Objective To explore the impact of national volume-based procurement policies on the use of medicines in treatment of benign prostatic hyperplasia （BPH） and provide data support for the rational clinical use of medicines in BPH treatment. Methods Data on the use of BPH treatment medications from 2019 to 2023 were extracted from the Chinese Medicine Economic Information Network （CMEI）, covering 892 hospitals （including 645 tertiary hospitals and 247 secondary hospitals）. The changes in various indicators, including the consumption sum, Defined daily doses （DDDs）, Defined daily dose cost （DDDc）, and the ranking ratio （B/A） of these drugs were analyzed and compared. Results From 2019 to 2023, due to the influence of relevant policies, the overall consumption sums of medicines used in the sample hospitals in BPH treatment showed a trend of decreasing first and then rising steadily. The DDDs showed an overall upward trend, while the DDDc demonstrated a gradual decline. Tamsulosin and finasteride consistently ranked first and second in DDDs. The B/A value for tamsulosin was significantly higher than that of other BPH treatment medications. Conclusion The implementation of national centralized drug volume-based procurement policies and other policies from 2019 to 2023 had effectively reduced the economic burden of patients with benign prostatic hyperplasia. Tamsulosin and finasteride, which had the highest B/A in the two categories of α-blockers and 5α-reductase inhibitors, dominated the market for BPH treatment. The clinical use of BPH treatment medications was relatively rational.

Objective Based on the radiomics features extracted from the unenhanced CT images of the lower abdomen, a variety of machine learning models were constructed to explore their application value in the assessment of split renal function. Methods A retrospective analysis was conducted on the unenhanced CT images from 240 single kidneys in patients with clinically suspected renal dysfunction. Based on the results of single-photon emission computed tomography renal dynamic imaging, the cases were classified into the normal glomerular filtration rate group (n=118) and the decreased glomerular filtration rate group (n=122). The region of interest was outlined on the unenhanced CT images and the radiomics features were extracted. The features were selected by correlation analysis and least absolute shrinkage and selection operator, and the machine learning models were constructed based on the algorithms of decision tree, support vector machine, random forest, logistic regression, and extreme gradient boosting. Area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were calculated to compare the performance of different models. Results Sixteen radiomics features were selected for constructing the machine learning models. The support vector machine model showed relatively high performance for the assessment of split renal function on the test set, with an area under the receiver operating characteristic curve value of 0.883 (95% confidence interval: 0.804-0.961), an accuracy of 0.778, a sensitivity of 0.811, and a specificity of 0.743. Conclusion The machine learning models constructed based on unenhanced CT radiomics can be used to preliminarily assess split renal function, which provides an innovative, convenient, and safe method for clinical diagnosis and has positive significance for treatment.

ObjectiveTo observe the clinical efficacy and safety of Bushen Ruyan Formulation （补肾乳岩方， BRF） in treating premenopausal breast cancer patients of disharmony of the chong （冲） and ren （任） meridian type under endocrine intensive therapy. MethodsA total of 88 premenopausal breast cancer patients who received endocrine intensive therapy and were diagnosed with disharmony of the chong and ren meridian by traditional Chinese medicine （TCM） were included and randomly divided into a control group and a treatment group， with 44 cases in each group. The control group received ovarian function suppression （OFS） combined with endocrine therapy， while the treatment group was given oral BRF additionally. Both groups were treated for three months. The clinical efficacy was evaluated by comparing the pre- and post-treatment results of the Functional Assessment of Cancer Therapy-Breast （FACT-B）， modified Kupperman score， T cell subsets （CD3⁺， CD4⁺， CD8⁺， CD4⁺/CD8⁺）， sex hormone levels， including estradiol （E₂）， luteinizing hormone （LH）， follicle-stimulating hormone （FSH）， progesterone （P）， testosterone （T）， and prolactin （PRL）， tumor markers， such as carcinoembryonic antigen （CEA）， carbohydrate antigen 125 （CA125）， and carbohydrate antigen 153 （CA153）， TCM syndrome score， and TCM syndrome efficacy. Blood routine tests， liver function and kidney function were monitored to assess safety. ResultsThe FACT-B scores of each domains and the total scores of the treatment group increased， while the social/family status score of the control group decreased. The treatment group had significantly higher scores in all domains and total score compared to the control group （P＜0.05 or P＜0.01）. The modified Kupperman score and TCM syndrome score of the treatment group decreased， and were lower than those of the control group （P＜0.01）. The levels of CD3⁺ and CD4⁺ in the treatment group increased， and were higher than those of the control group （P＜0.05）. Serum testosterone levels in the treatment group were lower than those in the control group （P＜0.05）. The total effective rate of TCM syndrome efficacy in the treatment group was 67.44%， significantly higher than the 23.26% in the control group （P＜0.05）. No significant abnormalities were observed in the blood routine tests or liver/kidney function indicators in either group before or after treatment. ConclusionBRF can effectively improve quality of life， alleviate symptoms， increase serum CD3⁺ and CD4⁺ levels， and enhance clinical efficacy in premenopausal breast cancer patients undergoing endocrine intensive endocrine therapy. It is also safe with no significant adverse effects.

