Objective To investigate the long-term efficacy and complications of brachytherapy in early stage prostate cancer.Methods The data of 117 cases of early stage prostate cancer patients were analyzed,aged from 51 to 84 years,with an average of 73 years.The PSA ranged from 0.4 to 47.6 μg/L (14.7 in average),Gleason score ranged from 4 to 9 (6.4 in average),clinical stage ranged from T1b to T2c,the prostate volume ranged from 13 to 69 ml (31 ml in average),and the positive biopsy rate was 8％to 100％ (45％ in average).The low-risk,intermediate-risk and high-risk prostate cancer were 22,29 and 66 cases.Biochemical no evidence of disease (bNED),overall survival and complications were recorded.Results Followed up from 19 to 114 months (84 months in average),33 cases had biochemical recurrence (bNED rate,72％).Twelve patients died,among which 4 patients died of prostate cancer.The overall survival rate was 90％,and the cancer-specific survival rate was 97％.The bNED rates in low-risk,intermediate-risk and high-risk groups were 86％,79％ and 64％,and the difference was significant among the 3groups (P=0.040).The overall survival rates were 100％,90％ and 86％,with no significant difference among the 3 groups (P=0.189).Urinary retention occurred in 11 cases (9％),among which 1 patient had TURP treatment.No serious complications such as rectal fistula occurred.Conclusions The long-term efficacy of brachytherapy in early stage prostate cancer is definite with few complications.With a mean followup of 7 years,the bNED rate was 72％ and the overall survival rate was 90％.

Objective To investigate the prognostic factors of biochemical relapse in patients with early stage prostate cancer after brachytherapy.Methods From December 2003 to December 2007,117 patients (age 51-84 years,median 73 years) with early stage prostate cancer underwent brachytherapy at our hospital.The PSA ranged from 0.4 to 47.6 μg/L (median,14.7 g/L),in which 75 cases with PSA＜ 20.0 μg/L and 42 cases with PSA≥20.0 μg/L.Clinical stage ranged from T1b to T2c.The prostate volume ranged from 13 to 69 ml (average,31 ml),and the percentage of positive biopsy cores was 8％ to 100％ (average,45％),in which 69 cases with a positivity＜50％ and 48 cases with a positivity≥50％.The D90 ranged from 106 to 170 Gy (average,142 Gy).And 6 patients were treated with external beam radiation in combination.The biochemical no evidence of disease (bNED) rate was recorded.And possible prognostic factors,including risk stratification,PSA,clinical stage,prostate volume,biopsy positivity and D90,were analyzed by using SPSS 19.0 software.Results The patients were followed up for 19 to 114 months (average,84 months; median,82 months).And biochemical relapse was observed in 33 cases (bNED rate,72％).The bNED rates in low-risk,intermediate-risk and high-risk groups were 86％,79％ and 64％,respectively and significant correlations were found between bNED rate and risk stratification (P=0.040).Moreover,the bNED rate was significantly higher in patients with the following factors,namely PSA＜20.0 μg/L (P =0.028),percentage of positive biopsy cores＜50％ (P =0.006) and high-dose implants (D90 ≥ 140 Gy) (P=0.009).Conclusions The long-term efficacy of brachytherapy in early stage prostate cancer is definite.Significant associations are found between bNED rate and risk stratification.And higher rates of biochemical relapse could be found in patients with PSA ≥ 20.0 μg/L,percentage of positive biopsy cores ≥ 50％ or D90＜ 140 Gy groups.

