Objective:This study investigated the independent risk factors for lymph node metastasis（LNM）in high-risk prostate cancer（HRPCa）patients undergoing robot-assisted radical prostatectomy（RARP），and constructed a nomogram model based on clinical data to improve the accuracy and clinical practicality of preoperative prediction of LNM.Methods:A retrospective analysis was conducted on the clinical data of 218 HRPCa patients who received RARP treatment at the First Medical Center of the PLA General Hospital from January 2020 to March 2025 as the modeling group. The age of the modeling group was（66.91±6.94）years old. 75 cases（34.40%）had a history of smoking，and 48 cases（22.02%）had a history of drinking. There were a body mass index（BMI）of 25.55（23.58，27.00）kg/m 2，a total prostate-specific antigen（tPSA）of 20.59（10.42，30.61）ng/ml，a free prostate-specific antigen（fPSA）of 1.87（1.04，3.26）ng/ml，a prostate volume（PV）of（41.19±21.00）ml，a prostate-specific antigen density（PSAD）of 0.52（0.30，0.84）ng/ml 2. Among the patients，60 cases（27.52%）had a preoperative biopsy Gleason score >8，and the percentage of positive biopsy cores（PPBC）was 50%（31%，80%）. Thirty-one patients（14.22%）were staged clinically as >T 2c. The diagnostic criteria for high-risk prostate cancer（HRPCa）were defined as meeting any one of the following：PSA >20 ng/ml，Gleason score on prostate biopsy ≥8，or clinical stage ≥T 3. Among the 218 patients in the modeling cohort，67 cases（30.73%）met two of the criteria，and 7 cases（3.21%）met all three criteria. All 218 patients underwent RARP，and based on postoperative pathology，they were divided into the LNM group and the non-LNM group. The relationship between the number of diagnostic criteria met and the occurrence of LNM was analyzed. An external validation cohort included 42 HRPCa patients who underwent RARP at the Third，Fifth Medical Centers of the PLA General Hospital between January 2023 and May 2025. Their mean age was（66.79±5.92）years. Eighteen patients（42.86%）had a smoking history，and nine（21.43%）had a history of alcohol consumption. The median BMI was 26.00（23.80，27.13）kg/m 2. The median tPSA level was 17.34（8.97，27.30）ng/ml. The median fPSA was 1.51（0.83，2.52）ng/ml，and the median PV was（35.57 ± 15.25）ml. The median PSAD was 0.57（0.23，0.87）ng/ml 2，and the median PPBC was 58%（36%，71%）. Three patients（7.14%）had a clinical stage >T 2c，and 12 patients（28.57%）had a Gleason score >8 on preoperative biopsy. Univariate and multivariate binary logistic regression analyses were used to identify independent risk factors for LNM，and a nomogram model was constructed based on these factors. The predictive performance of the model was evaluated using receiver operating characteristic（ROC）curves and calibration plots，and the model was validated in the external cohort. Result:According to postoperative pathology，45 patients were classified into the LNM group，and 173 into the non-LNM group. The probability of LNM increased proportionally with the number of diagnostic criteria met for HRPCa（meeting two criteria： OR = 4.762，95% CI 2.323-9.761， P < 0.01；meeting three criteria： OR = 10.667，95% CI 2.187-52.025， P=0.003）. Binary logistic regression analysis revealed that age（ OR=0.913，95% CI 0.859-0.971， P = 0.004），tPSA（ OR=1.039，95% CI 1.018-1.061， P<0.01），PPBC（ OR = 5.656，95% CI 1.101-29.056， P = 0.038），and clinical T stage（T 2c stage： OR=2.945，95% CI 0.888-9.769， P=0.077；>T 2c stage OR = 18.351，95% CI 4.790-70.306， P < 0.01）were independent risk factors for postoperative LNM in HRPCa patients after RARP. The ROC curve of the nomogram model based on these factors showed an area under the curve（AUC）of 0.853（95% CI 0.790-0.917）. In the external validation cohort，the nomogram achieved an AUC of 0.743（95% CI 0.556-0.929）. The calibration plots demonstrated good agreement between the predicted probabilities and actual observations. Conclusions:Age，tPSA，PPBC，and clinical T stage were independent predictors of postoperative LNM in HRPCa patients undergoing RARP. The greater the number of HRPCa diagnostic criteria met，the higher the likelihood of postoperative LNM. The nomogram developed in this study could effectively predict the risk of LNM in HRPCa patients after RARP.

