Lung-diaphragmatic protective ventilation aims to limit damage to the lung and diaphragm during mechanical ventilation in critically ill patients. The dynamic monitoring of respiratory drive and inspiratory effort is the focus of the clinical strategies for implementating lung-diaphragm protective ventilation strategies. This paper reviews the existing indicators for dynamic monitoring of respiratory drive and inspiratory effort at the three levels of respiratory muscle, pressure change, and pulmonary ventilation according to the physiological pathway of respiratory drive and discusses their significance, acquisition methods, and thresholds.

Objective  To establish an experimental protocol for inducing human macrophages into scar-associated macrophages (SAMs) in vitro. To investigate the mechanism underlying SAMs regulating hepatic stellate cell (HSC) activation. Methods  Published single-cell RNA sequencing (scRNA-Seq) data, which were obtained from human or murine fibrotic liver tissues, were used to study the expression of fibrosis-related genes in SAMs. Phorbol-12-myristate-13-acetate (PMA) and plasminogen (PLG) were used to induce the transformation of human monocyte THP-1 into SAMs. SAM supernatant was collected to culture with LX-2. The expressions of SAM markers, fibrosis-related genes and HSC activation markers were detected by real-time quantitative polymerase chain reaction（RT-qPCR）. Results  scRNA-seq revealed that SAMs were detected in both mouse fibrotic livers or human injured liver. SAMs highly expressed fibrosis-related genes such as SPP1, CTSD. PMA and PLG increased the expressions of SAM markers CD9, TRME2, LGALS3, CD63 in THP-1. Fibrosis-related genes SPP1, CTSD were highly expressed by SAMs. The supernatant of SAMs activated LX-2. Conclusion  SAMs are accumulated in mouse or human liver injury/fibrosis caused by different causes, and represent similar characteristics and functions. PMA and PLG induce the transformation of human monocyte THP-1 into SAMs. SAMs promote the activation of HSCs via SPP1 and CTSD, thus promoting the occurrence and development of liver fibrosis.

Objective  To explore the association between systolic blood pressure variability and in-hospital mortality in patients with sepsis. Methods  This study was a prospective, multicenter, and cohort study. Data were derived from the China Critical Care Sepsis Trial, which was conducted from January 2013 to August 2014. Patients aged ≥18 years with length of stay of intensive care unit （ICU）more than 24 h were included. The patients who were diagnosed  as sepsis for more than 48 h and lack of blood pressure for 2 h or longer were excluded. Systolic blood pressure, diastolic blood pressure, fluid intake and output were collected. The systolic blood pressure coefficient of variation (SBP_cv) was calculated and divided into four groups (Q₁, Q₂, Q₃, Q₄) according to the interquartile of SBP_cv. The multivariable Logistic regression was applied to explore the association between systolic blood pressure variability and in-hospital mortality. Results  A total of  1 356 patients with sepsis were included, with 929 (68.5%) males and 427 (31.5%) females, median age 67.0 years (52.0, 78.0).Among them,  483 (35.6%) patients died during hospitalization. After adjusting for potential confounding factors, for every 10% of SBP_cv increasing, the risk of in-hospital mortality increased 43% (OR=1.43, 95%CI:1.11-1.98). Compared with Q1 group, patients in Q4 group had a 69% increased risk of in-hospital mortality (OR=1.69, 95%CI:1.31-2.25) and a 23% increased risk of 28 d mortality (OR=1.23, 95%CI:1.07-1.84). Conclusion  Higher systolic blood pressure variability was correlated with higher risks of in-hospital mortality and 28 d mortality.

Objective  To compare the differences of clinical manifestation between odontogenic sinusitis (ODS) patients with and without sinusitis symptoms. Methods  The clinical data of totally 92 ODS patients’ clinical data were retrospectively collected, who underwent endoscopic sinus surgery in the Department of Otolaryngology, Head and Neck Surgery in Beijing TongRen Hospital, Capital Medical Uniersity, from June 2020 to June 2022. Among them, 77 cases had sinusitis symptoms（SS group）, and 15 cases had no sinusitis symptoms（non-SS group）. The survey items included medical history, symptoms, etiology, endoscopic examination and sinus computed tomography(CT)were compared.Results  Compared with the SS group, the non-SS group has a shorter course of disease ［(4.9 ± 3.4) months vs (10.4 ± 11.0) months, P=0.048)］, and a higher proportion of first consultation in Department of Stomatology (100% vs 24.7%, P=0.035). There was no statistically significant difference in the positive rates of reported toothache and tooth loosening symptoms between the two groups of patients (29.9% vs 53.3%, P=0.133; 18.2% vs 35.3%, P=0.085). The proportion of periodontal endodontic combined lesions (PECL), apical periodontitis (AP), periodontitis (PE), and iatrogenic factor, accounted for the etiology of the two groups of patients, were 53.2% vs 20% (P=0.024); 28.6% vs 33.3% (P=0.76); 11.7% vs 26.7% (P=0.215); and 6.5% vs 20% (P=0.119), respectively. CT of the sinuses showed that the SS group had a higher proportion of involvement in the ostiomeatal complex (OMC), ethmoid sinus, and frontal sinus than non-SS group did, with 83.1% vs 26.7% (P=0.000); 80.5% vs 20% (P=0.000);  and 41.6% vs 0% (P=0.002), based on the evaluation of CT opacification. Conclusions  The multidisciplinary cooperation between Otolaryngology and Stomatology could early identify ODS patients without sinusitis symptoms, diagnose and treat timely dental related diseases, such as PECL, reduce the probability of endoscopic sinus surgery, and improve life quality of  patients. 

Objective  To investigate the impact of Candida albicans colonization on the mortality, duration of antibiotic therapy, immune and inflammation status in patients with ventilator-associated pneumonia (VAP) caused by multidrug-resistant Pseudomonas aeruginosa. Methods  This prospective multicenter cohort study included patients with VAP caused by multidrug-resistant Pseudomonas aeruginosa (MDR-Pa) admitted to six tertiary teaching hospitals from June 2018 to June 2023. The patients were divided into colonization group and non-colonization group based on the presence of Candida albicans detected in the broncho-alveolar lavage fluid (BALF). The 30-d all-cause mortality, duration of antibiotic therapy, immune and inflammation status were compared between the two groups after VAP diagnosis on the day1, day3, day5, and day7. Results  During the five-year research period, a total of 232 VAP patients caused by MDR-Pa were included from six participating units in the intensive care unit (ICU), with 105 cases in the colonization group and 127 cases in the non-colonization group. The Pseudomonas aeruginosa detected in BALF samples from the non-colonization group showed higher sensitivity to aminoglycosides, cephalosporins, and carbapenems compared to the colonization group (P<0.05). However, both groups showed lower sensitivity to 16 antibiotics compared to China antimicrobial surveillance network (CHINET) 2022 (P<0.05).  Interleukin-17A and (1,3)-β-D glucan levels in the non-colonization group were consistently lower than those in the colonization group at various time points, and other inflammatory markers were more likely to return to normal values (P<0.05). Additionally, the absolute values of T and Th lymphocytes in the non-colonization group recovered to normal levels faster on the day 7 (P<0.05). There was no statistically significant difference in the 30-d all-cause mortality between the two groups (25.7% vs 22.8%, P=0.61), but the non-colonization group had a significantly shorter duration of antibiotic therapy compared to the colonization group ［(11.3±3.1)d vs （14.2±4.7)d, P<0.01］, with a trend towards shorter ICU hospitalization time. Conclusion  The colonization of Candida albicans in the airway does not affect the 30-d all-cause mortality of patients with VAP caused by MDR-Pa. However, it does prolong the inflammatory response and the duration of antibiotic use, as well as delay the recovery of immune function.

