression of fibrosis. This article reviews the progress in research of non-invasive diagnostic methods for liver fibrosis in patients with chronic liver disease.
