Objective:To investigate the clinical application value of intraoperative frozen section (IFS) pathology in assessing the status of residual tissue margins during robot-assisted laparoscopic radical prostatectomy (RARP).Methods:A retrospective analysis was conducted on the clinical data of 26 patients from January 2024 to October 2024. The average age was (69.3±7.9) years, with an average BMI of (24.7±2.5) kg/m 2. The average preoperative PSA level was (22.7±23.0) ng/ml, and the average prostate volume was (37.4±16.1) ml. The PI-RADS scores were as follows: 15.4% (4/26) of the patients scored 3, 42.3% (11/26) scored 4, and 42.3% (11/26) scored 5, with an average PI-RADS score of (4.2±0.7). Preoperative clinical staging included 1 case of cT 1, 21 cases of cT 2, and 4 cases of cT 3. Biopsy pathology revealed Gleason scores of 6 in 19.2% (5/26) of the patients, 7 in 26.9% (7/26), 8 in 26.9% (7/26), 9 in 23.1% (6/26), and 10 in 3.9% (1/26). The overall positive biopsy core rate was 38.4% (184/479). All patients underwent RARP at our institution, and IFS was performed on residual margins at suspicious lesion sites identified by multiparametric MRI (mpMRI) during surgery. If the IFS result was positive, extended resection was performed, followed by a second IFS, until the maximum anatomical limit was reached or a negative margin was achieved. Finally, the resected prostate was examined using large-section histopathology, and the accuracy of IFS in assessing margin status was analyzed by comparing it with the large-section histopathology results. Results:Among the 26 patients, 11 had positive margins indicated by IFS or postoperative large-section histopathology. Of these, 6 patients showed positive surgical margins (PSM) on IFS, and after further extended resection, subsequent IFS results were negative. In 63.6% (7/11) of the patients, the margin results from IFS were consistent with those from postoperative large-section histopathology. Two patients had positive margins on IFS, which turned negative after further extended resection. Although postoperative large-section histopathology indicated positive margins at the posterior prostate, secondary IFS showed no residual tumor tissue, and postoperative PSA levels were all below 0.2 ng/ml. Another two patients had negative margins on IFS, but postoperative large-section histopathology revealed positive margins at some corresponding sites, with subsequent PSA levels also below 0.2 ng/ml.Conclusions:IFS can rapidly and accurately assess the margin status of residual tissue, to some extent avoiding the occurrence of positive margins.

Objective:To investigate the clinical application value of intraoperative frozen section (IFS) pathology in assessing the status of residual tissue margins during robot-assisted laparoscopic radical prostatectomy (RARP).Methods:A retrospective analysis was conducted on the clinical data of 26 patients from January 2024 to October 2024. The average age was (69.3±7.9) years, with an average BMI of (24.7±2.5) kg/m 2. The average preoperative PSA level was (22.7±23.0) ng/ml, and the average prostate volume was (37.4±16.1) ml. The PI-RADS scores were as follows: 15.4% (4/26) of the patients scored 3, 42.3% (11/26) scored 4, and 42.3% (11/26) scored 5, with an average PI-RADS score of (4.2±0.7). Preoperative clinical staging included 1 case of cT 1, 21 cases of cT 2, and 4 cases of cT 3. Biopsy pathology revealed Gleason scores of 6 in 19.2% (5/26) of the patients, 7 in 26.9% (7/26), 8 in 26.9% (7/26), 9 in 23.1% (6/26), and 10 in 3.9% (1/26). The overall positive biopsy core rate was 38.4% (184/479). All patients underwent RARP at our institution, and IFS was performed on residual margins at suspicious lesion sites identified by multiparametric MRI (mpMRI) during surgery. If the IFS result was positive, extended resection was performed, followed by a second IFS, until the maximum anatomical limit was reached or a negative margin was achieved. Finally, the resected prostate was examined using large-section histopathology, and the accuracy of IFS in assessing margin status was analyzed by comparing it with the large-section histopathology results. Results:Among the 26 patients, 11 had positive margins indicated by IFS or postoperative large-section histopathology. Of these, 6 patients showed positive surgical margins (PSM) on IFS, and after further extended resection, subsequent IFS results were negative. In 63.6% (7/11) of the patients, the margin results from IFS were consistent with those from postoperative large-section histopathology. Two patients had positive margins on IFS, which turned negative after further extended resection. Although postoperative large-section histopathology indicated positive margins at the posterior prostate, secondary IFS showed no residual tumor tissue, and postoperative PSA levels were all below 0.2 ng/ml. Another two patients had negative margins on IFS, but postoperative large-section histopathology revealed positive margins at some corresponding sites, with subsequent PSA levels also below 0.2 ng/ml.Conclusions:IFS can rapidly and accurately assess the margin status of residual tissue, to some extent avoiding the occurrence of positive margins.