Objective  To explore the association between cumulative exposure indicators of serum uric acid to serum creatinine ratio (SUA/Scr) and incident carotid plaque. Methods  This study included 9 228 individuals who met the inclusion and exclusion criteria from the Beijing Health Management Cohort. The cumulative exposure, cumulative exposure burden and high exposure time of SUA/Scr were calculated based on the values of SUA/Scr in three physical examinations in 2010 to 2011 (visit 1), 2012 to 2013 (visit 2), and 2014 to 2015 (visit 3). Carotid plaque was diagnosed by carotid ultrasound, and the follow-up was until December 31, 2021. Logistic regression model was used to analyze the association between SUA/Scr cumulative exposure indicators and carotid plaque occurrence, and sensitivity analysis was performed by excluding the participants with the usage of antihypertensive drugs, or glucose-lowering drugs, or lipid-lowering drugs. Results  The mean age of the study population was (48.89±10.22) years, and 5 846(63.35%) participants were males. The participants were divided into four groups according to the quartiles of SUA/Scr cumulative exposure, namely Q1-Q4 groups. After adjusting for covariates in models, compared with Q1 group, the ORs (95%CIs) of incident carotid plaque in Q2, Q3 and Q4 groups were 1.221 (95%CI：1.066-1.400), 1.255(95%CI： 1.095-1.439) and 1.478 (95%CI：1.287-1.697). Cumulative exposure burden greater than 0 (OR=1.223，95%CI：1.109-1.349) and high exposure time of 6 years (OR=1.332，95%CI：1.171-1.515) were both associated with increased risk of carotid plaque occurrence. Sensitivity analysis excluded participants with the usage of any antihypertensive drugs, glucose-lowering drugs, or lipid-lowering drugs. The results were similar to those in main analysis. Conclusion Cumulative exposure, cumulative exposure burden and high exposure time of SUA/Scr were associated with increased risk of incident carotid plaque. In the primary prevention of carotid plaque, we should focus not only on SUA/Scr value at a single point time, but also on long-term monitoring of SUA/Scr values.

Objective  To train C57/6J wild-type mice and Sapap3 gene knockout mice to perform reversal learning induced by olfaction, tactility audition, respectively, and to explore the feasibility of reversal learning paradigm induced by olfaction, tactility audition and the cognitive flexibility of Sapap3 gene knockout mice. Methods  C57/6J wild-type mice and Sapap3 gene knockout mice (8-10 weeks old) were randomly divided into three groups and trained with the head fixed. The correct rate, error rate and learning rate of the licking events at each stage were analyzed to observe the learning ability of the mice under the three reversal learning paradigms. Results  The time required to reach the learning criterion was significantly different between Sapap3 knockout mice and C57/6J wild type mice in the reversal stage of olfactory and auditory reversal learning paradigm. Conclusion  The behavioral paradigm of reversal learning can be used to detect cognitive flexibility, which lays a behavioral foundation for the subsequent research on the diseases and brain regions related to cognitive flexibility.

Objective  To construct a bispecific antibody targeting epidermal growth factor receptor（EGFR） and OX40 and evaluate the function for tumor-specific T cell activation. Methods  The gene of anti-OX40/anti-EGFR bispecific antibody was cloned into eukaryotic expression vector, and then the constructed vector were transfected to 293F cells for the bispecific antibody purification. The binding activity of anti-OX40/anti-EGFR bispecific antibody with the cells expressing target proteins  were detected by flow cytometry. To identify the activation of T cells mediated by anti-OX40/anti-EGFR bispecific antibody, the activation of NF-κB signal activation was evaluated by Jurkat-OX40-NF-κB-GFP reporter cells and the activation of primary T cells was detected by interleukin-2（IL-2） and interferon-γ（IFN-γ） secretion of peripheral blood mononuclear cell(PBMC). Results  Anti-OX40/anti-EGFR bispecific antibody was successfully constructed and purified, and its binding ability to HEK293 cells expressing OX40 and EGFR was verified. Jurkat-OX40-NF-κB-GFP reporter cells were activated by the bispecific antibody with the crosslinking of A549 cells. Further, the anti-OX40/anti-EGFR bispecific antibody promoted the secretion of IL-2 and IFN-γ of PBMC. Conclusion  Anti-OX40/anti-EGFR bispecific antibody was successfully constructed which could specifically recognize OX40 and EGFR and activate tumor specific T cells.

Objective  To analyze the association between suicidality and biological parameters in patients with bipolar depression episodes and to provide a basis for evaluation and monitoring. Methods  A retrospective cross-sectional study was conducted on hospitalized patients with bipolar depression episodes at Beijing Anding Hospital,Capital Medical University,from January 2014 to December 2017. The patient data including demographic,clinical,and biological parameters were collected from the electronic medical records system and analyzed using R (version 4.2.2) statistical software.  Results  A total of 2 027 patients with bipolar depression episodes were included,with 417 (20.6%) exhibiting suicidal ideation or behavior. Compared to the non-suicidal group,the suicidal group had a higher proportion of females and comorbid medical conditions. Additionally,serum IgA and testosterone (TES) levels were higher in the suicidal group (all P < 0.05). Multivariate Logistic regression analysis revealed significant positive associations between IgA,comorbid medical conditions,and suicidal ideation and behavior. Conclusion  Elevated serum IgA levels and the presence of comorbid medical conditions are risk factors associated with suicidal ideation and behavior in patients with bipolar depression episodes. This finding contributes to more accurate risk identification and effective intervention strategies.

Objective  To analyze the cognitive functional differences in patients with depressive episodes regarding suicidal ideation and suicidal behavior,  and further to explore the impact of cognitive functioning on suicidal behavior. Methods  A total of 133 patients with depressive episodes who sought treatment at Beijing Anding Hospital,Capital Medical University,were selected and divided into three groups based on the presence of suicidal behavior and ideation within the past two weeks: depression control (DC) group, suicidal ideation (SI) group, and suicide attempt (SA) group. The Hamilton Depression Scale-17 item (HAMD-17),the Scale for Suicide Ideation (SSI),and the MATRICS Consensus Cognitive Battery (MCCB) were used to assess the patients' clinical symptoms and cognitive functioning. Logistic regression analysis was applied to analyze various factors.  Results  The total HAMD-17 scores of the three groups (F=59.661,P<0.001) showed statistically significant differences,with post hoc comparisons revealing significantly higher scores in the SA and SI groups compared to the DC group. MCCB results indicated that the DC group had significantly higher scores in verbal learning and memory compared to the SI group (P<0.01),and both the DC and SA groups had significantly higher scores in reasoning and problem-solving compared to the SI group (P<0.05). Logistic regression results revealed that reasoning and problem-solving (P=0.022,OR=1.067,95% CI: 1.009-1.127) and cognitive impairment factors (P<0.001,OR=1.739, 95% CI: 1.128-2.2443) were independent risk factors for suicidal behavior in patients with depressive episodes，and recurrent (P=0.003,OR=0.100,95% CI: 0.022-0.458) and social cognition (P=0.033,OR=0.953,95% CI: 0.912-0.996) were protective factors for suicidal behavior in patients with depressive episodes. Conclusion  Cognitive impairment is a crucial factor influencing the occurrence of suicidal behavior in patients with depressive episodes. 

