Objective:To investigate the relationship of expression of vascular endothelial growth factor (VEGF) and clinical features in patients with intracranial aneurysm and arteriovenous malformation (AVM).Methods:A total of 64 patients with AVM and intracranial aneurysm,who were treated in First Hospital of Shijiazhuang from February 2011 to November 2015,were chosen as research subjects,AVM were 32 cases and intracranial aneurysm were 32 cases.The samples were sectioned for VEGF immunohistochemical staining;the location and intensity of staining were recorded;the positive indexes were computed.The VEGF expression of different age and Hunt&Hess classification in patients with intracranial aneurysms were analysed;the VEGF expression of different diameters,ages,Spetzler classification in patients with AVM were analysed.Results:There were no statistical differences in the VEGF expression of different ages in patients with intracranial aneurysms (P＞0.05);the VEGF expression of different Hunt&Hess classification in patients with intracranial aneurysms was statistical difference (P＜0.05).The positive rate of VEGF in the artery of AVM was lower than that in the vein,the difference was statistically significant (P＜0.05).There were no statistical differences in the VEGF expression of the different Spetzler classification,different diameters and different ages in patients with AVM (P＞0.05).Conclusion:The expression of VEGF in the vein and the artery of patients with AVM is different,the expression of VEGF is not correlated with the age of intracranial aneurysm and the size and age of AVM.VEGF cannot be used as a predictor in the patients with intracranial aneurysms and AVM.

Objective Todetecttheexpressionlevelsoftumornecrosisfactor-α(TNF-α)and interleukin-6(IL-6)inintracranialaneurysms.Methods Sixteenconsecutivepatients(aneurysm group)with intracranial aneurysm confirmed by digital subtraction angiography (DSA)and clipped by microneurosurgery were enrolled retrospectively. A total of 19 trauma patients without vascular disease confirmed by CT and magnetic resonance imaging (MRI)in the same period were used as a control group. Hematoxylin-eosin (HE)staining and immunohistochemical staining were used to detect the aneurysm wall tissue and the colored portions of TNF-α and IL-6 in normal vessel wall,the mean value of optical density after its expression was analyzed,and the intensity of staining was compared. Results (1)Each layer of artery walls of the control group had no obvious TNF-α and IL-6 expression. The inner,media and out membranes of the aneurysm wall tissue of the aneurysm group had positive expression of TNF-αand IL-6. (2)The mean optical densities of TNF-α and IL-6 in patients of the aneurysm group were 0. 182 ± 0. 069 and 0. 148 ± 0.062 respectively,and they were higher than 0. 144 ± 0. 031 and 0. 105 ± 0. 020 of the control group. The differences were statistically significant (all P<0. 05). (3)The mean optical densities of TNF-α expression of each layer of the inner,media and out membranes in the aneurysm walls were 0. 224 ± 0. 071,0. 134 ± 0. 040,and 0. 106 ± 0. 065,respectively. There were significant differences (P<0.01). (4)The mean optical density expressed by IL-6 in the out membrane of the aneurysm walls was lower than the media and inner membranes (0. 096 ± 0. 018 vs. 0. 145 ± 0. 050,and 0. 148 ± 0. 070). There were significant differences (P<0. 05). (5)The results of Spearman correlation analysis showed that the mean optical density of TNF-αof the aneurysm group was positively correlated with that of IL-6 (r=0. 452, P<0.05).Conclusion TheexpressionlevelsofTNF-αandIL-6intheaneurysmwalltissueare higher,and they may be involved in intracranial aneurysm formation and rupture.

Objective:To investigate the effect of local anesthesia in patients with a PI-RADS score of 5 and ECOG score ≥2 for prostate puncture.Methods:Retrospective analysis of case data of 33 patients admitted to the Subei People's Hospital for prostate puncture from April 2020 to April 2022. Age (82.5±3.6) years. There were 18 cases with hypertensive disease, 8 cases with diabetes mellitus, and 6 cases with both diabetes mellitus and hypertensive disease. Body mass index (25.2±3.5) kg/m 2. prostate-specific antigen (PSA)(131.5±69.7) ng/ml. prostate volume (38.5±21.4) ml. all patients had a PI-RADS score of 5 on multiparametric magnetic resonance (mpMRI) and an Eastern Cooperative Oncology Group (ECOG) score ≥2. All 33 cases in this group underwent trans-perineal targeted prostate puncture using local anesthesia at the tip of the prostate. The visual analog score (VAS) and visual numeric score (VNS) were applied by the same surgeon to assess the patient's pain level and satisfaction at the time of puncture (VAS-1 and VNS-1) and 30 min after puncture (VAS-2 and VNS-2), and to record the duration of the procedure and the occurrence of postoperative complications. Results:In this group of 33 cases, the VAS-1 score was (1.9±0.3) and the VAS-2 score was (0.1±0.2); the VNS-1 score was (2.9±0.2) and the VNS-2 score was (3.9±0.1). Postoperative pathological results indicated that one of the 33 patients had a negative puncture result (pathology report indicating interstitial inflammation), while the rest of the patients had a positive puncture pathology report (puncture pathology report indicating prostate cancer), with a positive rate of 97%. One case of postoperative carnal haematuria occurred, which gradually improved after the patient was advised to drink water and take alpha-blockers. No perineal hematoma occurred, and all patients did not suffer complications such as urinary tract infection, urinary retention, azoospermia, vagal reaction, and infectious shock.Conclusion:In patients with a PI-RADS score of 5 and ECOG score ≥2, the use of single-hole local anesthesia for performing trans-perineal targeted puncture biopsy has the advantages of good paroxysmal pain and high safety.