Objective To evaluate the outcomes and complications of permanent brachytherapy combined with external beam radiotherapy and hormonal therapy for local high-risk or intermediated-risk prostate cancer.Methods There were 354 men with local high-risk or intermediated-risk prostate cancer were reviewed,including 111 men with local intermediated-risk prostate cancer and 243 men with local highrisk prostate cancer.The age of the patients were 48 to 84 years old (mean age 72.4 years old).The preoperative PSA levels were in a range of 3.8 to 99.8ng/ml (mean 29.6 g/ml) and the preoperative Gleason scores were 4 to 9 (mean 6.8).The prostate volume were 13.7 to 65.0 ml (mean 30.5 ml).All the patients were treated with brachytherapy combined with hormonal therapy,including 69 patients received additional external beam radiotherapy.All patients were followed up for biochemical progression-free survival (bPFS),distant disease free survival (DDFS),overall survival (OS),cause-specific survival (CSS) rate and complications.Results Among 354 cases,174 cases underwent brachytherapy after the diagnosis of prostate cancer,and 157 cases underwent brachytherapy after maximal androgen blockade (MAB) treatmentfor 3 months,while the other 23 patients with large prostate underwent brachytherapy after MAB treatment for 6 months.All 354 cases were treated with MAB after brachytherapy.One hundred and eleven cases in intermediated-risk group were treated with MAB for 6 months and 243 cases in high-risk group were treated with MAB for 6 months to 3 years.Another 69 patients received adjuvant external radiotherapy.All cases were followed up for 9 to 128 months (mean 91 months),including 135 cases having biochemical recurrence,and 63 cases having distant metastasis.There were 81 cases died,including 24 cases died of prostate cancer.The overall bPFS,DDFS,OS and CSS were 61.9％,82.2％,77.1％ and 93.2％ respectively.There were significant difference in the survival rate between the high-risk group and the intermediated-risk group(P ＜ 0.001).The incidence of urinary retention and long term urethral stricture were 6.8％ and 1.7％,respectively.No serious complications occurred.Conclusion Permanent brachytherapy combined with external beam radiotherapy and hormonal therapy treating local high-risk or intermediated-risk prostate cancer can be effective with few complications.

Objective To observe the effects of modified Poge Jiuxin decoction combined with acupuncture in the treatment of septic cardiomyopathy(SIC),and explore its possible mechanism.Methods Totally 72 patients with SIC admitted to Chengdu First People's Hospital from January 2022 to June 2023 were enrolled.The patients were divided into control group and treatment group according to random number table method,with 36 cases in each group.Patients in control group received basic treatment for SIC.On this basis,the treatment group was administrated with modified Poge Jiuxin decoction[includes Prepared Aconite 30 g(earlier decocted),Red Ginseng 30 g(another stew),Cornel Meat 60 g,Dried Ginger 30 g,Raw Keel 30 g(earlier decocted),Raw Oyster 30 g(earlier decocted),Magnet 30 g(earlier decocted),Poria Cocos 90 g,Plantain Seeds 30 g(in bag),Roasted Licorice 60 g,Musk 0.5 g(artificial)],one dose a day,100 mL in 3 meals a day.Acupuncture at bilateral Zusanli,Guangyuan,Neiguan,Sanyinjiao and Qihai points,twice a day.Both groups were treated for 7 days.The changes of C-reactive protein(CRP),procalcitonin(PCT),cardiac tropomin I(cTnI),N-terminal pro-B type natriuretic peptide(NT-proBNP)and lactic acid(Lac)were observed before and after treatment,acute physiology and chronic health evaluationⅡ(APACHEⅡ)and sequential organ failure assessment(SOFA)were calculated,left ventricular ejection fraction(LVEF),left ventricle fractional shortening(LVFS),and mitral orifice early/late diastolic blood flow velocity ratio(E/A ratio)were measured with echocardiography,the heart rate(HR),mean arterial pressure(MAP),mechanical ventilation time,vasoactive drug use time,in the intensive care unit(ICU)stay time,the incidence of multiple organ dysfunction syndrome(MODS)and 28-day mortality were recorded.Results After treatment,the indexes of inflammation(CRP,PCT),myocardial markers(cTnI,NT-proBNP),hemodynamics and perfusion(HR,Lac),illness severity score(APACHEⅡ,SOFA)and the 28-day mortality in the two groups were significantly reduced,while LVEF and MAP were significantly increased compared to before treatment.The improvement of various indexes in the treatment group were better than those in the control group[CRP(mg/L):22.18±9.46 vs.68.45±13.46,PCT(μg/L):1.16±0.59 vs.4.35±1.28,LVEF:0.48±0.06 vs.0.41±0.05,cTnI(μg/L):0.60±0.14 vs.0.98±0.30,NT-proBNP(ng/L):204.35±26.54 vs.240.12±56.12,HR(bmp):88.75±10.05 vs.98.57±10.56,MAP(mmHg,1 mmHg≈0.133 kPa):82.10±5.08 vs.73.46±3.55,Lac(mmol/L):0.75±0.28 vs.1.60±0.36,APACHEⅡscore:10.46±1.80 vs.15.50±2.16,SOFA score:2.60±1.24 vs.6.76±1.60,all P<0.05].After treatment,LVFS and E/A ratio in the two groups increased significantly compared to those before treatment,however,there was no significant difference between the treatment group and the control group after treatment[LVFS:(25.12±3.46)%vs.(22.61±3.88)%,E/A ratio:1.16±0.46 vs.0.96±0.32,both P>0.05].The vasoactive drug use time and ICU stay time were shortened in the treatment group than those in the control group[vasoactive drug use time(days):9.62±3.05 vs.10.48±3.40,ICU stay time(days):12.51±2.04 vs.13.72±1.14,both P<0.05],the incidence of MODS and the 28-day mortality were lower than those of the control group[38.89%(14/36)vs.52.77%(9/36),44.44%(16/36)vs.47.22%(17/36)],but there were no statistical differences(both P>0.05).Conclusion Modified Poge Jiuxin decoction combined with acupuncture can effectively improve the prognosis of patients with SIC,and its mechanism may be related to inhibition of inflammatory reaction and improvement of cardiac function.