Objective To construct and verify a nomogram model for predicting social urinary control recovery in patients undergoing robot-assisted radical prostatectomy (RARP) immediately after extubation. Methods A retrospective analysis was conducted on the clinical data of 64 patients diagnosed with prostate cancer and treated by a single surgeon. The immediate urinary control status of the patients after removal of the catheter was evaluated, and LASSO regression was used for feature screening. Multiple Logistic regression was performed on the selected features to determine independent risk factors and establish a predictive model. And the discriminability, calibration, and clinical practicality of the model were evaluated using receiver operating curve (ROC), Hosmer Lemeshow test and calibration curve, and clinical decision curve (DCA) analysis. Results The variables in the outcome prediction model include D'Amico grading and distance of the levator muscle. The area under the ROC curve (AUC) was 0.742 (95%CI, 0.500 to 0.913, P < 0.001), indicating that the model had good discriminability. The calibration curve indicated that the model had good calibration ability. The DCA curve showed good clinical practicality. Conclusion The clinical predictive model developed inthis study can predict the recovery of immediate social urinary control in patients with RARP after surgery, which can further quantify the probability of achieving immediate social continence.

Objective:To analyze the general chapter for lotions 0127 of the Chinese Pharmacopoeia 2020 Vol-ume Ⅳ,and discuss how to improve the general technical requirements of lotions 0127 in the Chinese Pharma-copoeia.Methods:By comparing the general chapter for lotions in domestic and international pharmacopoe-ias,the definition,classification,process,storage and corresponding inspection requirements were analyzed.Results and Conclusions:The general chapter for lotions 0127 of the Chinese Pharmacopoeia should be revised,including improvement of the definition,increasement of forms of preparations,and expansion of included varieties,so as to promote scientific regulation for drugs and exhibit a guiding role of the Chinese pharmacopoeia in drug control.

Objective To analyze the effects of vesicoprostatic muscle(VPM)reconstruction on the early urinary control recovery and safety of patients undergoing robot-assisted radical prostatectomy(RARP).Methods A total of 128 patients who underwent RARP in our hospital during Sep.1,2021 and Aug.31,2023 were enrolled and divided into the non-reconstruction group(n=64)and reconstruction group(n=64)using random number table method.The reconstruction group received Montsouris+VPM reconstruction surgery,while the non-reconstructive group underwent Montsouris surgery only.Urinary control and perioperative data were collected with telephone interview,outpatient follow-up and inpatient records.The two groups were matched using overlap weighting and the Kaplan-Meier method was used to calculate urinary incontinence rates at 1,2 and 3 months after extubation.Early urinary control(3 months after extubation),operation time,intraoperative bleeding,positive rate of incision margin,and incidence of early postoperative complications(＜30 days)(Clavien-Dindo scale)were compared between the two groups.Results The recovery rate of urinary control at 1,2 and 3 months after extubation was significantly higher in the reconstruction group than that in the non-reconstruction group(33.9％vs.11.2％;46.7％vs.16.1％;70.6％vs.45.6％,P＜0.05),but the positive rate of resection margin was lower(16.1％vs.41.7％,P＜0.05).There were no significant differences in operation time,intraoperative bleeding and early postoperative complications between the two groups(P＞0.05).Conclusion VPM reconstruction can improve urinary control recovery in RARP patients early after extubation without increasing the risk of surgery.

Objective: To propose updates and amendments for the nitroglycerin tablets quality in the Chinese pharmacopoeia 2020 due to the failure of effective separation of 4 known impurities and nonseparation of free nitrate ion and excipients.
Methods: Related substances were analyzed using gradient elution by HPLC, and free nitrate ion was determined on SAX column by different HPLC method.
Results: Using the improved method to test the related substances and free nitrate ion of nitroglycerin tablets,the content of the maximum individual impurity were not more than 0.5%, the total content was not more than 2.4% and the content of free nitrate ion was not more than 6.3%.
Conclusion: The improved method is accurate and feasible. It provided a reference for the updates and amendments of the quality standard of nitroglycerin tablets in the Chinese Pharmacopoeia 2020.