Objective:This study investigated the independent risk factors for lymph node metastasis（LNM）in high-risk prostate cancer（HRPCa）patients undergoing robot-assisted radical prostatectomy（RARP），and constructed a nomogram model based on clinical data to improve the accuracy and clinical practicality of preoperative prediction of LNM.Methods:A retrospective analysis was conducted on the clinical data of 218 HRPCa patients who received RARP treatment at the First Medical Center of the PLA General Hospital from January 2020 to March 2025 as the modeling group. The age of the modeling group was（66.91±6.94）years old. 75 cases（34.40%）had a history of smoking，and 48 cases（22.02%）had a history of drinking. There were a body mass index（BMI）of 25.55（23.58，27.00）kg/m 2，a total prostate-specific antigen（tPSA）of 20.59（10.42，30.61）ng/ml，a free prostate-specific antigen（fPSA）of 1.87（1.04，3.26）ng/ml，a prostate volume（PV）of（41.19±21.00）ml，a prostate-specific antigen density（PSAD）of 0.52（0.30，0.84）ng/ml 2. Among the patients，60 cases（27.52%）had a preoperative biopsy Gleason score >8，and the percentage of positive biopsy cores（PPBC）was 50%（31%，80%）. Thirty-one patients（14.22%）were staged clinically as >T 2c. The diagnostic criteria for high-risk prostate cancer（HRPCa）were defined as meeting any one of the following：PSA >20 ng/ml，Gleason score on prostate biopsy ≥8，or clinical stage ≥T 3. Among the 218 patients in the modeling cohort，67 cases（30.73%）met two of the criteria，and 7 cases（3.21%）met all three criteria. All 218 patients underwent RARP，and based on postoperative pathology，they were divided into the LNM group and the non-LNM group. The relationship between the number of diagnostic criteria met and the occurrence of LNM was analyzed. An external validation cohort included 42 HRPCa patients who underwent RARP at the Third，Fifth Medical Centers of the PLA General Hospital between January 2023 and May 2025. Their mean age was（66.79±5.92）years. Eighteen patients（42.86%）had a smoking history，and nine（21.43%）had a history of alcohol consumption. The median BMI was 26.00（23.80，27.13）kg/m 2. The median tPSA level was 17.34（8.97，27.30）ng/ml. The median fPSA was 1.51（0.83，2.52）ng/ml，and the median PV was（35.57 ± 15.25）ml. The median PSAD was 0.57（0.23，0.87）ng/ml 2，and the median PPBC was 58%（36%，71%）. Three patients（7.14%）had a clinical stage >T 2c，and 12 patients（28.57%）had a Gleason score >8 on preoperative biopsy. Univariate and multivariate binary logistic regression analyses were used to identify independent risk factors for LNM，and a nomogram model was constructed based on these factors. The predictive performance of the model was evaluated using receiver operating characteristic（ROC）curves and calibration plots，and the model was validated in the external cohort. Result:According to postoperative pathology，45 patients were classified into the LNM group，and 173 into the non-LNM group. The probability of LNM increased proportionally with the number of diagnostic criteria met for HRPCa（meeting two criteria： OR = 4.762，95% CI 2.323-9.761， P < 0.01；meeting three criteria： OR = 10.667，95% CI 2.187-52.025， P=0.003）. Binary logistic regression analysis revealed that age（ OR=0.913，95% CI 0.859-0.971， P = 0.004），tPSA（ OR=1.039，95% CI 1.018-1.061， P<0.01），PPBC（ OR = 5.656，95% CI 1.101-29.056， P = 0.038），and clinical T stage（T 2c stage： OR=2.945，95% CI 0.888-9.769， P=0.077；>T 2c stage OR = 18.351，95% CI 4.790-70.306， P < 0.01）were independent risk factors for postoperative LNM in HRPCa patients after RARP. The ROC curve of the nomogram model based on these factors showed an area under the curve（AUC）of 0.853（95% CI 0.790-0.917）. In the external validation cohort，the nomogram achieved an AUC of 0.743（95% CI 0.556-0.929）. The calibration plots demonstrated good agreement between the predicted probabilities and actual observations. Conclusions:Age，tPSA，PPBC，and clinical T stage were independent predictors of postoperative LNM in HRPCa patients undergoing RARP. The greater the number of HRPCa diagnostic criteria met，the higher the likelihood of postoperative LNM. The nomogram developed in this study could effectively predict the risk of LNM in HRPCa patients after RARP.

