Fujian Provincial People's Hospital

Dear Editor, We recently read with great interest the article entitled “FANS-UAS under local anesthesia for urinary stones with high risk postoperative urosepsis” by Zhang et al in your prestigious journal[1]. In this study, nephrolithiasis accompanied by asymptomatic bacteriuria (ASB) or asymptomatic pyuria (ASP) are considered urinary stones associated with a high risk of postoperative urosepsis (HR-POU). They found that retrograde intrarenal surgery (RIRS) assisted by flexible and navigable suction ureteral access sheath (FANS-UAS) under local anesthesia (LA) is feasible and safe for these HR-POU patients, and preliminary results indicate it may reduce the incidence of postoperative fever. These findings provide an attractive new option for stones with HR-POU. However, several issues merit further discussion. This study is compliant with the TITAN Guidelines 2025 – governing declaration and use of AI[2]. For patients with stone obstruction complicated by pyonephrosis or perinephric abscess, clinical priority is given to drainage methods such as ureteral stent placement or percutaneous nephrostomy[3]. Stone management is deferred to a second-stage procedure once the local infection has improved. However, this study performed first-stage FANS-UAS assisted RIRS on all 28 patients with kidney stones complicated by pyonephrosis without any discussion. Given the potential increased risk of infection following first-stage surgery, preoperative risk assessment and personalized treatment are particularly critical for these patients when opting for a primary surgery treatment plan. Based on the above, we recommend conducting a detailed analysis and discussion of the preoperative assessment and postoperative outcomes for patients with renal calculi complicated by pyonephrosis in this study. In most studies, general anesthesia (GA) is the preferred anesthetic type for RIRS[4]. The advantages of GA in kidney stone surgery include high patient compliance, controlled duration of anesthesia, and control over patient respiratory movements[5]. However, there are few studies evaluating the efficacy of LA during RIRS. This study found no significant differences between the two types of anesthesia in terms of surgical success rate, intraoperative bleeding, and operating time; however, patients in the LA group had a lower risk of postoperative fever. Furthermore, through comparative analysis of postoperative blood immune cells, the authors speculate that the cause may be attributed to the lack of significant impairment in immune function. It is our view that analyzing postoperative immune cells alone cannot fully elucidate the impact of primary surgical treatment under different anesthetic modalities on the immune function of patients with kidney stones. Instead, preoperative immune status should serve as the baseline, and different anesthetic techniques should be evaluated by comparing the degree of change in immune function before and after surgery between the two patient groups. During procedures performed under non-general anesthesia, unstable spontaneous breathing, uncontrollable coughing and sneezing reflexes, or patient movement that cannot be prevented during surgery due to inadequate analgesia may all negatively impact the successful completion of the surgical procedure. According to a study by Sahan et al, mucosal tears and hemorrhage occurred in 4.4% and 2.2% of patients in the regional anesthesia group, respectively[4]. In this study, three cases (0.8%) of patients undergoing LA experienced ureteral perforation. It is conceivable that the surgeon’s comfort level during procedures under local anesthesia would also be significantly reduced. Therefore, the safety and efficacy of RIRS assisted by FANS-UAS under LA require further discussion. In conclusion, this study pioneers an attractive new treatment option for patients with HR-POU kidney stones, but further prospective randomized controlled trials are needed to evaluate its safety and efficacy.