Objective:To explore the feasibility of pressure tolerance threshold (PTO) in evaluating the effect of local anesthesia in patients undergoing transperineal prostate biopsy.Methods:Patients who underwent periprostatic nerve block prostate biopsy in Northern Jiangsu People's Hospital from March 2022 to October 2023 were prospectively enrolled.Inclusion criteria: ① suspicious prostate nodules detected by digital rectal examination, any prostate-specific antigen (PSA) value; ② transrectal prostate ultrasound (TRUS) or magnetic resonance imaging (MRI) showing suspicious lesions, any PSA; ③ the PSA >10 ng/ml; ④PSA 4-10 ng/ml, suspicious free/total PSA or suspicious PSA density. Inclusion was required if one of these criteria was met. Exclusion criteria: ① previous history of prostate biopsy or prostate surgery; ② severe cardiovascular and cerebrovascular diseases or coagulation disorders; ③ severe urinary tract infection; ④ taking analgesics within 24 hours before surgery; ⑤ unable to complete the pain score or refused to cooperate; ⑥ rectal stenosis or other rectal lesions detected by digital rectal examination.The PTO of all patients was measured by the same physician using a tenderness measuring instrument before puncture. Visual analogue scale (VAS) was used to evaluate the pain during the operation. According to the VAS score, the patients were divided into mild pain group (VAS score 0-3 points) and moderate to severe pain group (VAS score 4-10 points). The clinical data of the two groups were compared. The correlation between PTO and VAS score was further analyzed. The receiver operating characteristic (ROC) curve of PTO to predict pain during puncture was drawn, and the optimal cut-off value of PTO was calculated by the maximum Youden index.Results:A total of 304 patients were enrolled in this study, including 184 patients in the mild pain group and 120 patients in the moderate to severe pain group.There were no significant differences in age [69 (63, 73) years old vs. 69 (61, 74) years old], body mass index[24.0(22.9, 25.0)kg/m 2 vs. 23.9(22.8, 24.7)kg/m 2], PSA[14.6(10.5, 25.1)ng/ml vs. 14.0(10.5, 20.7)ng/ml], and hypertension[59.8%(110/184) vs.64.2%(77/120)]between the mild pain group and the moderate to severe pain group ( P> 0.05), while there were significant differences in PTO[(6.69±1.20)kgf/cm 2 vs.(5.13±0.92)kgf/cm 2], number of puncture needles[19(18, 22)needles vs. 22(20, 24)needles], prostate volume[36.5(26.6, 52.5)ml vs. 63.2(47.4, 89.4)ml], diabetes[35.3%(65/184) vs. 23.3%(28/120)], and major trauma experience[37.5%(69/184) vs.15.8%(19/120)] ( P<0.05). There was a high correlation between PTO and VAS score ( r=0.689, P<0.001). ROC curve analysis showed that when PTO was 5.99 kgf/cm 2, the accuracy of predicting moderate to severe pain during prostate biopsy was the highest. The AUC was 0.848, the Youden index was 0.675, the sensitivity and specificity were 89.2% and 78.3%, respectively. Conclusions:PTO can evaluate the effect of local anesthesia in patients undergoing transperineal prostate biopsy.PTO can be measured before surgery in patients undergoing transperineal prostate biopsy. When the patient's PTO is ≥5.99 kgf/cm 2, the patient's pain tolerance is better and the local anesthesia effect is feasible.When the patient's PTO is less than 5.99 kgf/cm 2, the patient's pain tolerance is poor, so the patient could be recommended to undergo spinal anesthesia or general anesthesia to reduce the pain during prostate biopsy.