Objective  To explore the correlation of simple measurement of inspiratory muscle pressure index from the ventilator (PMIvent) and reference measurement of inspiratory muscle pressure index on experimental condition (PMIref), the relationship between PMIvent and inspiratory effort, and further to determine the clinical feasibility and validity of PMI for assessing inspiratory effort during pressure support ventilation (PSV).  Methods  Adult acute respiratory failure patients undergoing mechanical ventilation were screened daily and enrolled 24 h after switching to PSV mode. Baseline ventilators were set according to the principle of keeping tidal volume/ predicted body weight(VT/PBW) at 6-8 mL/kg and respiratory rate (RR) at 20-30 breaths/min and the decision of the responsible ICU physician. A downward support pressure ( PS )titration was conducted from 20 cmH₂O to 2 cmH₂O. Three end-inspiratory holdings (EIO) and three end-expiratory holdings (EEO) were performed. PMIvent was calculated as the difference between plateau pressure (Pplat) within 2 s after EIO and the airway peak pressure (Ppeak) at EIO. PMIref was calculated as the difference between Pplat at one cardiac cycle after EIO and Ppeak at EIO. Flow, airway pressure (Paw), and esophageal pressure (Pes) signals were displayed continuously and saved. PMIref, PMIvent and esophageal pressure time product per breath (PTPes) were measured. PTPes per minute was calculated as the product of PTPes and RR. The “normal” range of PTPes per minute was defined as 50 to 200 cmH2O·s·min-1. The accuracy of PMIvent compared to PMIref was assessed with a Bland-Altman plot. The correlation between PMI and inspiratory effort was evaluated as the coefficient of determination (R²). The ability of PMI to detect high/low effort was assessed using the area under the receiver operating characteristics curve (ROC AUC). The optimal cut-off values were selected based on the Youden index. Results  The accuracy and precision of PMIvent compared to PMIref showed a low bias (0.18) with smaller 95% limits of agreements (-0.44,0.80). PMIref was significantly related to the PTPes per minute (between-patients R²=0.61, within-patients R²=0.80, respectively). PMIvent was also related to the PTPes per minute (between-patients R²=0.62, within-patients R²=0.81). For a cut-off PTPes<50 cmH₂O·s·min^-1, PMIvent showed an ROC AUC of 0.93 ［0.89,0.96］, and the best threshold was -0.77 cmH₂O. Conclusion  PMIvent can effectively replace PMIref. Like PMIref, PMIvent was significantly related to inspiratory effort and had the potential value to predict low inspiratory effort. 

Objective  To explore the correlation between suicide attempt (SA) in adolescents with non-suicidal self-injury (NSSI)and  the function change of the hypothalamic-pituitary-thyroid (HPT) axis and the hypothalamic-pituitary-adrenal (HPA) axis function change. Methods  A cross-sectional survey was conducted among adolescents aged 13-19 years with a history of NSSI who were hospitalized in Beijing Anding Hospital,Capital Medical University from December 2020 to May 2022. The clinical features,thyroid function ［free triiodothyronine (FT3),free thyroxine (FT4),total T3 (TT3),total T4 (TT4),thyroid stimulating hormone (TSH)］, adrenocorticotropin (ACTH) and cortisol (CORT) levels were collected. The patients were divided into non-SA group and SA group according to the  absence or presence of SA in the last one year. According to the time period of SA occurrence (1 month),patients in the SA group were divided into recent SA and past SA. The multivariate logistic regression model was used to analyze the influencing factors of SA behavior.  Results  A total of 79 adolescent patients of mood disorder with NSSI were enrolled.Among them, 49 (62.03%) patients had SA and 29(59.18%) patients had attempted suicide within the past month. The univariate analysis showed that there were statistical differences in age of disease onset,gender,and education level between the SA and non-SA groups (P<0.05). There were statistical differences in age,TSH, and ACTH level between the recent SA group and past SA group (P<0.05). The logistic regression analysis showed that female (P=0.027,OR=2.941,95%CI: 1.131-7.649) was risk factor for SA behavior. Low ACTH level（P=0.043，OR=1.019，95%CI：1.001-1.037）was related factor for recent SA. Conclusion  Female adolescents of mood disorders with NSSI were more likely to attempt suicidality and ACTH was related with recent SA.

Objective  To deepen the understanding of acute cerebral infarction with the onset of isolated vertigo. Methods  We retrospectively analyzed the patients with the onset of isolated vertigo that were previously treated in Department of Neurology,  China Civil Aviation General Hospital. They were divided into acute cerebral infarction group(25 cases in the case group) and non-acute cerebral infarction group(25 cases in the control group). The demographic characteristics, risk factors of cerebrovascular disease and imaging characteristics were analyzed. Results  In the case group, the proportions of males and the patients who were over 55 years old were significantly higher than those of control group  (72% vs  44% and 80% vs  52%, respectively, P<0.05 ). The proportions of patients with hypertension and diabetes in the case group were higher than those in the control group(72% vs  56%, 52% vs  40%, respectively), and the proportion of patients with hyperlipidemia was lower than those in the control group (84% vs 96%). There was no significant difference between the two groups(P＞0.05). The proportions of clinical manifestations with nausea, vomiting, hearing loss and nystagmus in the case group were higher than those in the control group (68% vs  56%, 52% vs  40%, 16% vs  4%, and 24% vs  16%, respectively), while the proportion of tinnitus was lower than that in the control group (8% vs 16%). There was no significant difference between the two groups (P >0.05). In the case group, there were 18 cases（72%） of cerebellar infarction, 5 cases（20%） of brainstem infarction, 1 case（4%） of occipital lobe infarction and 1 case（4%） of hippocampus infarction. Conclusion  Among patients with acute cerebral infarction who started with isolated vertigo，Men had a significantly higher risk of acute cerebral infarction than women, and patients over 55 years old had a significantly higher risk than the adult patients under 55 years old. 2.Head magnetic resonance imaging showed most of the infarction sites were in the blood supply area of the vertebrobasilar artery system: located mainly in the cerebellum and brainstem.

Objective  To identify potential diagnostic markers for moderate or severe endometriosis（EM）.Methods  Two publicly available gene expression profiles (GSE51981 and GSE7305 datasets) from human EM and control samples were downloaded from the GEO database. Differentially expressed genes (DEGs) were screened between 48 moderate or severe EM and 71 control samples. The Least absolute shrinkage and selection operator (LASSO) regression model and support vector machine recursive feature elimination (SVM-RFE) analysis were performed to identify candidate biomarkers. The area under the receiver operating characteristic  (AUC)  curve value was obtained and used to evaluate discriminatory ability. The expression level and diagnostic value of the biomarkers in EM were further validated in the GSE7305 dataset. The compositional patterns of the 22 types of immune cell fraction in EM were estimated based on the merged cohorts by using CIBERSORT. Results  A total of 73 DEGs were identified between samples with moderate-to-severe EM and normal controls. These DEGs were significantly enriched in malignant tumors and immune-related pathways. Thirteen candidate gene biomarkers were further screened  by using two machine learning methods, LASSO regression model and SVM-RFE analysis. Among them, the ADAT1 gene showed high diagnostic value for moderate-to-severe EM, which was validated in the validation dataset. Immune infiltration analysis showed that the levels of plasma cells and T cells follicular helper  were significantly higher in moderate-to-severe EM than those in the normal group. The diagnostic marker gene ADAT1 was positively correlated with activated dendritic cells, T cells gamma delta, T cells CD4 memory activated, eosinophils, neutrophils, and B cells naive. In contrast, ADAT1 was negatively correlated with plasma cells, T cells CD8, T cells regulatory and monocytes.Conclusion  ADAT1 may be a diagnostic biomarker for moderate-to-severe EM, providing new insights into the occurrence, progression, and molecular mechanisms of EM.