BackgroundSevere postoperative complications (SPCs) adversely affect outcomes in esophageal squamous cell carcinoma (ESCC) following neoadjuvant therapy. The prognostic significance of preserved ratio impaired spirometry (PRISm) and inflammation-based biomarkers such as the systemic inflammation response index (SIRI) and lymphocyte-to-monocyte ratio (LMR) remains unclear.MethodsWe retrospectively analyzed 224 ESCC patients who underwent esophagectomy after neoadjuvant therapy. PRISm was defined by FEV1 < 80% predicted and FEV1/FVC ≥ 0.7. Preoperative inflammatory indices, including SIRI, NLR, and LMR, were collected. The primary endpoint was the incidence of SPCs (Clavien–Dindo grade ≥ III); secondary endpoints included overall survival (OS) and recurrence-free survival (RFS). Multivariate regression was used to identify independent predictors. Nomograms were developed and validated using ROC curves, calibration plots, and decision curve analysis (DCA).ResultsPRISm and decreased SIRI independently predicted higher SPC risk (p < 0.05). The SPC nomogram demonstrated good discrimination (AUC = 0.726). PRISm was also associated with significantly worse OS and RFS (p < 0.001). Elevated SIRI and low LMR correlated with poor long-term outcomes. OS and RFS nomograms showed good calibration and outperformed TNM staging in clinical utility.ConclusionPRISm and systemic inflammatory markers are independent predictors of complications and prognosis in ESCC after neoadjuvant therapy. The proposed nomograms offer practical tools for individualized preoperative risk stratification and may support tailored perioperative management, especially in older or high-risk patients.

Gout is a chronic inflammatory disease, and cardiovascular disease (CVD) is regarded as one of its complications. The aim of our study was to explore the association between systemic inflammation response index (SIRI) and the risk of CVD in gout. Six cycles of NHANES data were analyzed. Machine learning algorithms were employed to screen covariates, followed by SHAP interpretation to assess variable importance. Participants with gout were stratified by SIRI quartiles, and logistic regression was performed to evaluate CVD risk. RCS were applied to assess nonlinear trends, while discrimination, calibration, and clinical utility were evaluated using ROC, DCA, and calibration curve. Additionally, the Framingham risk score (FRS) model was integrated with SIRI, and model improvement was quantified via net reclassification improvement and integrated discrimination improvement. Among 1260 participants with gout, 436 (weighted 28.77%) had CVD comorbidities. A linear positive association was observed between SIRI and CVD risk (P for nonlinear = 0.824), with each 1-unit increase in SIRI corresponding to 29.7% higher CVD risk (OR = 1.297, 95% CI 1.073-1.568). Participants in the highest SIRI quartile Q4 (OR = 2.060, 95% CI 1.141-3.721) exhibited increased CVD risk compared to Q1. The final model demonstrated robust discrimination (AUC = 0.755, 95% CI 0.729-0.783). Incorporating SIRI into the NHANES and clinical datasets improved the discrimination of the FRS model by 5.2% and 1.9%. A positive linear association was identified between SIRI and CVD risk in gout patients. The model constructed based on machine learning demonstrated comparable robustness to the FRS model in predicting CVD. These findings provide a theoretical and empirical foundation for early CVD identification, prevention, and management in this population. Key Points • The positive linear association between the systemic inflammation response index and cardiovascular disease, as well as its subtypes in patients with gout. • SIRI can serve as a valuable complement to the Framingham risk score model.

BackgroundTraditional Chinese Medicine techniques have unique advantages in complementary cancer treatment, and their clinical application largely relies on patient acceptance. Scientific assessment of patients’ acceptance of Traditional Chinese Medicine techniques is a key step in promoting their clinical application. However, no scientifically validated tools exist to assess cancer patients’ acceptance of Traditional Chinese Medicine techniques.PurposeTo develop and validate the acceptance scale for Traditional Chinese Medicine techniques in cancer patients.Patients and MethodsThe study involved scale development and psychometric testing. Items were generated via conceptual definition, literature review, and qualitative research based on the Technology Acceptance Model. Two rounds of expert review and a pilot study refined the scale and assessed content validity. Psychometric evaluation was conducted on 370 cancer patients, including item analysis, exploratory and confirmatory factor analysis, validity assessments, and reliability testing.ResultsThe finalized 25-item scale has four dimensions: perceived usefulness, perceived ease of use, behavioral intention, and apprehensions about usage. Content validity indices ranged from 0.933 to 1.000. Exploratory factor analysis revealed four common factors, accounting for 66.6% of the variance. Confirmatory factor analysis showed good fit (χ2/df=2.304, GFI=0.803, CFI=0.907, NFI=0.847, RMSEA=0.079). Convergent validity indicated Average Variance Extraction values of 0.493–0.679 and Composite Reliability of 0.858–0.913. Correlations between dimensions ranged from 0.624 to 0.730, with satisfactory discriminant validity. Reliability was high (Cronbach’s alpha=0.951, split-half=0.871, test-retest=0.876).ConclusionThis scale is a reliable and effective tool for assessing cancer patients’ acceptance of Traditional Chinese Medicine techniques. It provides guidance for clinical practice and research involving these techniques.

