Objective To compare the safety and efficacy between RevoLix 2 μ m continuous-wave (CW) laser resection of bladder tumor and transurethral resection of bladder tumor (TURBT) in patients with non-muscle-invasive bladder tumor, and to evaluate clinical value of 2 μ m CW laser resection for nonmuscle-invasive bladder tumor. Methods 62 patients with non-muscle-invasive bladder tumor were divided into 2 groups including 2 μ m CW laser resection group (32 cases) and TURBT group (30 cases) according to the random number table.The intravesical instillation of pirarubicin was performed regularly. The operative time,drop in hemoglobin,indwelling catheterization time,and operative complications were analyzed.Results All cases were completed successfully. The mean operative times of 2 μm CW laser resection group and TURBT group were 32.5±10.5 min and 31.3± 9.8 min, respectively, and no statistical difference could be found between both groups (t =0.364,P=0.674).3 cases were found to have obturator nerve reflex in TURBT group,but no obturator nerve reflex was found in 2 μn CW laser resection group.Bladder irrigation time of 2 μm laser resection group was statistically shorter than that of TURBT group [ (6.2±2.6)h vs (23.8±6.5)h,t =8.294,P=0.006]. There was also no significant difference in postoperative catheterization time between both groups [(4.2±1.5)d vs (5.2±1.8)d,t=1.468,P=0.103 ]. Postoperative hospitalization time of the two groups was not shown significant difference [ (5.3± 1.5) d vs (5.8±2.8) d,t =0.627,P =0.531 ].All cases were followed up for 6～18 months,and there were no significant difference in the recurrence rate between both groups (x2=0.481,P =0.562). Conclusion 2 μm CW laser resection is a novel excellent treatment for non-muscle-invasive bladder tumor and has the similar effect as TURBT with the advantage of significantly less blood loss and rapid recovery after surgery.

Objective To evaluate the impact of 120 W 2 μ m continuous-wave laser vapoenucleation versus and transurethral resection of the prostate (TURP) in patients with symptomatic benign prostatic hyperplasia (BPH) on sexual function.Methods One hundred and twenty-two patients with BPH were selected,63 cases were treated with 120 W 2 μ m continuous-wave laser vapoenucleation versus(2 μ m laser group),59 cases were treated with TURP(TURP group).International index of erectile function(IIEF) scores and self-made general assessment questions were completed before and 12 months after treatment to determine the impact on sexual function.IIEF scores included erectile function (EF),sexual desire,orgasm,sexual satisfaction and overall satisfaction.Results The IIEF scores difference was no significant before treatment between two groups (P ＞ 0.05).In two groups,there was no significant difference in EF,sexual desire,sexual satisfaction and overall satisfaction score between before treatment and 12 months after treatment(P＞ 0.05),orgasm score 12 months after treatment was significantly lower than that before treatment [2 μm laser group:(5.9 ± 1.5) scores vs.(8.6 ± 2.7) scores;TURP group:(5.5 ± 1.6) scores vs.(8.7 ± 1.8) scores] (P ＜0.05).Multiple linear regression analysis showed that two groups EF score and the international prostate symptom score,quality of life score and Q.~ positive linear correlation.Logistic regression analysis showed that the incidence of retrograde ejaculation and orgasm reduced significantly assoeiated(P ＜ 0.05),as an independent predictor of orgasm reduced after treatment(P ＜ 0.05).Conclusions There is no difference between these two surgical techniques regarding to impact on sex function.No significant EF improvement after surgery in both groups,but these two techniques can significantly decrease the IIEF orgasmic function domain and this is mainly caused by retrograde ejaculation.

Objective To measure the level of circulating endothelial progenitor cell (EPC) and serum vascular endothelial growth factor (VEGF), and to investigate its clinical significance in patients with different stages of renal cell carcinoma (RCC). Methods The level of circulating EPC was quantified by assaying CD45-CD34+VEGFR-R2 +cell phenotype in 45 patients with RCC (RCC group), 30 patients with benign renal tumors(benign renal tumors group) and 30 healthy controls (control group). Serum VEGF was quantified by enzyme- linked immunosorbent assay (ELISA). The results were compared. Results The level of EPC in RCC groups was (0.265 ± 0.042)%, in benign renal tumors group was(0.053 ± 0.008)% , and in control group was (0.048 ± 0.006)%. The level of EPC in RCC group was significantly higher than that in benign renal tumors group and control group (P<0.05). The level of EPC in Ⅲ- Ⅳ stage patients was significantly higher than that in Ⅰ-Ⅱ stage patients:(0.312 ± 0.038)%vs. (0.215 ± 0.021)%, P<0.05. Three months after operation, the level of EPC in 33 RCC patients without pretreatment was (0.078 ± 0.003)% and significantly lower that before treatment (P<0.05). The level of VEGF in RCC groups was (305.5 ± 29.1) ng/L, in benign renal tumors group was (29.8 ± 3.2) ng/L, and in control group was (25.1 ± 2.8) ng/L. The level of VEGF in RCC group was significantly higher than that in benign renal tumors group and control group (P<0.05). The level of VEGF inⅢ-Ⅳstage patients was significantly higher than that inⅠ-Ⅱstage patients:(365.6 ± 34.6) ng/L vs. (256.2 ± 23.2) ng/L, P<0.05. Pearson association analysis showed that the level of EPC had positive associations with VEGF (r=0.714, P<0.01). Multiple linear regression showed that the size of kidney neoplasms was a dependent factor for the level of EPC. Conclusions The level of EPC has a positive association with VEGF. EPC maybe a new biomarker for RCC.