Objective  To study the effect of nitric oxide （NO） on the in vitro antibacterial activity of Porphyromonas gingivalis (P.g). Methods  The antibacterial performance of different concentrations of NO (10,30,50 mmol/L) on P.g was assessed by colony forming units,total NO detection kit,reactive oxygen species detection kit,and calcium ion fluorescent probe Fluo-4 AM. Moreover,the effects of NO treatment on intracellular levels of reactive oxygen species （ROS） and calcium ions in P.g cells were also examined.  Results  NO exhibited significant in vitro antibacterial activity against in P.g cells,and its antibacterial activity was positively correlated with the concentration of NO drugs and treatment duration (P<0.05). NO treatment significantly increased intracellular levels of ROS and calcium ions in P.g cells (P<0.05). Conclusion  NO can effectively inhibit the activity and growth ability of P.g,and cause intracellular ROS and calcium ion metabolism disorders. Our study demonstrates the potential therapeutic effect and clinical application of NO donor drugs in peri-implantitis.

Objective To explore the application value of standardized nursing in multi-tracers imaging of nuclear medicine department. Methods  One hundred and ten patients who underwent positron emission tomography/computed tomography (PET/CT) and positron emission tomography/magnetic resonance imaging (PET/MRI) with various tracer imaging techniques at the Department of Radiology and Nuclear Medicine,Xuanwu Hospital,Capital Medical University from June 2020 to November 2020 were selected as the study subjects. According to the random number table method,the subjects were divided into an observation group and a control group. The control group received routine care,while the observation group received standardized care on the basis of routine care. The Self Rating Anxiety Scale (SAS) score and satisfaction survey score of two groups were compared.  Results  All 110 subjects successfully completed the examination process of tracer injection,image acquisition,and post acquisition observation,without any adverse events. After confirmation by clinical doctors,the obtained images met the diagnostic requirements. There was no statistically significant difference in gender and age between the two groups (P>0.05). The SAS score of the observation group was lower than that of the control group (t=16.310,P<0.01), but the nursing satisfaction score was higher than that of the control group (t=4.348,P<0.01). Conclusion  The standardized nursing in nuclear medicine multi-tracers imaging can reduce patients' anxiety,improve nursing satisfaction,ensure smooth completion of examinations within a limited time window,and obtain high-quality images.

Objective To explore the fluoro-18-deoxyglucose (¹⁸F-FDG) positron emission tomography/computed tomography (PET/CT) features of bone marrow necrosis and improve the understanding of the disease. Methods  The PET/CT and clinical data of 9 patients with bone marrow necrosis diagnosed by magnetic resonance imaging (MRI) were retrospectively analyzed. Compared to MRI,the distribution of lesions was summarized. The ¹⁸F-FDG metabolic and CT features of the selected largest lesion were analyzed.  Results  There were 6 males and 3 females with a median age of 28.0 years. All patients were diagnosed with lymphoma. MRI scans of the hip,spine and knee were performed in 6,2,and 1 case respectively. The iliac lesions in 6 cases showed internal high signal intensity on T1-weighted images (T1WI),low signal intensity on T2-fat suppressed images (T2FSI),and peripheral linear hypointensity on T1WI. The iliac lesions in 5 cases demonstrated internal decreased ¹⁸F-FDG metabolism,peripheral linear increased ¹⁸F-FDG uptake and density on PET/CT. The iliac lesion in one case did not show abnormal ¹⁸F-FDG metabolism and density on PET/CT,the lesion was narrow and long on MRI. The vertebral lesions in two cases showed isointensity to hypointensity on T1WI and hyperintensity on T2FSI. On PET/CT,one vertebral lesion was isometabolic with slightly higher density,the other vertebral lesion showed reduced ¹⁸F-FDG metabolism with normal density. One femoral lesion showed high signal intensity on T1WI and low signal intensity on T2FSI,with increased ¹⁸F-FDG metabolism and density on PET/CT. PET/CT revealed more lesions beyond the scan range of MRI in 8 cases. In 8 cases,abnormal signs were demonstrated on much earlier PET/CT scans performed at a median time about 13.5 (8.25,32.75) months before the MRI scan,but no one complained of any related discomfort at that time. The iliac lesions in 5 cases had decreased ¹⁸F-FDG uptake,of which 3 lesions showed peripheral linear high-density,and 2 lesions showed no abnormal density. The iliac lesion in one case did not show abnorma^{l 18}F-FDG metabolism and density. One vertebral lesion showed reduced metabolism and isodensity. In the case with knee MRI,the earlier PET/CT showed multiple linear increased ¹⁸F-FDG uptake in the bilateral femoral heads and the humerus heads,without abnormal density. During follow up PET/CT scans,the femoral head lesions in 3 cases showed cortical fracture and collapse,the vertebral lesions 2 cases demonstrated multiple Schmorl's nodules or compression fracture. Conclusion  Decreased ¹⁸F-FDG uptake,with probably subsequent peripheral linear increased metabolism and density,is a common PET/CT feature of bone marrow necrosis. PET/CT is helpful to detect bone marrow necrosis and find multiple skeletal lesions.

目的 探讨肾小管及肾小球相关标志物在2型糖尿病(type 2 diabetes mellitus, T2DM)患者不同肾损伤阶段的诊断价值。方法 选取于2018年4月1日至2019年10月31日入住首都医科大学附属北京同仁医院内分泌科的T2DM患者272例，完善临床生化指标及尿蛋白四项：尿微量白蛋白/肌酐(urinary albumin to creatinine ratio, ACR)、α1-微球蛋白/肌酐(urinary α1-microglobulin to creatinine ratio, UA1CR)、免疫球蛋白G/肌酐(urinary immunoglobulin G to creatinine ratio, UIGG)、转铁蛋白/肌酐(urinary transferrin to creatinine ratio, UTRF);进行眼底照相、核医学99mTc-EC检测肾有效血浆流量(effective renal plasma flow, ERPF)和99mTc-DTPA检测肾小球滤过率(glomerular filtration rate, GFR)。根据ACR和眼底检查结果分为4组：正常蛋白尿无糖尿病视网膜病变(diabetic retinopathy, DR)132例，即对照组(ACR≤30 mg/g);正常蛋白尿合并DR 32例，为糖尿病肾病(diabetic kidney disease, DKD)前期组；微量蛋白尿组78例(30300 mg/g)。比较四组间尿蛋白四项和ERPF、GFR的水平，通过受试者工作特征(receiver operating characteristic, ROC)曲线评价上述各指标在不同肾损伤阶段的诊断价值。结果 尿蛋白四项和ERPF、GFR的水平在不同组间差异有统计学意义(P<0.05)。在尿蛋白正常组中，DR组中肾小管功能标志物UA1CR较对照组明显升高(P<0.01);肾小球功能标志物ACR、UTRF和GFR在两组间差异无统计学意义(P>0.05),DR组UIGG较对照组升高(P<0.01)。在微量蛋白尿组和大量蛋白尿组，尿蛋白四项随肾损伤程度增加而增加，而ERPF和GFR随肾损伤程度增加而降低。ROC曲线分析显示，在尿蛋白排出正常的T2DM患者中合并DR组中肾小管功能标志物UA1CR和ERPF的曲线下面积(area under the curve, AUC)分别为68.2%(P<0.01)和60.5%(P<0.05),而肾小球功能标志物ACR和GFR的AUC均小于60%,差异无统计学意义(P>0.05)。尿蛋白四项及GFR在微量和大量蛋白尿组的AUC均大于60%(P<0.05),ERPF在大量蛋白尿组AUC为67.2%(P<0.05)。结论 T2DM极早期微血管改变即ACR正常仅有DR时，肾小管标志物UA1CR先于肾小球标志物ACR和GFR发生变化。肾损伤早期，肾小管标志物诊断效能优于肾小球；肾损伤后期，肾小球标志物诊断效能优于肾小管。提示DKD肾小管功能的改变可能早于肾小球。