Objective To investigate clinical characteristics and the risk factors of sepsis-induced myocardial dysfunction(SIMD),and to provide evidence for the diagnosis,treatment and prevention of SIMD.Methods The clinical data of 284 patients with sepsis(≥18 years old)admitted to the department of critical care medicine of Chengdu Integrated Traditional Chinese Medicine&Western Medicine Hospital/Chengdu First People's Hospital from January 2020 to December 2022 were retrospectively analyzed.This includes gender,age,chronic underlying diseases,the mean arterial pressure(MAP),heart rate(HR),laboratory test results,disease severity score,the proportion of requiring mechanical ventilation,vasoactive drugs treatment and renal replacement therapy,length of intensive care medicine(ICU)stay and the 28-day mortality.Patients were divided into SIMD group and non-SIMD group according to the occurrence of SIMD,allowing for an analysis of the clinical characteristics of two groups of patients.Univariate and multivariate Logistic regression analyses were used to identify the risk factors of SIMD,and receiver operator characteristic curve(ROC curve)were plotted to analyze the predictive value of each risk factor for the occurrence of SIMD.Results A total of 284 septic patients were included,including 136 cases(47.89％)in the SIMD group and 148 cases(52.11％)in the non-SIMD group.Compared with the non-SIMD group,the levels of age,N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac tropomin I(cTnI),lactic acid(Lac)at admission to ICU,the proportion of vasoactive drugs treatment,acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)and sequential organ failure assessment(SOFA)in the SIMD group were significantly higher than those in the non-SIMD group[age(years):75.92±2.35 vs.55.02±1.68,NT-proBNP(ng/L):3 037.00±544.50 vs.2 493.92±630.21,cTnI(μg/L):0.12±0.07 vs.0.06±0.03,Lac in ICU(mmol/L):4.46±1.21 vs.2.98±1.02,the proportion of vasoactive drugs treatment:40.44％(55/136)vs.21.62％(32/148),APACHEⅡ score:24.25±1.02 vs.20.95±0.85,SOFA score:7.41±4.69 vs.6.21±2.81,all P<0.05],but the 24-hour Lac clearance rate of the SIMD group was significantly lower than that of the non-SIMD group[(13.80±7.01)％vs.(25.41±8.90)％,P<0.05].Multivariate Logistic regression analysis showed that age≥75 years,24-hour Lac clearance rate and NT-proBNP≥3 000 ng/L were the independent factors of SIMD in patients with sepsis[odds ratio(OR)and 95％confidence interval(95％CI)were 5.990(2.143-16.742),0.348(0.155-0.786)and 2.708(1.093-6.711),P values were 0.001,0.011 and 0.031].ROC curve analysis showed that age,24-hour Lac clearance rate,NT-proBNP had predictive value for the development of SIMD[area under the curve(AUC)were 0.637,0.811,0.743,95％CI were 0.573-0.701,0.761-0.860,0.687-0.800,all P<0.05].Conclusions SIMD occurs more frequently in patients with sepsis.Increased age,elevated NT-proBNP,and reduced 24-hour Lac clearance rate are independent risk factors of SIMD,warranting clinical attention.