Adrenal tuberculosis is still the main cause of primary adrenal insufficiency (Addison Disease) in China. A case of bilateral adrenal tuberculosis without PAI symptoms was admitted to Department of Urology, Shanxi Provincial People’s Hospital. Pathological report showed adrenal tuberculosis. We present an overview and discuss how to diagnose early adrenal tuberculosis and reduce misdiagnosis rate so as to preserve residual adrenal function to the greatest extent.

Objective To observe the effect of saikosaponin-d on transcriptional activation of estrogen receptor in rat hepatic stellate cells(HSC-T6), and to explore its pharmacological mechanism. Methods The rat HSC-T6 were cultured in vitro for the study. After transient transfection of HSC-T6 with the ER-specific reporter gene ERE-tk-Luc by liposome, the effect of saikosaponin-d and estradiol on luciferase activity was observed by Dual-Luciferase Reporter Assay System under the conditions of various drug concentrations, various treatment time and addition of estrogen receptor inhibitor ICI182. 780. Results When the concentrations of saikosaponin-d and estradiol were in the range of 0.01-5 μmol/L, 0.01-1 μmol/L respectively, luciferase activity was increased in a dose-dependent manner . Luciferase activity arrived the highest when saikosaponin-d concentration was 5 μmol/L and estradiol concentration was 1 μmol/L, but the effect was weakening when estradiol concentration reached 5μmol/L. In respect of the effect of treatment time, when HSC-T6 were separately treated with 5μmol/L of saikosaponin-d and 1 μmol/L of estradiol for 24 h, the luciferase activity was the highest. And ICI182.780 could significantly inhibit the induction of saikosaponin-d and estradiol for luciferase activity. Conclusion Saikosaponin-d has an effect on promoting the transcriptional activation of estrogen receptor in HSC-T6.

Objective To investigate methods and results of endovascular treatment in TASC (Ⅱ) D-type femoral artery occlusion. Methods From January 2012 to May 2013, 26 cases (26 branches) of superficial femoral artery occlusion with endovascular treatment of TASC (Ⅱ) D-type superficial femoral artery occlusion were retrospectively reviewed. The effi-cacy was evaluated through ABI, CTA, DSA and symptoms improved. Results 26 branches were treated with endovascular methods. Technical success rate was 80.7%(21/26), including 13 branche with stent implantation, 6 branches with Silver-hawk atherectomy and 2 branches with Viabahn stent implantation. All patients were followed up for a mean period of (10.3 ± 1.2)months, primary patency rates at 6 months were 69.2%in stent group, 66.7%in Silverhawk atherectomy group and 100%in Viabahn stent group. Conclusion Endovascular treatment of TASC (Ⅱ) D-type femoral artery occlusion can lead to satisfactory short term patency rates, and Viabahn stent is the latest treatment.

Objective:To explore the feasibility of predicting complexity of intensity modulated radiotherapy(IMRT)plan through adopted machine learning method to extract planomics features of radiotherapy,so as to provide a new method for comprehensive evaluation of the complexity of IMRT plan.Methods:The medical case data of 3203 patients with pelvic tumor,or abdominal tumor or head and neck tumor,who admitted to The First Affiliated Hospital with Nanjing Medical University from December 2022 to November 2023,were selected.All patients adopted Monaco system to conduct design for plan,and underwent treatment on Precise and Axesse accelerators.The evaluation indicator of complexity of 10 plans was calculated by using Python software,and the planomics features in the files of radiotherapy plans were extracted through format conversion and pyradiomics tool of imaging omics.The planomics features of radiotherapy were selected through data cleaning,filtering method and embedding method of machine learning.The corresponding predictive model of the evaluation indicator of complexity of 10 common plans was respectively constructed through used Gradient Boosting Decision Tree algorithm.The goodness of fit(R2)was adopted to evaluate the prediction performance of the model,and the 5-fold cross-validation method was adopted to detect the generalization ability of the model.Results:There were statistically significant differences between Precise accelerator and Axesse accelerator in average leaf to area(LA),plan irregularity(PI)of beam shape and standard circle,modulation complexity score(MCS)of the variability between shape and area of subfield,and the advantage value of leaf travel(LT)(t=63.894,-63.678,72.582,-48.858,P＜0.01),respectively.A total of 107 planomics features were extracted through pyradiomics tool,and 38 features were remained after filtering method conducted screening,and 4 to 11 features were remained after embedding method conducted screening.The goodness of fits of mean field area(MFA),LA and leaf gap average(LGA)value were better in the validation set,with R2＞0.970,however the goodness of fits of the proportion of small aperture score 20 mm(SAS20)was poor in validation set,with R2=0.917.The 5-fold cross-validation results showed that the average value of prediction accuracy of all indicators of complexity was＞90％.Conclusions:The extracted planomics features of radiotherapy based on radiomics method can accurately predict the complexity of IMRT plan,which are expected to play a greater role in improving the ensure efficiency of individual quality of patient,and screening radiotherapy plan with higher-quality.