目的 初步探究肾虚证亚健康人群认知功能改变的神经影像学机制。方法 对35例肾虚型亚健康受试者和35例健康对照进行重复性成套神经心理状态测验(Repeatable Battery for the Assessment of Neuropsychological Status, RBANS)及评估，并进行静息态功能磁共振扫描。应用皮质分析方法计算两组被试脑区的低频震荡振幅(amplitude of low frequency fluctuations, ALFF)值和分数低频振幅(fractional ALFF, fALFF)值，并分析异常功能活动脑区与认知功能及临床症状之间的相关性。结果 与健康受试者相比，肾虚型亚健康受试者的即刻记忆、注意编码及RBANS测验总分显著降低；并发现其左侧初级视觉皮质、左侧背侧枕叶皮质及右侧辅助运动皮质等脑区的ALFF/fALFF值异常改变。此外，左侧背侧枕叶皮质、右侧额叶眼动区ALFF值，左侧初级视觉皮质fALFF值与肾虚证积分均成正比。右侧额叶眼动区ALFF值，右侧辅助运动皮质fALFF值与测验总分成反比。结论 肾虚型亚健康受试者的记忆与注意功能受损，左侧枕叶和右侧额叶等多个脑区神经活动的改变可能是肾虚证亚健康人群认知功能改变的潜在神经机制。

目的 探索维生素D₂软胶囊对伴有糖尿病肾病（diabetic kidney disease, DKD）的2型糖尿病（type 2 diabetes mellitus, T2DM）患者蛋白尿水平的影响。方法 回顾性分析2020年10月至2022年3月在北京市某三级医院内分泌科住院治疗的估算肾小球滤过率（estimated glomerular filtration rate, eGFR）≥60 mL·（min·1.73 m²）^-1的伴DKD的95例T2DM患者。根据患者的治疗方案分为未使用维生素D制剂的对照组（CON组，n=33）、使用维生素D₂软胶囊的普通维生素D组（NVD组，n=31）和使用骨化三醇软胶囊的活性维生素D组（AVD组，n=31）。通过医院病例系统收集基线和治疗12周时患者的临床资料及维生素D和DKD相关指标，包括血清25羟维生素D（25-hydroxy vitamin D,25OHD）、血清甲状旁腺激素（parathyroid hormone, PTH）、血钙、尿钙和尿白蛋白与肌酐比值（urinary albumin-to-creatinine ratio, UACR）等。结果 基线时CON组、NVD组和AVD组大量蛋白尿患者分别为8例（24.24%）、 9例（29.03%）和7例（22.58%）,差异无统计学意义（P=0.831）。治疗12周时，NVD组和AVD组ln（UACR）水平均显著降低（P均<0.001）,两治疗组间差异无统计学意义（P=0.371）。NVD组和AVD组的总有效率分别为80.65%和74.19%,显著高于CON组（33.33%）(P<0.001和P=0.002)。NVD组和AVD组的疗效差异无统计学意义（P=0.245）。CON组出现1例血钙增高、1例高尿钙、1例高尿酸血症、1例肾结石、1例肌肉痉挛；NVD组出现1例高尿钙、1例高尿酸血症；AVD组出现1例血钙增高、1例高钙血症、1例低PTH、2例高尿钙、2例高尿酸血症。两治疗组均无停药事件发生。结论 维生素D₂软胶囊与骨化三醇软胶囊均可显著降低肾功能正常的伴DKD的T2DM患者尿蛋白水平。普通维生素D与活性维生素D相比可能安全性更好。

目的 利用同位素标记相对和绝对定量(isobaric tag for relative and absolute quantification, iTRAQ)蛋白质组学技术，分析糖尿病增殖期视网膜病变(proliferative diabetic retinopathy, PDR)患者与糖尿病无视网膜病变患者(diabetes patients without retina diseases, NDR)之间蛋白表达的差异，寻找PDR的候选血清标志物。方法 收集2016年至2017年首都医科大学附属北京同仁医院内分泌科住院的PDR患者21例，以及性别年龄匹配的NDR患者21例。患者血清样本混匀后提取蛋白，采用iTRAQ标记，并进行液相质谱-串联质谱检测(liquid chromatograph-mass spectrometer and mass spectrometer, LC-MS/MS)分析，筛选出差异蛋白行基因本体论(Gene Ontology, GO)数据库功能富集及京都基因与基因组百科全书(Kyoto Encyclopedia of Genes and Genome, KEGG)通路显著性富集分析。对相对定量结果进行独立样本t检验，通过差异倍数(fold change, FC)和P值判定蛋白表达量变化。结果 以差异倍数>1.2倍(上/下调),P值≤0.05为标准，筛选出差异蛋白29个，其中PDR组上调蛋白8个，下调蛋白21个。通过对差异蛋白的GO功能显著性富集分析，结果显示，差异基因的功能可分为生物过程、细胞组分和分子功能三个板块。差异表达基因功能涉及生物调节、细胞组成、细胞代谢过程、细胞结合和催化活性等方面。KEGG通路显著性分析显示，上调最为明显的血管紧张素转换酶(angiotensin converting enzyme, ACE)参与肾素-血管紧张素系统(renin angiotensin system, RAS)、肾素分泌等通路，上调蛋白——胰岛素样生长因子I(insulin like growth factor I,IGF-1)参与HIF-1、FoxO、mTOR、PI3K-Akt和AMPK等多条与代谢相关的信号通路。下调显著的蛋白——肌球蛋白6(myosin-6)参与心肌细胞收缩和信号传导通路。结论 采用iTRAQ蛋白质组学分析显示，PDR患者与NDR患者存在多种蛋白表达差异，ACE、IGF-1和Myosin-6有望作为糖尿病视网膜病变候选血清诊断标志物，未来可能为PDR的诊断和治疗提供新的靶点。

<正>首都医科大学(以下简称首医)内分泌与代谢病学系于2005 年正式成立，是培养内分泌与代谢病领域，特别是糖尿病为专业方向的临床专科高级人才的专科学系。主要培养内分泌与代谢病(糖尿病)专科医师，7年制临床研究生、硕士研究生、博士研究生、在职申请学位的硕士和博士研究生以及科研型研究生。近年来，学系在系主任杨金奎教授的带领下，经过学系全体成员的共同努力，在医、教、研、人才培养等方面取得了丰硕的成绩，特别是在科研上取得了突破。