In recent years, air pollution has been increasingly recognized as a contributing factor to the onset of different diseases. This study seeks to investigate the potential link between air pollutants and dry eye (DE), as well as to identify key genes that may play a pivotal role in this relationship. A comprehensive search of multiple online databases was conducted to determine target genes associated with both air pollutants and DE. Protein-protein interaction (PPI) analysis and visualization were performed for the overlapping genes. This was followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) functional enrichment analyses to elucidate potential mechanisms. Subsequently, molecular docking and molecular dynamics simulation (MDS) analysis were employed to examine interactions between key genes and air pollutants. Eight ubiquitous air pollutants (benzene, SO₂, O₃, NO, CO, toluene, formaldehyde, and naphthalene) were chosen for analysis, and a total of 26 intersecting targets associated with DE were identified. Functional enrichment analyses using GO and KEGG pathways indicated that these targets are predominantly involved in biological processes including lipid metabolism, hormone regulation, oxidative stress, and inflammatory responses. This analysis underscored six pivotal genes linked to air pollutants and DE. Molecular docking analysis substantiated potential interactions between air pollutants and these core targets. Futhermore, MDS analysis revealed more stable relationships between MMP-2, EGFR, MMP-9, ESR-1 and air pollutants. These findings indicate that TNF, EGFR, MMP-9, ESR-1, ICAM-1, and MMP-2 are integral to the mechanisms through which air pollutants influence DE. This research provides fresh insights about molecular mechanisms linking air pollutants and DE, emphasizing the critical need to enhance public awareness regarding the pervasive issue of air pollution.

Sonazoid, a combined blood pool and Kupffer-cell agent, can be specifically phagocytosed by Kupffer cells in the liver, allowing lesion detection and characterization of focal liver lesions (FLLs) at the post-vascular phase, apart from the vascular phase, which is similar to that of other second-generation ultasound (US) contrast agents. Sonazoid contrast-enhanced US (CEUS) is currently approved for use in some Asian countries. With the increasing use of Sonazoid CEUS for FLLs in clinical practice, developing consensus or guidelines to help standardize its use is required. The expert consensus aimed to review recent evidence and make evidence-based recommendations for radiologists and clinicians involved in the management of liver diseases regarding the use of Sonazoid CEUS in the surveillance or detection, characterization of FLLs, CEUS for interventional and intraoperative use, and tumor treatment response evaluation in patients with FLLs. This consensus was conducted without using artificial intelligence tools in accordance with the TITAN Guidelines 2025.

