Objective To observe the safety and efficacy of levosimendan in the perioperative pe-riod for patients with pulmonary hypertension associated with valvular heart disease undergoing heart valve replacement surgery.Methods A total of 90 patients with pulmonary hypertension associated with valvular heart disease who underwent valve replacement surgery from April 2023 to May 2024 were enrolled.Based on the use of levosimendan,patients were divided into low-dose group,high-dose group,and control group,with 30 patients in each group.The control group received conventional drug therapy;the low-dose group received one dose of levosimendan from 3 days before surgery to 3 days after surgery combined with conventional drug therapy;the high-dose group received two doses of levosimendan from 3 days before surgery to 3 days after surgery combined with conventional drug therapy.Data on brain natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter(LVEDD),creatinine(Cr),mean pulmonary artery pressure(mPAP),PH related to left heart disease(PH-LHD)status,postoperative ICU stay,postoperative hospital stay,and cardiac function classification were collected and recorded at admission and before discharge.Results There were no statistically significant differences in gender,age,and body mass among the control group,low-dose group,and high-dose group(P＞0.05).There was no sta-tistically significant difference in the increase in Cr among the three groups(P＞0.05).There were statistically significant differences in postoperative ICU stay between the control group and the high-dose group,and between the control group and the low-dose group(P=0.017,0.028).However,there was no statistically significant difference in postoperative ICU stay between the low-dose group and the high-dose group(P=0.839).There were statistically significant differences in postopera-tive hospital stay between the control group and the high-dose group,and between the control group and the low-dose group(P=0.001,0.009),but no statistically significant difference was found between the low-dose group and the high-dose group(P=0.463).No serious complications oc-curred in any of three groups,and no patients withdrew from the study.Only one patient in the high-dose group experienced hypotension during the postoperative use of levosimendan,which nor-malized after fluid replacement.There was no statistically significant difference in the decrease in mPAP among the three groups(P＞0.05).There was a statistically significant difference in the de-crease in BNP between the control group and the high-dose group(P=0.025);however,there were no statistically significant differences in the decrease in BNP between the control group and the low-dose group,or between the low-dose group and the high-dose group(P=0.068,0.970).There was a statistically significant difference in the increase in LVEF between the control group and the high-dose group(P=0.019);however,there were no statistically significant differences in the increase in LVEF between the control group and the low-dose group,or between the low-dose group and the high-dose group(P=0.055,0.652).There were statistically significant differences in the decrease in LVEDD between the control group and the low-dose group,and between the control group and the high-dose group(P=0.019,0.033);however,there was no statistically significant difference between the low-dose group and the high-dose group(P=0.829).In the control group,18 patients(60.0％)had clinically effective treatment,22 patients(73.3％)in the low-dose group,and 24 patients(80.0％)in the high-dose group.There was no statistically significant differ-ence in clinical efficacy among the three groups(P=0.220).Conclusion Levosimendan is safe and effective in the perioperative period for patients with pulmonary hypertension associated with valvular heart disease,and high-dose use can more significantly improve LVEF and reduce BNP levels.

Objective To analyze the single nucleotide polymorphism (SNP) and copy number variation (CNV) of cardiac myxoma to find the SNP sites and CNV events that may play important roles in the occurrence of tumors. Methods The patients with myxoma admitted to our hospital from 2015 to 2019 were randomly selected. The SNP analysis and the CNV test in gene level were performed through whole exome sequencing (WES). The samples were divided into two groups according to the mean size of the tumor: a diameter≤5.7 cm group and a diameter>5.7 cm group. The analysis results were compared between the two groups. Results A total of 14 patients were enrolled, including 8 females and 6 males with a mean age of 61.4 (41-79) years. Thirty-seven cancer-genes with SNP were detected, among which 18 mutated sites had a mutation rate of>10%; and TP53, EP300 and CREBBP played a core binding role in protein-protein interaction-network. The GO enrichment results showed significant differences in the regulation of cell secretion of the mutated genes, and the KEGG enrichment results showed significant differences in the PI3K-AKT and JAK-STAT signaling pathways in the occurrence of myxoma. In addition, 17 new mutation sites of tumor genes with high mutation effect were found in SNP detection. The WES results of 14 samples showed that the CNV events were detected in 120 tumor genes of the samples, 10 of which were included in two tumor databases. The GO enrichment results showed significant differences in the tube development and regulation of cell proliferation, and the KEGG enrichment results showed significant differences in the comprehensive tumor signaling pathway. Statistical differences of ERCC6L and INTS6L in CNV test were found (P=0.030). Conclusion There may be multiple tumor gene site mutations in the process of tumor generation, among which there are multiple core tumor genes such as TP53, EP300 and CREBBP, regulating tumor cells through PI3K-AKT and JAK-STAT signaling pathways and playing an important role in tumor generation. The CNV of ERCC6L and INTS6L genes may be related to tumor growth.