目的 研究医源性早发性卵巢功能不全（premature ovarian insufficiency, POI）性激素水平的变化及对糖代谢的影响。方法 募集2022年1月到2024年4月就诊于首都医科大学附属北京妇产医院内分泌科的20～40岁的60例因造血干细胞移植（hematopoietic stem cell transplantation, HSCT）导致的医源性POI患者和60例特发性POI患者，一般资料包括身高、体质量、年龄，并计算体质量指数（body mass index, BMI）,实验检测指标包括卵泡刺激素（follicle stimulating hormone, FSH）、黄体生成素（luteinizing hormone, LH）、雌二醇（estradiol, E₂）、皮质醇（cortisol, F）、总睾酮（total testosterone, TT）、游离睾酮（free testosterone, FT）、空腹血糖（fasting plasma glucose, FPG）及空腹胰岛素（fasting insulin, FINS）。结果 医源性POI患者体质量、BMI、E₂、TT、FT低于特发性POI患者，差异有统计学意义（P均<0.05）。医源性POI患者的FSH、LH、FINS、FPG高于特发性POI患者，差异有统计学意义（P均<0.05）。医源性POI患者与特发性POI患者的年龄、身高和皮质醇相比，差异无统计学意义（P均>0.05）。医源性POI患者高胰岛素血症的比例明显高于特发性POI患者（P=0.025）。结论 医源性POI患者性激素水平的降低和糖代谢异常均比特发性POI患者更加严重，可能原因是疾病治疗对卵巢功能的损伤更大。但医源性POI是可以预防的。卵巢组织冻存（ovarian tissue cryopreservation, OTC）可以同时保护生育力和卵巢内分泌功能，使医源性POI的防治从不可能变为可能，因此在接受放射治疗和化学药物治疗之前进行OTC十分有必要。

目的 探讨液相色谱串联质谱(liquid chromatography-tandem mass spectrometry, LC-MS/MS)法在多囊卵巢综合征(polycystic ovary syndrome, PCOS)患者中高雄激素血症(hyperandrogenemia, HA)检出率，探讨不同种类雄激素在PCOS中的诊断价值。方法 纳入2023年1月至2023年12月于首都医科大学附属北京妇产医院妇科内分泌门诊就诊合并雄激素过多临床表现的PCOS患者100例为试验组，同期就诊的健康备孕人群100例为对照组。LC-MS/MS法检测总睾酮(total testosterone, TT)、游离睾酮(free testosterone, FT)、生物活性睾酮(bioavailable testosterone, BIO-T)、雄烯二酮(androstenedione, A2)、17羟孕酮、双氢睾酮、脱氢表雄酮、硫酸脱氢表雄酮、性激素结合球蛋白指标，绘制受试者工作特征曲线，计算曲线下面积(area under curve, AUC),评价各雄激素水平对PCOS的诊断效能，化学发光免疫法(chemiluminescence immunoassay, CLIA)和LC-MS/MS 2种方法比较TT检测水平的诊断价值以及对HA的检出率。结果 与对照组相比，试验组TT、黄体生成素(luteinizing hormone, LH)、LH/卵泡刺激素(follicle stimulating hormone, FSH)、抗苗勒管激素、空腹胰岛素、稳态模型的胰岛素抵抗指数均明显升高(P<0.05),FT的AUC诊断灵敏度最高为86.4%(P<0.05, 95%CI:0.815～0.912),其次为TT的AUC为84.4%(P<0.05, 95%CI:0.812～0.909)、BIO-T的AUC为82.2%(P<0.05, 95%CI:0.792～0.896)、A2的AUC为84.2%(P<0.05, 95%CI:0.790～0.895)。与CILA法相比，利用LC-MS/MS法检测TT诊断PCOS的灵敏度更高(AUC 0.891 vs 0.841),且对于合并雄激素过多临床征象的PCOS患者HA检出率明显高于CLIA法(P<0.05)。结论 LC-MS/MS法对多种雄激素指标检测灵敏度高、准确性好，FT对于高雄激素临床表现的PCOS诊断价值最高，且该法可提高PCOS的检出率，实现HA的早期筛查，更适合临床推广应用。

目的 探讨程序性细胞死亡蛋白1(programmed cell death protein 1,PD-1)单抗联合化学药物治疗(以下简称化疗)在局部晚期非小细胞肺癌新辅助治疗中的疗效和安全性。方法 回顾性分析2021年6月至2023年6月于首都医科大学附属北京友谊医院胸外科43例接受新辅助免疫治疗联合化疗的局部晚期(ⅡB～ⅢB)非小细胞肺癌患者的临床资料，评估其影像学及病理学疗效，并观察免疫相关不良反应。结果 影像学疗效评价显示客观缓解率为76.7%,疾病控制率为93.0%。34例(79.1%)接受手术的患者中，R0切除率97.1%、完全病理缓解率为29.4%、主要病理缓解率为55.9%。1～2级免疫相关不良反应发生率为67.4%,3级及以上不良反应发生率为7.0%。结论 新辅助PD-1单抗联合化疗治疗非小细胞肺癌疗效显著，病理缓解率及R0切除率高，免疫相关不良反应及手术并发症在可接受范围内，安全性较高。

目的 观察达格列净对冠状动脉粥样硬化性心脏病(以下简称冠心病)合并射血分数保留的心力衰竭(heart failure with preserved ejection fraction, HFpEF)患者的心功能的影响。方法 将2021年1月至2022年9月于首都医科大学附属北京朝阳医院心内科住院的冠心病合并HFpEF患者作为研究对象，选择其中服用达格列净的69例患者为达格列净组，未服用达格列净的81例患者为对照组。2组患者均接受标准冠心病二级预防治疗，如无禁忌证，给予心力衰竭标准化治疗。通过医院信息系统收集患者基本信息、住院及出院12个月门诊随访资料，包括血糖、血脂、N末端脑钠肽前体(N-terminal pro-B-type natriuretic peptide, NT-proBNP)等化验指标，左室射血分数(left ventricular ejection fraction, LVEF)、左心室舒张末期内径、左心室收缩末期内径、左心室后壁厚度、每搏输出量、左心室舒张功能E/e’avg等超声指标，记录住院及随访期间心源性死亡、急性左心衰发作、心衰再住院、心绞痛再住院及药物不良反应等。结果 达格列净组患者的血脂、血糖控制程度及NT-proBNP、LVEF、E/e’avg的改善程度均优于对照组，差异有统计学意义(P<0.05)。随访期间达格列净组患者急性左心衰发作，因心衰再住院发生率较对照组明显减少，差异有统计学意义(P<0.05)。结论 达格列净可以提高冠心病合并HFpEF患者心脏舒张功能，降低NT-proBNP浓度，提高生活质量及心力衰竭再住院率，具有良好的安全性。