Objective:To investigate the factors affecting the effect of periprostatic nerve block (PNB), establish a prediction model of pain degree, and verify the prediction efficiency.Methods:The clinical data of 314 patients who underwent transperineal prostate biopsy in our hospital from June 2022 to January 2023 were retrospectively analyzed. The median age was 71 (65, 76) years, the median prostate-specific antigen (PSA) was 14.6 (10.70, 24.65) ng/ml, and the median puncture needle number was 21 (19, 23) needles, median prostate volume 45.86 (31.52, 67.96) ml, median body mass index (BMI)24.02(22.97, 25.33)kg/m 2, including 109 patients with a history of diabetes, 90 patients with a history of surgery, and 57 patients with a history of severe trauma. The patients were divided into mild pain group (1-3 points), moderate pain group (4-6 points) and severe pain group (7-10 points) according to the intraoperative visual analogue scale (VAS). According to the clinical characteristics, the factors affecting the effect of PNB were analyzed by univariate analysis and multiple ordered logistic regression method. R language was used to construct a nomogram model for predicting PNB effect, receiver operating characteristic (ROC) curve and calibration curve were drawn, and Hosmer-Lemeshow test was carried out to verify the prediction efficiency of the model. Results:The results of univariate analysis showed that 171 patients in the mild pain group had a median age of 71 (65, 75) years, a median PSA14.5 (9.6, 24.6) ng/ml, a median number of puncture needles of 20 (18, 22), and a median prostate volume of 34.94 (26.36, 45.12) ml, median BMI24.17(23.14, 25.79)kg/m 2, including 74 patients with a history of diabetes, 51 patients with a history of surgery, and 40 patients with a history of severe trauma; There were 110 patients in the moderate pain group, the median age was 71 (65, 76) years, the median PSA14.8 (11.03, 24.27) ng/ml, the median number of puncture needles was 23 (20, 24) needles, median prostatic volume 63.24 (49.14, 78.72) ml, median BMI23.91(22.58, 24.88)kg/m 2, including 26 patients with a history of diabetes, 29 patients with a history of surgery, and 10 patients with a history of severe trauma; In the severe pain group, 33 patients had a median age of 73 (67, 78) years, a median PSA14.6 (10.85, 34.80) ng/ml, and a median puncture needle number of 23 (22.5, 24) needles, median prostate volume 70.64 (61.50, 104.51) ml, median BMI24.32(23.00, 26.06)kg/m 2, including 9 patients with a history of diabetes, 10 patients with a history of surgery, and 7 patients with a history of severe trauma. The results of univariate analysis showed that the number of puncture needles ( P<0.01), prostate volume ( P<0.01), history of diabetes ( P=0.002) and history of major trauma ( P= 0.009) were the factors affecting the effect of PNB. Multiple logistic regression analysis showed that puncture needle number ( P=0.009), prostate volume ( P<0.01) and diabetes history ( P=0.041) were independent risk factors for PNB effect. The area under ROC curve (AUC) of the moderate and above pain prediction model was 0.872, P<0.01; the area under ROC curve of the severe pain prediction model was 0.817, P<0.01; the result of Hosmer-Lemeshow test of the moderate and above pain prediction model was χ2=5.001, P=0.757. The results of the severe pain prediction model were χ2=4.452 and P=0.814. The calibration curve was established, which showed that the prediction probability of pain degree was in good agreement with the actual risk. Conclusions:The number of puncture needles, prostate volume and history of diabetes are the risk factors affecting the effect of PNB. The prediction model of PNB effect based on this model can be used to predict the pain degree of patients undergoing prostate biopsy after PNB.