We retrospectively analyzed the clinical characteristic of one patient with metastatic prostate cancer and the relative literatures were reviewed. A 40-year-old man was admitted and diagnosed as prostate cancer on March 20, 2018(T 4N 1M 1a) with prostate-specific antigen (PSA) at 47.99 ng/ml. The first 68Ga-PSMA PET/CT showed multiple nodular lesions in the bilateral peripheral bands of the prostate, multiple nodular lesions in the right apex, abnormal uptake of nuclides in multiple lymph nodes in the abdominal aortic wandering zone, the abdominal aortic bifurcation zone, and the bilateral iliac artery wandering zone at the level of the lumbar 2-5 vertebral body, and metastasis was considered. The patient was treated with six cycles of drug castration combined with antiandrogenic treatment and pre-operative system chemotherapy(docetaxel). Six months later, the PSA decreased to 0.225ng/ml. Robot-assisted laparoscopic prostatectomy and expanded pelvic lymph node dissection was performed. Postoperative total androgen blocking therapy was maintained, and PSA slowly increased. Ten months after operation, salvage radiotherapy for enlarged lymph nodes was performed in pelvic extension field, prostate tumor bed area and pelvic cavity. PSA remained stable for 7 months postradiotherapy, and then increased. The patient developed castration-resistant prostate cancer and was treated with triptorelin combined with abiraterone. PSA was decreased, and local radiotherapy was performed for new lymph node metastases in the neck. 68Ga-PSMA PET/CT could provide a decision-making basis for accurate clinical staging, therapeutic effect evaluation and distant metastatic lesions location with guiding value for the formulation of individualized treatment plans.

Hormone-sensitive prostate cancer with visceral metastasis is a difficulty in clinical diagnosis and treatment. We treated a patient with hormone-sensitive prostate cancer with visceral metastasis and managed it under the multi-disciplinary treatment model (MDT). A 55-year-old man presented to the hospital complaining of increased prostate-specific antigen (PSA) found in the physical examination for 2 days. At admission, the PSA was 389.2ng/ml, and 68Ga-PSMA PET/CT showed metastatic malignant lesions of the prostate, with lymph node metastasis, lumbar vertebral metastases and liver tubercles. Transrectal prostate puncture biopsy: prostate adenocarcinoma, Gleason score of 4+ 5=9. The patient has no history of androgen deprivation therapy (ADT) and diagnosed as metastatic hormone-sensitive prostate cancer (mHSPC). Then the patient received total androgen blockade therapy (CAB regimen). After MDT discussion, metastatic prostate cancer was diagnosed based on the liver histopathology of percutaneous biopsy. After the second MDT discussion, the regimen was changed to abirone plus ADT. After 6 months, the blood PSA was controlled at a level between 0.003 to 0.006 ng/ml, and the testosterone was less than 2.5ng/dl. Re-examination of 68Ga-PSMA PET/CT showed that lower signal of radionuclide in all lesions, especially no more abnormal uptake lesions were identified in the liver.

Objective To compare the diagnostic efficacy of 68Ga-prostate specific membrane antigen (PSMA)-617 PET/CT and multi-parameter MRI for primary prostate cancer.Methods From June 2017 to November 2017,24 patients (age (67.6±7.0) years) with suspected prostate cancer were prospectively enrolled.All patients underwent 68Ga-PSMA-617 PET/CT and multi-parameter MRI.Pathological diagnosis was considered as the gold standard.The diagnostic efficacy of the two methods was analyzed and the difference was evaluated by receiver operating characteristic (ROC) curve analysis(Z test).Results Based on the puncture biopsy and/or excision biopsy,18 patients were diagnosed as prostate cancer and 6 patients were diagnosed as benign diseases.According to the five-zone analysis for the prostate (24 patients with 120 zones),48 and 56 zones were detected accurately in prostate cancer patients by PET/CT and multi-parameter MRI respectively,which was 54 and 41 for benign patients.The cut-off value of maximum standardized uptake value (SUVmax) in 68Ga-PSMA-617 PET/CT for diagnosing prostate cancer was 4.85,the area under curve (AUC),sensitivity,specificity,positive predictive value,negative predictive value,accuracy and Youden index were 0.890,75.00％ (48/64),96.43％ (54/56),96.00％ (48/50),77.14％ (54/70),85.00％(102/120),71.43％ respectively for prostate cancer by PET/CT,and 0.837,87.50％(56/64),73.21％ (41/56),78.87％ (56/71),83.67％ (41/49),80.83％ (97/120) and 60.71％ respectively by multi-parameter MRI.The difference of AUC was statistically significant (Z=2.82,P＜0.01).Conclusions The diagnostic accuracy of 68Ga-PSMA-617 PET/CT imaging for prostate cancer is higher than that of multi-parameter MRI.Both modalities have high diagnostic efficiency and can be used scientifically as complementary.