目的 报道解析型内侧膝关节单髁置换(unicompartmental knee arthroplasty, UKA)手术流程及影像学结果，并以UKA术中关节间隙变化为主要指标，探究解析型UKA对手术规划和假体设计的指导作用。方法 研究纳入2022年5月至2024年4月间开展的机器人辅助解析型内侧UKA手术患者，报道解析型UKA手术基本流程及达到动态间隙平衡的患者比例，分类解析动态间隙平衡曲线形态模式，并对比纳入患者术前及术后髋膝踝(hip-knee-ankle, HKA)角，股骨后髁偏心比(posterior condylar offset ratio, PCOR)及胫骨后倾(posterior tibial slope, PTS)。结果 本研究共纳入18例解析型内侧UKA手术患者，9例(50.0%)达到动态间隙平衡。动态间隙曲线主要呈现为U型(44.4%)、倒U型(33.3%)和水平型(11.1%)。其中13例患者获得间隙平衡求解曲线，在股骨髁未截骨状态下，间隙平衡求解曲线显示屈膝10°～50°范围内关节撑开间隙均明显大于屈膝70°～120°。试模植入后，4例(30.8%)间隙平衡求解曲线达到直线型，7例(53.8%)表现为屈膝70°及以上，关节间隙随着屈膝角度增大而增大。本组患者术后HKA角度(178.67°±3.09°)较术前(173.00°±2.88°)明显改善(P<0.001)。术后与术前PCOR平均值差异无统计学意义(0.51±0.05 vs 0.52±0.03,P=0.518),但术后PTS值(7.75°±3.28°)显著小于术前PTS(10.66°±3.03°)(P=0.001)。结论 解析型内侧UKA通过对术中多重参数的实时量化解析，可指导手术方案决策，术后影像学力线满意，部分患者可实现整个屈伸过程中动态间隙平衡。

目的 探讨宫颈癌保留神经的广泛性子宫切除术(nerve sparing radical hysterectomy, NSRH)治疗宫颈癌的效果及对排尿功能的影响。方法 纳入2019年5月至2022年5月于首都医科大学附属北京妇产医院就诊并诊断为宫颈癌的患者55例，国际妇产科联盟分期分布在ⅠB至ⅡA2。其中28例患者接受了NSRH(NSRH组),27例患者接受了广泛性全子宫切除术(radical hysterectomy, RH)(RH组)。比较2组患者手术相关指标及术后排尿功能。结果 NSRH组平均年龄为(51.0±7.9)岁，RH组平均年龄为(46.3±8.5)岁，年龄分布差异有统计学意义(P<0.05)。2组出血量差异无统计学意义(P>0.05)。2组患者手术切缘均为阴性。术后病理提示阴道长度、淋巴结转移、间质浸润深度、淋巴脉管浸润比较差异均无统计学意义(P>0.05)。在术后膀胱功能方面，NSRH组残余尿较RH组多(P<0.05),但NSRH组拔尿管的时间较RH组明显缩短(P<0.05)。结论 NSRH能够在确保手术范围的同时，减轻对术后排尿功能的影响，缩短术后恢复时间。

智能骨科属于智能医学的重要分支，具备智能医学的基本特征和独特属性，是将现代骨科技术与人工智能(artificial intelligence, AI)、医疗大数据、手术机器人等前沿技术有机融合，挖掘骨科疾病发生、发展与演变的客观规律，并探索智能化诊疗方法及其临床实践应用的新兴交叉学科。智能骨科是现代骨科发展的新方向，也是当前世界尖端医疗科技临床转化的重点领域。现阶段智能骨科临床应用研究聚焦于智能医学工程与智慧医疗。骨科医生应该正确理解智能骨科概念，明确数据驱动与医工交叉是智能骨科发展路径，准确把握智能骨科内涵，坚持临床需求牵引智能骨科技术创新，同工程技术人员紧密结合，在交叉领域坚持探索，理性而非盲目地运用前沿工程技术，争取不断开发出智能骨科的创新技术和解决方案，极大提升骨科精准治疗水平。

目的 评估采用新型的个性化3D打印钴铬钼合金对巨大距骨骨软骨损伤（osteochondral lesion of talus, OLT）进行修复的手术效果及安全性。方法 对2021年10月至2023年4月期间,本中心因距骨骨软骨损伤行3D个性化部分置换的12例患者,进行三维建模制定个性化方案并手术植入假体,术后3个月、6个月、1年定期随访。评估踝关节功能及疼痛程度、术后复查X线检查假体位置以及是否存在假体周围透光线。结果 12例患者平均病损表面积（252.5±91.1）mm²,平均病损体积（1 571.5±99.0）mm³,术后平均随访时间（21.7±5.6）个月,总体满意率91.7%;美国足与踝关节协会（American Orthopedic Foot and Ankle Society, AOFAS）(后足)评分从术前平均（69.42±10.36）分提升至（89.83±6.89）分；足部功能指数（Foot Function Index, FFI）评分从术前（55.00±31.86）分降至（14.08±7.95）分；视觉模拟疼痛量表（Visual Analogue Scale, VAS）评分从平均（3.75±2.14）分降至（1.17±1.19）分,差异均具有统计学意义（P<0.01）。患者均未出现感染、伤口愈合不良以及骨折不愈合等重大并发症。结论 针对巨大的距骨非包容性骨软骨损伤,3D个性化打印假体填充治疗技术在平均21个月时随访,手术效果满意度高,患者功能及疼痛均明显改善,且未观察到重大并发症,为治疗此类OLT提供了新型的临床解决方案。

目的 本研究旨在比较机器人辅助和导航辅助技术在骨样骨瘤治疗中的安全性和有效性，通过回顾性队列研究分析两种技术辅助下患者在手术时间、出血量、成功率、术后并发症及恢复情况等方面的差异。方法 纳入2022年8月至2023年12月期间在首都医科大学附属北京积水潭医院接受机器人辅助或导航辅助治疗的64例骨样骨瘤患者(机器人辅助组，n=25;导航辅助组，n=39)。收集患者的年龄、性别、病灶部位、术前病灶大小、出血量、手术时间、随访时间、术前和出院前视觉模拟评分(Visual Analogue Score, VAS)、成功率等数据，进行描述性统计分析和比较分析。结果 两组患者在年龄、性别、病灶部位、术前病灶大小、术前VAS评分和随访时间上差异无统计学意义。机器人辅助组的手术时间显著短于导航辅助组[(102.64±21.65) min vs(120.46±30.98)min,P=0.025]。机器人辅助组与导航辅助组出血量分别为[50(20,50) mL vs 50(20,100) mL],但两组间差异无统计学意义(P=0.287)。两组在出院前VAS评分变化上差异无统计学意义(P> 0.05)。两组治疗成功率均为100%。结论 机器人辅助手术在骨样骨瘤治疗中具有显著的优势，尤其在手术时间和手术精度方面表现优越。未来的研究应进一步探索这两种技术的长期效果和经济性，以为临床实践提供更全面的指导。

目的 探讨上尿路结石行输尿管镜碎石术后尿源性脓毒血症的早期诊治策略。方法 回顾性分析北京市隆福医院2019年1月至2023年8月诊治的32例上尿路结石输尿管镜碎石术后发生尿源性脓毒血症的患者资料，以对照原则按1∶2比例匹配选取64例同期手术而未出现尿源性脓毒血症的患者临床资料进行统计分析，分析引发尿源性脓毒血症的危险因素和早期诊治策略。结果 通过检测术后2、6、12 h血白细胞和降钙素原作为早期预警的关键指标，早期诊断尿源性脓毒血症，早期治疗给予静脉滴注美罗培南(1.0 g,每8 h 1次)抗感染治疗，并液体复苏治疗和维持出入量平衡，所有32例尿源性脓毒血症患者均成功康复出院。单因素分析提示，年龄(≥60岁)、手术时间(≥120 min)、女性、术前尿培养阳性、术前发热、结石直径(≥20 mm)是上尿路结石术后尿源性脓毒血症的独立危险因素(P<0.05)。结论 上尿路结石输尿管镜碎石术后相关尿源性脓毒血症是临床急危重症。术前高危因素包括年龄≥60岁、女性、术前尿培养阳性、术前发热和结石直径≥20 mm,术后2、6、12 h血白细胞和降钙素原可以作为早期预警的关键指标，术后早期发现并积极抗感染治疗是诊治尿源性脓毒血症的关键措施。