Evidence from the VALIGA Immunoglobulin A (IgA) nephropathy (IgAN) cohort supports the clinical value of subclassifying focal segmental glomerulosclerosis lesions (S). Our study aimed to validate and explore the clinical significance of S subclassification in an Asian population. A total of 746 patients with IgAN were retrospectively included. The chi-squared automatic interaction detection method was used to identify subgroups of S lesions associated with proteinuria, eGFR, and major adverse kidney events (MAKE). Kaplan-Meier analysis was performed to assess differences in MAKE. Hazard ratios for S1 lesions with respect to MAKE were estimated using Cox proportional hazards regression models. Propensity score analysis was used to evaluate whether immunosuppressive therapy was associated with a favorable outcome within subgroups. Among 746 patients, S1 lesions were present in 80% of individuals, with segmental capillary occlusion by matrix (not otherwise specified (NOS), 69%), simple capsular adhesion without capillary occlusion (Adh, 63%), and podocyte hypertrophy (PH, 16%) being the top three subtypes. All three lesion types were associated with proteinuria, and NOS was also correlated with eGFR. Patients in the S1 with NOS+Adh+ subgroup had the worst prognosis. Moreover, immunosuppressive therapy was associated with better outcomes in S1 patients with NOS+Adh+. Subgroup analysis showed that the effect of NOS+Adh+ lesions on MAKE was significantly influenced by systolic blood pressure (SBP). Patients with NOS+Adh+ lesions and SBP >130 mmHg had a significantly increased risk of MAKE. Our study validated the clinical value of S subclassification in IgAN in an Asian population. Patients with NOS+Adh+ lesions have more severe proteinuria and renal function damage. Their overall renal prognosis is significantly worse; however, they can benefit from a treatment strategy that combines renin-angiotensin system inhibitors with immunosuppressants. In addition, controlling SBP to below 130 mmHg seems to be an appropriate range.

ABSTRACT Objective To evaluate the feasibility and safety of renal denervation (RDN) in patients with end-stage renal disease (ESRD) and refractory hypertension (RHT). Method A retrospective analysis was conducted on the baseline and follow-up data of ESRD patients who underwent RDN at the First Affiliated Hospital of Fujian Medical University between December 2017 and December 2024. Based on the etiology of ESRD, the patients were divided into three groups: diabetic nephropathy group (DN group), chronic glomerulonephritis group (CG group), and hypertensive nephrosclerosis group (HE group). RDN was performed using the NavStar pressure monitoring perfusion monopolar ablation catheter (Abbott, USA). A 3D model was constructed using the ENSITE system, and four-quadrant spiral point-by-point ablation was performed from distal to proximal on the main renal arteries and their branches bilaterally. Each ablation site was treated for 40 seconds at a temperature of 40°C. The ablation power was set at 8W for renal artery branches and 12W for the main branches. Result A total of 25 ESRD patients were enrolled, including 10 in the DN group, 8 in the CG group, and 7 in the HE group. All patients underwent regular hemodialysis with controlled dry weight. The number of ablation points was 15.04 ± 2.62 for the main branches and 4.68 ± 1.03 for the branch vessels. Fluoroscopy time was 23.64 ± 6.89 minutes, and contrast agent volume was 28.4 ± 8.5mL. No significant differences were observed among subgroups in terms of impedance, contrast agent volume, or fluoroscopy time before and after ablation. HE group had the least number of ablation points in both main and branch vessels. One case of vascular dissection requiring renal artery stent implantation occurred in the CG group, and one case of pseudoaneurysm occurred in the HE group. The median follow-up duration was 7.90 ± 1.55 months. During follow-up, one patient was lost to follow-up in each the DN and CG groups, and one patient in each the CG and HE groups died due to myocardial infarction. Major adverse cardiovascular events (MACE) occurred in one patient each in the CG and HE groups, both requiring hospitalization for heart failure. Postoperative follow-up was completed in 21 patients. Among them, 15 (71.43%) exhibited a positive response to RDN, including 8 (88.89%) in the DN group, 4 (66.67%) in the CG group, and 3 (50%) in the HE group. Compared with preoperative values, office systolic and diastolic blood pressure, as well as 24-hour ambulatory systolic and diastolic blood pressure, showed significant reductions after RDN. Conclusion Renal denervation (RDN) effectively reduced blood pressure in patients with end-stage renal disease (ESRD) and resistant hypertension (RHT). Among the etiological subgroups, patients with diabetic nephropathy may represent the most suitable candidates for RDN within the ESRD population.