Objective To compare the diagnostic efficacy of 68Ga-PSMA-617 PET/CT and multiparameter MRI in the diagnosis of primary tumors of newly diagnosed prostate cancer.and analyze the correlation between SUVmax and clinical parameters of prostate cancer.Methods A retrospective analysis of the clinical data of 104 patients with newly diagnosed prostate cancer who underwent 68Ga-PSMA-617 PET/CT and multi-parametric MRI from June 2017 to April 2018.The final pathological results were used as the gold standard for diagnosis.The age ranged from 42 to 89 years,with an average of (70.4 ± 8.9) years.The median total serum PSA was 18.44 (8.71,48.01)ng/ml.The pathological results were positive in 68 cases and negative in 36 cases.The sensitivity,specificity was calculated,the ROC curve was drawn and AUC value was calculated.The relationship between SUVmax value of prostate cancer and clinical parameters was analyzed.Results The sensitivity of 68Ga-PSMA-617 PET/CT was 95.59％ (65/68) and the specificity was 88.89％ (32/36);the sensitivity of MRI examination was 91.18％ (62/68) and the specificity was 63.89％ (23/36).There were statistical differences between the specificity of the two examination (P =0.012).The ROC curve of 68 Ga-PSMA-617 PET/CT was plotted and the AUC value was 0.954.Among the 104 suspected prostate cancer patients,the median SUVmax of benign prostatic tissue was 3.20(2.83,3.70),and the median SUVmax of prostate cancer tissue was 12.21 (7.48,17.46).Among 68 patients with prostate cancer,there were statistical differences between SUVmax values of prostate cancer tissues with different Gleason scores (P ＜ 0.01),ISUP group (P ＜ 0.01),risk grades (P =0.021),and SUVmax values.There was a positive correlation with Gleason score and ISUP group (r1 =0.7420,P＜0.01;r2 =0.754,P＜0.01).Conclusions The 68Ga-PSMA-617 PET/CT examination had higher diagnostic efficacy than the multiparametric MRI for prostate cancer.The higher the SUVmax value predict the higher grade and higher risk.

Dementia is a neuropsychiatric disorder characterized by cognitive impairment,and behavioral and psychological symptoms.Behavioral and psychological symptoms of dementia (BPSD) are common in patients with dementia and can have a major impact on the quality of life for patients and caregivers,and accelerate their cognitive decline.Atypical antipsychotics (AAP) possess excellent efficacy and tolerability in BPSD treatment;however,compared with conventional drugs,the use of antipsychotics has been widely debated for concerns over safety in elderly patients with dementia.The US FDA has issued several specific recommendations and emphasized that treatment of BPSD with AAP is"off-label".We have searched and reviewed the literature on the treatment of BPSD with AAP published in the last 10 years,and evaluated the efficacy and safety of AAP for clinicians' reference.

Objective To compare the diagnostic differences for the detection of bone metastases between 68Ga-PSMA-617 PET/CT and 99Tcm-MDP bone scintigraphy in preliminary diagnosed prostate cancer patients.Methods Seventy-three patients who were diagnosed with prostate cancer by pathology were retrospectively analyzed from June 2017 to February 2018,and they all underwent both ss Ga-PSMA-617 PET/CT and 99Tcm-MDP bone scintigraphy without therapy beforehand.Mean age was 69.1 (range 40-88) years,the mean PSA level was 144.59 (range 5.62-1 260.00) ng/ml,and the Gleason score ranged 6-10.The patients were divided into two groups by whether or not had bone metastases according to the aforementioned two examinations.Both the sensitivity and specificity are calculated.The number of bone metastatic focus of the two examinations were also compared through the Wilcoxon rank testing.Results Thirty-two of 73 patients were diagnosed with bone metastases.68Ga-PSMA-617 PET/CT and 99Tcm-MDP detected 32 and 31 bone metastases,with the sensitivity of 100.0％ (32/32,95 ％ CI 89.1％-100.0％) and 90.6％ (29/32,95％ CI 75.0％-98.0％),the specificity of 100.0％ (41/41,95％ CI 91.4％-100.0％) and 95.12％ (39/41,95％ CI 83.5％-99.4％),and the AUC of 1.000 (95％ CI 0.951-1.00) and 0.929 (95％ CI 0.844-0.976),respectively.There was significant difference in AUC between the two methods(P =0.034).Two examinations exhibited significantly different number of metastatic sites (Z =-2.949,P =0.003).Conclusions 68 Ga-PSMA-617 PET/CT outperform 99Tcm-MDP bone scintigraphy for the detection of bone involvement in prostate cancer patients.It will be an important imaging supplement for prostate cancer patients and play an important role in term of the accurate treatment based on the more accurate evaluation.