Objective:To explore the feasibility of pressure tolerance threshold (PTO) in evaluating the effect of local anesthesia in patients undergoing transperineal prostate biopsy.Methods:Patients who underwent periprostatic nerve block prostate biopsy in Northern Jiangsu People's Hospital from March 2022 to October 2023 were prospectively enrolled.Inclusion criteria: ① suspicious prostate nodules detected by digital rectal examination, any prostate-specific antigen (PSA) value; ② transrectal prostate ultrasound (TRUS) or magnetic resonance imaging (MRI) showing suspicious lesions, any PSA; ③ the PSA >10 ng/ml; ④PSA 4-10 ng/ml, suspicious free/total PSA or suspicious PSA density. Inclusion was required if one of these criteria was met. Exclusion criteria: ① previous history of prostate biopsy or prostate surgery; ② severe cardiovascular and cerebrovascular diseases or coagulation disorders; ③ severe urinary tract infection; ④ taking analgesics within 24 hours before surgery; ⑤ unable to complete the pain score or refused to cooperate; ⑥ rectal stenosis or other rectal lesions detected by digital rectal examination.The PTO of all patients was measured by the same physician using a tenderness measuring instrument before puncture. Visual analogue scale (VAS) was used to evaluate the pain during the operation. According to the VAS score, the patients were divided into mild pain group (VAS score 0-3 points) and moderate to severe pain group (VAS score 4-10 points). The clinical data of the two groups were compared. The correlation between PTO and VAS score was further analyzed. The receiver operating characteristic (ROC) curve of PTO to predict pain during puncture was drawn, and the optimal cut-off value of PTO was calculated by the maximum Youden index.Results:A total of 304 patients were enrolled in this study, including 184 patients in the mild pain group and 120 patients in the moderate to severe pain group.There were no significant differences in age [69 (63, 73) years old vs. 69 (61, 74) years old], body mass index[24.0(22.9, 25.0)kg/m 2 vs. 23.9(22.8, 24.7)kg/m 2], PSA[14.6(10.5, 25.1)ng/ml vs. 14.0(10.5, 20.7)ng/ml], and hypertension[59.8%(110/184) vs.64.2%(77/120)]between the mild pain group and the moderate to severe pain group ( P> 0.05), while there were significant differences in PTO[(6.69±1.20)kgf/cm 2 vs.(5.13±0.92)kgf/cm 2], number of puncture needles[19(18, 22)needles vs. 22(20, 24)needles], prostate volume[36.5(26.6, 52.5)ml vs. 63.2(47.4, 89.4)ml], diabetes[35.3%(65/184) vs. 23.3%(28/120)], and major trauma experience[37.5%(69/184) vs.15.8%(19/120)] ( P<0.05). There was a high correlation between PTO and VAS score ( r=0.689, P<0.001). ROC curve analysis showed that when PTO was 5.99 kgf/cm 2, the accuracy of predicting moderate to severe pain during prostate biopsy was the highest. The AUC was 0.848, the Youden index was 0.675, the sensitivity and specificity were 89.2% and 78.3%, respectively. Conclusions:PTO can evaluate the effect of local anesthesia in patients undergoing transperineal prostate biopsy.PTO can be measured before surgery in patients undergoing transperineal prostate biopsy. When the patient's PTO is ≥5.99 kgf/cm 2, the patient's pain tolerance is better and the local anesthesia effect is feasible.When the patient's PTO is less than 5.99 kgf/cm 2, the patient's pain tolerance is poor, so the patient could be recommended to undergo spinal anesthesia or general anesthesia to reduce the pain during prostate biopsy.

Objective:To investigate the effect of local anesthesia in patients with a PI-RADS score of 5 and ECOG score ≥2 for prostate puncture.Methods:Retrospective analysis of case data of 33 patients admitted to the Subei People's Hospital for prostate puncture from April 2020 to April 2022. Age (82.5±3.6) years. There were 18 cases with hypertensive disease, 8 cases with diabetes mellitus, and 6 cases with both diabetes mellitus and hypertensive disease. Body mass index (25.2±3.5) kg/m 2. prostate-specific antigen (PSA)(131.5±69.7) ng/ml. prostate volume (38.5±21.4) ml. all patients had a PI-RADS score of 5 on multiparametric magnetic resonance (mpMRI) and an Eastern Cooperative Oncology Group (ECOG) score ≥2. All 33 cases in this group underwent trans-perineal targeted prostate puncture using local anesthesia at the tip of the prostate. The visual analog score (VAS) and visual numeric score (VNS) were applied by the same surgeon to assess the patient's pain level and satisfaction at the time of puncture (VAS-1 and VNS-1) and 30 min after puncture (VAS-2 and VNS-2), and to record the duration of the procedure and the occurrence of postoperative complications. Results:In this group of 33 cases, the VAS-1 score was (1.9±0.3) and the VAS-2 score was (0.1±0.2); the VNS-1 score was (2.9±0.2) and the VNS-2 score was (3.9±0.1). Postoperative pathological results indicated that one of the 33 patients had a negative puncture result (pathology report indicating interstitial inflammation), while the rest of the patients had a positive puncture pathology report (puncture pathology report indicating prostate cancer), with a positive rate of 97%. One case of postoperative carnal haematuria occurred, which gradually improved after the patient was advised to drink water and take alpha-blockers. No perineal hematoma occurred, and all patients did not suffer complications such as urinary tract infection, urinary retention, azoospermia, vagal reaction, and infectious shock.Conclusion:In patients with a PI-RADS score of 5 and ECOG score ≥2, the use of single-hole local anesthesia for performing trans-perineal targeted puncture biopsy has the advantages of good paroxysmal pain and high safety.