AIM: To evaluate the expression of tumor necrosis factor-α(TNF-α)in the iris and ciliary body of Wistar rats in the endotoxin-induced uveitis(EIU), and the effect of Xuebijing injection on its expression.METHODS:A total of 65 Wistar rats were randomly divided into three groups: Group A(normal saline, n=5), Group B(normal saline+endotoxin-injected, n=30), and Group C(Xuebijing+endotoxin-injected, n=30). The EIU model was induced in Wistar rats of the groups B and C by injecting LPS into the plantar surfaces of the hind feet, and normal saline(15 mL/kg)or Xuebijing(15 mL/kg)were intraperitoneally administered 30 min before LPS administration. The rats of the groups B and C were further divided into 6 subgroups after LPS injection, including 6, 12, 18, 24, 48, and 72 h subgroups, with 5 rats in each group. Furthermore, the intraocular inflammation of the rats was observed at each time above, the number of infiltrating cells in the aqueous humor was counted, and the pathological changes were observed in the iris and ciliary body of rats using hematoxylin and eosin(HE)staining. TNF-α expression in iris and ciliary tissue at different postoperative time points was evaluated using immunohistochemistry.RESULTS: Clinical observations indicated no signs of uveitis in the group A, signs of uveitis were observed in the group B. Both iris symptoms and damage were significantly reduced in the group C compared to the group B(P<0.01). Cell counts in the aqueous humor revealed no inflammatory cells in the group A, while the number of aqueous humor cells in the group C was significantly reduced compared to Group B(P<0.01). HE staining revealed no cellular infiltration in the group A. In the group B, some cellular infiltration was observed in the eyes at 6 h post-LPS exposure. The number of infiltrating cells increased over time, peaked at 24 h, and gradually declined thereafter. In the group C, cell infiltration was not obvious at 6 h, few at 24 h, and nearly disappeared by 48 h. Immunohistochemical staining showed higher TNF-α expression in the ciliary body and iris in the group B than in the group A(P<0.01). Compared to the group C, TNF-α expression in the group B was significantly upregulated following LPS injection(P<0.01).CONCLUSION:TNF-α expression was elevated in EIU rats, and there was a positive correlation between its mean optical density ratio and inflammation degree. Moreover, Xuebijing injection could alleviate inflammation response through the reduction of TNF-α levels.

Objective To investigate the effect of resveratrol on the tumor microenvironment in osteosarcoma. Methods A C57BL/6 xenograft mouse model was established and treated with resveratrol. Single-cell sequencing was performed to analyze changes in the tumor microenvironment. Immunohistochemistry was used to assess immune cell infiltration, while Western blotting was conducted to examine alterations in cellular signaling pathways. Results Resveratrol significantly inhibited the proliferation of LM8 osteosarcoma cells in C57BL/6 mice compared to the control group. Additionally, CD8⁺ T cell recruitment was enhanced. The Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3) signaling pathway was notably downregulated in LM8 osteosarcoma cells following resveratrol treatment. Conclusion Resveratrol promotes CD8⁺ T cell infiltration by inhibiting the JAK2/STAT3 signaling pathway, suggesting its potential as a therapeutic agent in osteosarcoma treatment.
Osteosarcoma/genetics* ; STAT3 Transcription Factor/genetics* ; Resveratrol/pharmacology* ; Animals ; Janus Kinase 2/genetics* ; Signal Transduction/drug effects* ; Tumor Microenvironment/immunology* ; Cell Line, Tumor ; Mice, Inbred C57BL ; Mice ; Humans ; Cell Proliferation/drug effects* ; Bone Neoplasms/metabolism* ; CD8-Positive T-Lymphocytes/drug effects* ; Xenograft Model Antitumor Assays