Objective To compare the sedation and anti-inflammatory effects of dexmedetomidine and midazolam on critical ill children with multiple trauma. Methods A prospective randomized controlled trial was conducted. Sixty-five critical ill children with multiple trauma admitted to pediatric intensive care unit (PICU) of Anhui Province Children's Hospital from January 2014 to September 2016 were enrolled, who were randomly divided into dexmedetomidine group (33 cases) and midazolam group (32 cases). Children of both groups received sufentanil for analgesia. Children in dexmedetomidine group firstly received 1.0 μg/kg intravenous bolus of dexmedetomidine for 10 minutes, then continuous infusion of 0.2-0.7 μg·kg-1·h-1, while in midazolam group children received 1-5 μg·kg-1·min-1 of midazolam in continuous infusion. The goal of sedation was to maintain a Richmond agitation-sedation scale (RASS) score of -1 to 0. The level of serum interleukin (IL-6, IL-8, IL-10, IL-1β), tumor necrosis factor-α (TNF-α) and C-reactive protein (CRP) were detected by enzyme linked immunosorbent assay (ELISA) at 24, 48, 72 hours after treatment, and the duration of mechanical ventilation, ratio of continuous renal replacement therapy (CRRT), length of stay in the PICU, ratio of sepsis and multiple organ failure (MOF) and mortality were also recorded. Results Compared with midazolam, dexmedetomidine decreased the level of pro-inflammatory cytokines and increased the level of anti-inflammatory cytokines. At 24 hours after treatment, the levels of serum IL-1β, TNF-α significantly decreased and IL-10 significantly increased [IL-1β (ng/L):6.48±2.89 vs. 8.07±3.14, TNF-α (μg/L): 11.25±5.21 vs. 15.44±5.97, IL-10 (ng/L): 12.10±5.35 vs. 9.58±4.71, all P < 0.05]. At 48 hours after treatment, the levels of serum IL-6, IL-8, IL-1β, TNF-α and CRP significantly decreased and IL-10 significantly increased [IL-6 (ng/L): 209.67±80.49 vs. 336.31±123.94, IL-8 (ng/L):229.09±80.81 vs. 298.28±90.25, IL-1β (ng/L): 7.31±3.02 vs. 8.74±3.17, TNF-α (μg/L): 12.52±4.79 vs. 16.58±5.98, CRP (g/L): 47.82±24.92 vs. 72.35±31.71, IL-10 (ng/L): 12.90±5.42 vs. 10.01±4.79, all P < 0.05]. At 72 hours after treatment, the levels of serum IL-8 and CRP significantly decreased [IL-8 (ng/L): 234.64±96.24 vs. 290.28±103.97, CRP (g/L): 53.24±29.12 vs. 86.58±38.30, both P < 0.05]. Compared with midazolam, dexmedetomidine could significantly reduce the duration of mechanical ventilation (days: 4.7±1.3 vs. 6.6±2.1), length of PICU stay (days: 9.5±2.7 vs. 12.3±3.9, both P < 0.05), and the ratio of sepsis (33.3% vs. 53.1%, P < 0.05). But there were no significant differences in ratio of CRRT (18.2% vs. 18.8%), MOF (9.1% vs. 18.8%) and mortality (6.1% vs. 12.5%) between two groups (all P > 0.05). Conclusion Compared with midazolam, dexmedetomidine had better efficacy in the treatment of severe multiple trauma in children and reduce the level of inflammation.

Objective:To investigate the clinical efficacy of mechanical solitaire AB stents thrombectomy combined with intra-arterial thrombolysis in the treatment of patient with acute ischemic stroke.Methods:Fifteen patients with acute ischemic stroke admitted into our hospital from August 2014 to August 2016 were treated with mechanical thrombectomy with solitaire AB stents plus intra-arterial thrombolysis.The National Institutes of Health Stroke Scale score (NIHSS) of all patients were evaluated before and after treatment to compare the clinical efficacy.The prognosis ofpatients between two groups were compared via evaluating modified Rankin score (mRS)and gelasijia coma score (GCS).Results:After mechanical thrombectomy with solitaire AB stents plus intra-arterial thrombolysis treatment,14 patients achieved complete or part recanalization,and 1 patient was terminated treatment due to vital signs instability,and the rate ofrecanalization was 93.3％.The NIHSS score of patients before treatment was 12.93± 4.25,which was much higher than that after treatment (4.33± 1.45,P＜0.05).After follow-up by 3 months,the good mRS scores were obtained in all 18 patients,including 2 patients with mRS score of 2,5 patients with 1,and 8 patients with 0.Additionally,there was no patient with re-obstruction during follow-up period.Conclusion:Mechanical thrombectomy with solitaire AB stents combined with intra-arterial thrombolysis had a good capability and safety in the treatment of patients with acute ischemic stroke.