Objective:To analyze the epidemiological characteristics and influencing factors of venous thrombosis in elderly patients with severe trauma.Methods:A retrospective study was conducted to collect and statistically analyze general information[sex, age, body mass index(BMI)], causes of trauma, injury severity score(ISS), Glasgow coma score(GCS), coagulation function[prothrombin time(PT), international normalized ratio(INR), D-dimer], B-type natriuretic peptide(BNP), liver function(alanine aminotransferase, aspartate aminotransferase), creatinine, Caprini score, surgical approach, immobilization mode, days of hospitalization, and treatment cost.Results:Totally 179 elderly patients with severe trauma were enrolled, including 130 men(72.6%), aged(67.6±6.4)years.The BMI, ISS and GCS scores of elderly patients with severe trauma were(22.9±3.4)kg/m 2, 28.4±10.5 and 10.2±4.6, respectively.The Caprini score was 11.7±4.0.Of these patients, 32(17.9%)had VTE events.Compared with the VTE negative group, the VTE positive group was older( t=-2.214, P=0.028), with a higher Caprini score( t=-2.684, P=0.008)and more lower limb fractures( P=0.008)and pelvic fractures( P=0.001). There were no significant differences in coagulation function, liver function, atrial natriuretic peptide levels, creatinine levels and surgical approaches between the VTE negative group and the VTE positive group(all P<0.05). No significant difference was found in the proportion of patients receiving surgical treatment between the two groups( P=0.563). In the VTE positive group, 18.8% had no fracture, 50.0% had one fracture, and 31.2% had two or more fractures, and the difference was statistically significant compared with the VTE negative group( P=0.029). However, VTE events had no significant effect on the average length of stay and hospitalization costs in elderly trauma patients(all P<0.05). Conclusions:For elderly patients with severe trauma, VTE is more likely to occur with increased age, a high Caprini score, multiple fracture sites and pelvic fracture.In addition, pelvic fracture is an independent risk factor for VTE in very old trauma patients.Attention should be paid to prevention and treatment to achieve steady improvement in the overall prognosis of trauma in these patients.

The efficacy of constructivism teaching mode in physical diagnostics teaching was evaluated in this study. We built up the constructivism teaching mode in diagnostics teaching taking the clinical symptoms as the theme, and through such aspects as courseware design, teaching plan preparation, SP playing and inquiry, SimMan simulated physical examination, condition analysis, etc. Then questionnaires were conducted to analyze the role of the constructivism teaching mode in diagnostics teaching. The diagnostics constructivism teaching mode can provide students with a platform for self-construction of diagnostics and integrated application of knowledge. Meanwhile, students' sense of participation can be improved and multiple learning skills are enhanced during the course.

Objective:To explore the different design of readiness assurance process (RAP) and application in TBL teaching of rehabilitation medicine, and to compare the teaching effects.Methods:A total of 40 students who had clinical rotation in our department were chose as research subjects, and they were taught with TBL teaching. Two chapters of "Stroke Rehabilitation" and "Spinal Cord Injury Rehabilitation" were chosen for the two lectures. During the course of "Stroke Rehabilitation", the RAP adopted open-ended questions, and the application part simulated Teamwork meetings. In the course of "Spinal Cord Injury Rehabilitation", the RAP used close-ended multiple-choice questions, and the application part simulated making rehabilitation plan. At the end of the two lectures, questionnaires were send to students.Results:For the RAP part, more students preferred open-ended questions. In the application part, students preferred to make rehabilitation plan.Conclusion:The process of clinical diagnosis and treatment and the formulation of rehabilitation plan in clinical practice of rehabilitation medicine has been applied to different parts of TBL teachings, and students are favor of this teaching method, which provides a reference for the future TBL teaching design of rehabilitation medicine.

Objective Comparing the organ-system-based integrated curriculum model and tradi-tional teaching model in medical education to evaluate the effect of Integrated curriculum model. Methods The experiment group (Group A) included 45 students who had graduated in 2016 under integrated curricu-lum model, the control group (Group B) included 82 students who had graduated in the same year under traditional teaching model. Comparing the test score between two groups to see if a significant difference emerged, including general education courses, graduation examination, clinical intern examination, uninte-grated curriculum and National Medical Licensing Examination. Using SPSS 19.0 statistics, 2-Independent-sample T test. Results There were no significant difference in the scores of general education courses between the groups. The total score of graduation theory examination in group A was 54.71±8.58, which was significantly higher than group B (49.13±12.21) (P=0.008), especially in internal medicine, surgery, gyne-cology and obstetrics, the contrast of the two groups being P=0.015, P=0.022, P=0.002 respectively. The total score of OSCE in group A was 69.56±5.64, which was significantly higher than group B (65.74±5.37) (P=0.000), especially in diagnose, clinical thinking ability, interpersonal communication skills and total score, the contrast of the two groups being P=0.019,P=0.001, P=0.000 respectively. The scores of clinical Intern examination in group A were superior to group B, especially in internal medicine, surgery, gynecology and obstetrics, the contrast of the two group being P=0.029, P=0.015, P=0.003 respectively. The scores of 3 unintegrated curriculum in group A were the same with group B. The total score of National Medical Licens-ing Examination in group A was (429.690±31.197), which was significantly higher than group B (412.370± 46.858) (P=0.048), especially in Clinical medicine, Preventive Medicine, the contrast of the two groups were P=0.011, P=0.022 respectively, in the level of knowledge, comprehension, application, the contrast of the two groups being P=0.022, P=0.041 respectively. Conclusions The integrated curriculum modal has more advantages in developing students' Comprehensive ability. There is no fixed pattern of integrated curriculum, and it needs continuous evaluation and improvement to ensure the effect.