A 10-year follow-up case of aldosterone and cortisol-secreting adrenocortical carcinoma, a rare disease presenting as an adrenal space-occupying lesion accompanied with hypertension and hypokalemia was reported, and the medical record was investigated in detail. Through case presentation and literature review, it was noted that patients with adrenocortical carcinoma presented a difference in clinical manifestations, pathology, and biological behaviors. This paper may help clinicians enhance their understanding of adrenocortical carcinoma. Especially significant adrenal space-occupying lesions highly suspicious of recurrence and producing different types of endocrine hormones should be paid more attention.

Objective:To analyze the effect of different lithotomy positions on hemodynamics in patients undergoing laparoscopic total hysterectomy.Methods:A total of 50 patients who underwent laparoscopic total hysterectomy at Zhoushan Women and Children's Hospital between January 2020 and June 2021 were included in this study. The patients were randomly divided into a control group and an observation group using a random number table method, with 25 patients in each group. The control group underwent conventional lithotomy position total laparoscopic hysterectomy, while the observation group underwent high and low lithotomy position total laparoscopic hysterectomy. The general surgical indicators, respiratory function indicators, blood gas analysis indicators, hemodynamic levels, incidence of complications, and clinical efficacy were compared between the two groups.Results:The general surgical indicators and airway peak pressure indicators in the observation group were significantly lower than those in the control group (both P < 0.05). There was no statistically significant difference in partial pressure of end-tidal carbon dioxide (PCO 2) and arterial carbon dioxide partial pressure (PaCO 2) between the two groups (both P < 0.05). At 15 minutes after pneumoperitoneum, the PaCO 2 level increased in each group, and the PaCO 2 level in the observation group was significantly higher than that in the control group (all P < 0.05). At the same time, the HCO 3- level decreased in each group, and the HCO 3- level in the observation group was significantly lower than that in the control group (all P < 0.05). At 5 minutes before recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the control group were (76.52 ± 8.61) beats/minute, (113.52 ± 5.36) mmHg (1 mmHg = 0.133 kPa), and (86.91 ± 4.21) mmHg, respectively. At 5 minutes after recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the control group were (89.52 ± 8.61) beats/minute, (106.85 ± 5.63) mmHg, and (80.96 ± 3.65) mmHg, respectively. At 5 minutes before recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were (76.36 ± 8.61) beats/minute, (112.79 ± 5.28) mmHg, and (86.89 ± 4.54) mmHg. At 5 minutes after recovery of body position, heart rate, systolic blood pressure, and diastolic blood pressure in the observation group were (75.63 ± 6.86) beats/minute, (111.99 ± 5.51) mmHg, and (85.06 ± 3.21) mmHg, respectively. At 5 minutes after recovery of body position, heart rate in the control group was increased and that in the observation group was decreased compared with heart rate measured at 5 minutes before recovery of body position. At 5 minutes after recovery of body position, heart rate in the observation group was significantly lower than that in the control group. Diastolic blood pressure and systolic blood pressure decreased in each group, and the amplitudes of reductions in diastolic blood pressure and systolic blood pressure in the observation group were significantly lower than those in the control group. ( t = 6.04, 3.26, 4.22, all P < 0.05). There was no statistically significant difference in incidence of adverse reactions between the two groups ( P > 0.05). The overall response rate in the observation group was significantly higher than that in the control group ( P < 0.05). Conclusion:Compared with conventional lithotomy position total laparoscopic hysteretsotomy, high and low lithotomy position total laparoscopic hysterectomy takes a shorter duration for total laparoscopic hysterectomy, leads to a shorter length of hospital stay, results in less blood loss, causes fewer postoperative infections, and results in more stable hemodynamics and a lower incidence of complications.