Objective To evaluate the effects of nurses′standardized training and to provide basis for revision of the standardized training programme by investigating core abilities of nurses before and after standardized training and post competency of nurses after the training.Methods 198 nurses in this hospital who participated in standardized training in 2013 were selected as research objects and their core abilities before and after the training and their post competency after the training were evaluated by questionnaires with separate evaluation by themselves and others.Results After standardized training,total score of nurses′core abilities were (80.26 ±10.53),higher than the score before the training (73.73 ±9.65)(t =6.303,P <0.01).After the training,for the results of nurses′self-evaluation in post competency,dimensions of good personal characteristics (4.61 ±0.51 ),clinical nursing abilities (4.61 ±0.51 ),supporting and interpersonal communication abilities (4.33 ±0.64),critical thinking abilities (4.14 ±0.82),and professional construction and development abilities (4.27 ±0.66)were all higher than the results of evaluations by others (t =7.57, 6.11,5.52,3.22,3.22;P <0.01).Conclusions Standardized training has a positive effect on improving core abilities of nurses,which is in accordance with clinical needs;the evaluation results of nurses′post competency can provide basis for revision of the standardized training programme;person-post matching helps to motivate nurses to improve their skills.

Objective:To assess the predictive value of dosiomics in predicting the occurrence of bone marrow suppression (BMS) in patients with pelvic tumors during radiotherapy.Methods:A retrospective analysis was conducted on the clinical data and radiotherapy planning documents of 129 patients with pelvic region tumors who underwent radiotherapy at the First Affiliated Hospital of Nanjing Medical University from January 2019 to January 2023. The region of interest (ROI) was outlined for bone marrow in the pelvic region by Accu Contour software in planning CT, and the ROI was exported together with the dose distribution file. According to a stratified randomization grouping method, the patients were divided into the training set and test set in an 8 vs. 2 ratio. The dosiomic features were extracted from the ROI, and the two independent samples t-test and the least absolute shrinkage and selection operator (LASSO) algorithm was employed to identify the best predictive characteristics. Subsequently, the dosiomic scores were calculated. Clinical predictors were identified through both univariant and multivariate logistic regression analyses. Predictive models were constructed by using clinical predictors alone and combining clinical predictors and dosiomic scores. The efficacy of predictive model was assessed by plotting the receiver operating characteristic (ROC) curve and evaluating its performance through the area under the ROC curve (AUC), the calibration curve, and decision curve analysis (DCA). Results:Fourteen dosiomic features that showed a strong correlation with the occurrence of BMS were screened and utilized to calculate the dosiomic scores. Based on both univariant and multivariate logistic regression analyses, chemotherapy, planning target volume (PTV) and V 5 Gy were identified as clinical predictors. According to the combined model, the AUC values for the training set and test set were 0.911 and 0.868, surpassing those of the clinical model (AUC=0.878 and 0.824). Furthermore, the analysis of both the calibration curve and DCA suggested that the combined model had higher calibration and net clinical benefit. Conclusion:The combined model has a high diagnostic value for predicting BMS in patients with pelvic tumors during radiotherapy.

Objective To compare the effect and safety of stenting versus directional atherectomy (DA) in the treatment of TASCⅡ A and B superficial femoral artery lesions.Methods 100 patients with TASC Ⅱ A and B lesions were divided into percutaneous transluminal stenting(PTS) group (n =50) and DA group (n =50).Patients were compared in terms of technical success rate,treatment success rate,first operation cost,postoperative ankle brachial index (ABI),limb salvage rate,survival,and patency.Results The technical success rate in both PTS and DA group was 100％.The treatment success rate was 98％ vs.86％,P＞0.05.Postoperative ABI:0.82 ±0.19 vs.0.80 ±0.27,P＞0.05.First operation cost:(34 820 ± 1 051) yuan vs.(45 635 ± 1 358) yuan,P ＜0.001;All patients were followed-up for up to 2-year,the cumulative patency rate was 81.6％ vs.72.9％ (P＞0.05).Limb salvage rate was 97.9％ vs.93.8 ％,P ＞ 0.05.Conclusion There were no significant differences in the effect and safety of PTS versus DA in the treatment of TASCⅡ A and B superficial femoral artery lesions.