Objective:To investigate the factors affecting the effect of periprostatic nerve block (PNB), establish a prediction model of pain degree, and verify the prediction efficiency.Methods:The clinical data of 314 patients who underwent transperineal prostate biopsy in our hospital from June 2022 to January 2023 were retrospectively analyzed. The median age was 71 (65, 76) years, the median prostate-specific antigen (PSA) was 14.6 (10.70, 24.65) ng/ml, and the median puncture needle number was 21 (19, 23) needles, median prostate volume 45.86 (31.52, 67.96) ml, median body mass index (BMI)24.02(22.97, 25.33)kg/m 2, including 109 patients with a history of diabetes, 90 patients with a history of surgery, and 57 patients with a history of severe trauma. The patients were divided into mild pain group (1-3 points), moderate pain group (4-6 points) and severe pain group (7-10 points) according to the intraoperative visual analogue scale (VAS). According to the clinical characteristics, the factors affecting the effect of PNB were analyzed by univariate analysis and multiple ordered logistic regression method. R language was used to construct a nomogram model for predicting PNB effect, receiver operating characteristic (ROC) curve and calibration curve were drawn, and Hosmer-Lemeshow test was carried out to verify the prediction efficiency of the model. Results:The results of univariate analysis showed that 171 patients in the mild pain group had a median age of 71 (65, 75) years, a median PSA14.5 (9.6, 24.6) ng/ml, a median number of puncture needles of 20 (18, 22), and a median prostate volume of 34.94 (26.36, 45.12) ml, median BMI24.17(23.14, 25.79)kg/m 2, including 74 patients with a history of diabetes, 51 patients with a history of surgery, and 40 patients with a history of severe trauma; There were 110 patients in the moderate pain group, the median age was 71 (65, 76) years, the median PSA14.8 (11.03, 24.27) ng/ml, the median number of puncture needles was 23 (20, 24) needles, median prostatic volume 63.24 (49.14, 78.72) ml, median BMI23.91(22.58, 24.88)kg/m 2, including 26 patients with a history of diabetes, 29 patients with a history of surgery, and 10 patients with a history of severe trauma; In the severe pain group, 33 patients had a median age of 73 (67, 78) years, a median PSA14.6 (10.85, 34.80) ng/ml, and a median puncture needle number of 23 (22.5, 24) needles, median prostate volume 70.64 (61.50, 104.51) ml, median BMI24.32(23.00, 26.06)kg/m 2, including 9 patients with a history of diabetes, 10 patients with a history of surgery, and 7 patients with a history of severe trauma. The results of univariate analysis showed that the number of puncture needles ( P<0.01), prostate volume ( P<0.01), history of diabetes ( P=0.002) and history of major trauma ( P= 0.009) were the factors affecting the effect of PNB. Multiple logistic regression analysis showed that puncture needle number ( P=0.009), prostate volume ( P<0.01) and diabetes history ( P=0.041) were independent risk factors for PNB effect. The area under ROC curve (AUC) of the moderate and above pain prediction model was 0.872, P<0.01; the area under ROC curve of the severe pain prediction model was 0.817, P<0.01; the result of Hosmer-Lemeshow test of the moderate and above pain prediction model was χ2=5.001, P=0.757. The results of the severe pain prediction model were χ2=4.452 and P=0.814. The calibration curve was established, which showed that the prediction probability of pain degree was in good agreement with the actual risk. Conclusions:The number of puncture needles, prostate volume and history of diabetes are the risk factors affecting the effect of PNB. The prediction model of PNB effect based on this model can be used to predict the pain degree of patients undergoing prostate biopsy after PNB.