Objective To analyze the pulmonary perfusion defect index (PPDI) of dual-energy computed tomography (CT) and pulmonary artery obstruction index (PAOI) of conventional CT angiography, and to investigate the clinical application value of dual-energy CT perfusion imaging in the examination of patients with acute pulmonary embolism. Methods A retrospective study was conducted on 21 patients diagnosed with acute pulmonary embolism in Weifang People's Hospital from January 1, 2022 to December 31, 2022. PPDI, PAOI, and maximum plasma D-dimer concentration (mg/L) were calculated. According to the 2019 ESC Guidelines, the patients were divided into low-risk group (n = 8) and medium-risk group (n = 12). The Mann-Whitney U test was used for between-group comparisons. The Spearman’s rank correlation coefficient was used to analyze the correlations between PAOI, PPDI, and plasma D-dimer concentration. Results The PPDI, PAOI, and D-dimer values in the low-risk group were 3.33 (2.09, 4.58), 5.00 (3.13, 5.00), and 0.67 (0.52, 0.79), respectively. The PPDI, PAOI, and D-dimer values in the middle-risk group were 8.34 (5.42, 12.50), 12.50 (8.13, 15.00), and 1.18 (0.86, 2.87), respectively. The Z-values of comparison between the two groups were −3.092, −3.650, and −3.318, respectively (all P < 0.05). There were significant differences in PPDI, PAOI, and D-dimer between the low-risk and middle-risk groups (P < 0.05). Positive correlations were observed between PPDI and PAOI, between PPDI and D-dimer, and between PAOI and D-dimer (r_s = 0.869, 0.918, 0.909, all P < 0.05). Conclusion Both PPDI and PAOI can be used for the clinical examination of patients with acute pulmonary embolism and evaluation of the severity of the disease. Compared with conventional CT, dual-energy CT perfusion imaging is more efficient in the diagnosis of acute pulmonary embolism, and facilitates accurate clinical treatment.

Objective To explore the application value of computed tomography (CT)-based three-dimensional digital navigation technology in microwave ablation of lung cancer. Methods A total of 92 patients with lung cancer in our hospital were retrospectively analyzed, and randomized to receive microwave ablation with the three-dimensional digital navigation technology or traditional CT-guided microwave ablation (three-dimensional navigation group and traditional group). The two groups were paired according to tumor location, size (the maximum diameter difference of less than or equal to 2 mm), and microwave ablation conditions, for a total of 46 pairs. The operation time, times of microwave ablation needle puncture, CT dose index, incidence rates of intraoperative complications, and postoperative lesion control were compared between the two groups. Results The operation time [(30.07 ± 6.36) min vs (47.20 ± 9.65) min], times of puncture [(1.72 ± 0.69) times vs (7.13 ± 3.00) times], CT dose index [(11.16 ± 2.20) mGy vs (26.67 ± 8.72) mGy], and incidence of intraoperative complications (10.87% vs 34.78%) in the three-dimensional navigation group were lower than those in the traditional group, and the response rate was higher in the three-dimensional navigation group than in the traditional group (93.48% vs 71.74%) (P < 0.05). Conclusion CT-guided three-dimensional digital navigation technology for microwave ablation of lung cancer makes the operation of interventional puncture more accurate and safe.

ObjectiveTo investigate the characteristics of surface electromyography (sEMG) of muscles in stroke patients with lower limb spasticity. MethodsFrom October, 2016 to July, 2020, a total of 32 stroke patients with hemiplegia and eleven healthy subjects (control group) were selected. The patients were divided into modified Ashworth Scale (MAS) 0 group (n = 13), MAS 1 group (n = 10) and MAS 1⁺ group (n = 9). All the groups were subjected to isokinetic passive movement at baseline, 90°/s, 150°/s, 210°/s and 270°/s, respectively. sEMG signals of rectus femoris muscle and lateral head of quadriceps femoris muscle including root mean square (RMS) and integrated electromyography (iEMG) were collected synchronically during isokinetic passive movement. ResultsThere was no significant difference in RMS and iEMG among baseline and the four angular velocities in the control group and MAS 0 group (P > 0.05). The RMS and iEMG of MAS 1 group at 270°/s were significantly different from baseline and the other angular velocities (P < 0.05), and no significant difference was found among the other velocities (P > 0.05). The RMS and iEMG of MAS 1⁺ group were significantly different among baseline and the four angular velocities (P < 0.05). ConclusionRMS and iEMG varies with angular velocity in hemiplegic patients with different muscle tension levels. In patients with the same muscle tension level, the changes of RMS and iEMG with angular velocity are consistent. RMS and iEMG can reflect the degree of spasm. The quantitative evaluation of spasm by sEMG in isokinetic passive movement mode is highly feasible and worthy of further clinical research and promotion.