Objective To investigate the effect of bitter gourd saponins on the salt -sensitive hypertension caused kidney damage in rats ,and analyze the mechanism of its therapeutic effect .Methods 50 SD rats were fed for 10 days with normal diet ,and then based on random number method ,the rats were randomly divided into 5 groups:the normal control group,model control group and the low total saponins bitter,medium and high dose treatment group,10 rats in each group.Then,the rats in the normal control group and the model control group were given 1mL· kg-1 · d-1 normal saline,and the rats in bitter gourd saponins groups were given high salt diet 8 weeks to establish the model .After 4 weeks,the total saponins of bitter gourd treatment groups were given 10,20 and 40mg· kg-1· d-1.8 weeks later, the rats were sacrificed and the renal pathology was detected by HE staining .The changes of blood pressure , heart rate,urinary function and blood renal function were also analyzed .At last,Western blot and semi -quantitative PCR were used to detect the endothelin -1 (ET-1) in renal tissue.Results For the systolic blood pressure,in whole of treatment,the normal control group maintained at about 120 mmHg, while the model control group maintained at 170mmHg,which of the bitter gourd saponins three doses groups compared to the model control group was significantly lower (t=1.765,1.982,2.126,all P<0.05),further improved.And the heart rate had no statistically significant difference among the groups(all P>0.05).Compared with the normal control group,the blood urea nitrogen (BUN), creatinine (Cr),uric acid (UA),urine volume,urinary protein and N -acetyl beta -D-Glucosaminidase (NAG) levels in the model control group were significantly increased (t=28.703,33.932,29.298,4.695,10.989,10.871, all P<0.05),which in the bitter gourd saponins treatment groups were significantly decreased (all P<0.05).HE staining showed that the rats in the normal group were normal ,and the model control group had obvious glomerular sclerosis and renal interstitial fibrosis , after bitter gourd saponins treatment , the condition was significantly improved .Immu-nohistochemistry,Western blot and semi-quantitative PCR showed that normal control group had almost a little expression of ET-1,and compared with the normal control group ,which of the model control group was significantly increased ( t=14.650,11.387,all P<0.05),and the ET-1 expression in the bitter gourd saponins treatment groups significantly decreased.Conclusion The bitter gourd saponins can significantly improve the symptoms of hypertension and renal damage induced by high salt diet in rats ,which may be related with regulation of ET -1 expression in renal tissue .

BACKGROUND:EdU is a new nuclear marker, and currently, it is rarely reported.
OBJECTIVE: To determine the optimal concentration of EdU to label human umbilical cord mesenchymal stem cels.
METHODS: Human umbilical cord mesenchymal stem cels were isolated, purified and subcultured. Cel morphology and growth were observed under inverted microscope. Flow cytometry was used to identify cel surface markers, as wel as adipogenic identification. EdU at concentrations of 5, 10, 20, 50, 100 μmol/L was used to label human umbilical cord mesenchymal stem cels for 24 hours. The optimal concentration that resulted in the highest labeling efficiency was selected, and then cel proliferation curve was drawn.
RESULTS AND CONCLUSION:Under the inverted microscope, cels grew adherently in a long spindle shape, and EdU-labeled cels had the same morphology. Flow cytometry showed that cels were positive for CD44, and had adipogenic differentiation ability. When the concentration of EdU was 5 and 10 μmol/L, the labeling efficiency was the highest, indicating that 5 and 10 μmol/L are the optimal concentrations of EdU to label human umbilical cord mesenchymal stem cels.

Objective To develop a simple new-type photographic device for the field battle and peace time,because of the function of the trivet of X-Ray machine is limited.Methods Circular chrome-plating seamless steel tubes,whose diameter is 4 cm and 5 cm respectively,were connected so as to constitute the arm structure in C shape and foundation in T shape.Results The simple new-type photographic device could project for patients in each kind of body posture and the range of focus adjustment could meet normal requirements.It was operated nimbly and freely.The material was durable and the structure was reasonable and stable.Conclusion The simple new-type photographic device meets the practical requirements in field battle and peace time.

The widely application of the radio knife alleviates the patient's pain and improve the medical quality.The radio knife is high frequency power equipment based on the theory that electricity concentrates on the skin.It can directly cut the tissue,homeostasis and cauterize.The safety requirement of this equipment is very strict because unsafe operation will burn the tissue,cause temporal unaware hurt and even endanger the patient's life.If the safety support system is imperfect,disastrous loss or medical conflict will be caused.Users must be cautious in using and familiar with the safety and protection of the radio knife.[Chinese Medical Equipment Journal,2008,29(2):96-98,104]