目的 通过尸体标本研究探索自主研发的智能化骨折复位机器人系统辅助股骨干骨折闭合复位的效果。方法 以4例新鲜冰冻成人尸体股骨为实验对象(男2例，女2例),参考8例股骨干骨折患者的骨折形态建立8个股骨干骨折模型(依据AO分型：A1型1例，A2型3例，A3型2例，B2型2例),使用本团队研发的智能化骨折复位机器人系统完成标本骨的自动复位并记录术中配准时间、骨折复位时间、手术总时间。截骨与复位后进行电子计算机断层扫描(computed tomography, CT),测量截骨前与复位后股骨长度和前倾角，利用Geomagic Qualify软件对术前和复位后股骨三维模型匹配，测量复位误差，以评价骨折复位精度和质量。结果 8例股骨干骨折标本均通过机器人系统完成了有效复位。术中配准平均时间为(33.3±3.7)min,骨折复位平均时间为(34.8±3.3)min,手术总时间平均为(68.0±4.1)min。复位后与复位前的长度差为(1.6±1.6)mm,前倾角差为(4.1±3.5)°。8例标本的平均复位误差为(4.3±2.2)mm。结论 智能化骨折复位机器人系统可以辅助完成股骨干骨折的闭合复位，复位过程符合临床手术流程，具有较高的复位精度和操作可行性，减少了传统手术的复位时间，避免了骨折端切开对骨折端血运的破坏，同时也减少了手术过程中的放射线暴露，为股骨干闭合复位提供了一种较好的方法。

目的 研究自噬抑制剂3-甲基腺嘌呤(3-methyladenine, 3-MA)对局灶性脑缺血再灌注大鼠缺血侧脑组织趋化因子受体2(C-X-C chemokine receptor type 2, CXCR2)、肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素-1β(interleukin-1β, IL-1β)、环氧化酶2(cyclooxygenase-2,COX2)的影响，探究脑缺血再灌注损伤过程中自噬对炎症的作用。方法 将雄性SD大鼠采用随机数字表法分为：假手术(Sham)组、大脑中动脉梗死(middle cerebral artery occlusion, MCAO)组和MCAO再灌注24 h+3-MA(3-MA)组，每组5只。按照改良线栓法制作MCAO大鼠模型，模拟缺血90 min。3-MA组大鼠于MCAO前腹腔注射10 mg/kg 3-MA。所有组别大鼠均再灌注24 h。达到再灌注时间后将大鼠处死，迅速断头、取脑，应用Western blotting法检测大鼠缺血侧脑组织CXCR2蛋白水平，免疫荧光染色法检测脑组织冰冻切片缺血半暗带区炎症因子TNF-α、 IL-1β及COX2阳性细胞数量，并分别对IL-1β、COX2进行细胞定位。结果 (1)MCAO组大鼠再灌注24 h缺血脑组织CXCR2蛋白水平比Sham组明显升高(P<0.05)。3-MA组大鼠缺血侧脑组织CXCR2蛋白水平比MCAO组显著减少(P<0.05)。(2) Sham组大鼠脑内偶见TNF-α、IL-1β和COX2阳性细胞，而MCAO组大鼠脑缺血半暗带区TNF-α、IL-1β和COX2阳性细胞数量均比Sham组显著升高(P<0.05)。相较于MCAO组，给予自噬抑制剂3-MA的缺血大鼠脑组织半暗带区中TNF-α、IL-1β和COX2阳性细胞数量均显著降低(P<0.05)。(3)IL-1β和COX2在脑缺血大鼠缺血半暗带区内分别与神经元标志物NeuN共定位。结论 自噬抑制剂3-MA降低脑缺血再灌注大鼠缺血侧脑组织中CXCR2表达以及炎症因子TNF-α、 IL-1β和COX2的阳性细胞数量，从而减轻脑缺血后的炎症反应，说明自噬是促进脑缺血后炎症反应的因素之一。

2024年10月7日，瑞典卡罗林斯卡医学院宣布将诺贝尔生理学或医学奖授予美国科学家Victor Ambros和Gary Ruvkun,以表彰他们在微小RNA(micro RNA, miRNA)发现方面的贡献。miRNA是一类通过与信使RNA(messenger RNA, mRNA)结合来调控基因表达的小分子RNA,这一机制不仅广泛存在于秀丽隐杆线虫(C. elegans)等模式生物中，还在包括人类在内的多细胞生物中起重要作用。Ambros和Ruvkun的研究颠覆了传统的基因调控模式，揭示了RNA在基因表达中的核心地位。miRNA在细胞发育和分化中扮演关键角色，同时为研究癌症、心血管疾病和神经退行性疾病等提供了全新视角。该发现与RNA干扰技术共同丰富了RNA领域的研究，推动了RNA药物的开发。

<正>初级听囊（rudimentaryotocyst,RO）是一种严重的内耳畸形,约在胚胎发育第3～4周内耳发育停滞造成,其结构特点为不伴内听道（internalauditory canal,IAC）的耳囊,影像表现为内耳结构是直径仅几毫米的圆形或椭圆形结构,且没有IAC^[1-2]。临床表现为重度-极重度感音神经性听力下降（sensorineural hearingloss,SNHL）。

目的 报告面神经发育异常遮挡圆窗患者人工耳蜗植入(cochlear implantation, CI)手术技术。方法 回顾性分析2009年3月至2023年7月收治的6例面神经发育异常遮挡圆窗的重度或极重度聋患者的临床资料，包括病史、听力学资料、影像学资料、手术方法等。结果 6例患者中，1例患者行前庭窗植入，2例患者行面后径路植入，3例患者行经耳道径路或耳道/耳后联合径路植入。6例患者均顺利植入电极，1例患者术后面瘫情况较术前无明显变化，余5例患者术后未见面神经损伤，6例患者均未出现外耳道后壁塌陷、脑脊液耳瘘等并发症发生。结论 重度或极重度聋患者人工耳蜗植入术中发现面神经发育异常遮挡圆窗情况时可根据面神经走行情况选择不同径路，完成人工耳蜗电极植入。

目的 探究不全分隔Ⅰ型(incomplete partition type Ⅰ,IP-Ⅰ)合并脑脊液漏患者人工耳蜗植入同期修补脑脊液漏手术技术及术后脑脊液漏控制及听觉言语康复效果。方法 回顾性分析8例IP-Ⅰ合并脑脊液耳漏的患者临床资料及术后随访结果。所有患者均行人工耳蜗植入同期行经水平半规管开窗脑脊液漏修补术，术后1周内使用抗生素治疗，术后1个月人工耳蜗开机，并开始接受听觉言语康复训练。结果 所有患者人工耳蜗电极顺利植入，术后随访时间1～17年，所有患者均未再次出现脑脊液耳漏，并获得不同程度的听觉获益。结论 人工耳蜗植入同期行经水平半规管开窗脑脊液漏修补的手术方法能够有效解决IP-Ⅰ合并脑脊液漏患者的相关症状，预防脑脊液漏复发并帮助患者重建听力。