Objective:To explore the effects of holmium laser enucleation of the prostate with early complete transection of the urethral mucosa at the tip of the prostate on urinary control function and sexual function in patients with benign prostatic hyperplasia (BPH).Methods:Eighty patients with BPH who underwent holmium laser enucleation of the prostate in the Affiliated Hospital of Yan′an University from January 2019 to January 2023 were collected as the research subjects. The patients were divided into the observation group and the control group by the random number table method, with 40 cases in each group. The observation group underwent early holmium laser enucleation of the prostate with early complete transection of the urethral mucosa at the tip of the prostate, while the control group underwent conventional holmium laser prostatectomy. The general conditions, urinary control function and sexual function of the two groups of patients after the operation were compared. The adverse ejaculation conditions 6 months after the operation were recorded.Results:There was no statistically significant difference in age and prostate volume between the two groups of patients (all P>0.05). The operation time, intraoperative blood loss, postoperative indwelling urinary catheter time and postoperative hospital stay in the observation group were significantly less than those in the control group (all P<0.05). The International Prostate Symptom Scale (IPSS) score, Quality of Life (QOL) score, the maximum flow rate (Qmax), and post void residual (PVR) in the bladder of the two groups of patients 6 months after the operation were compared with those before the operation, and the differences were statistically significant (all P<0.05), while there were no statistically significant differences between the groups (all P>0.05). There were no statistically significant differences in the International Index of Erectile Function (IIEF-5) scores and Erection Hardness Grading Scale (EHGS) grades of the two groups of patients 6 months after surgery compared with those before surgery (all P>0.05), and there were also no statistically significant differences between the groups (all P>0.05). There was no statistically significant difference in the ejaculation function score and ejaculation distress score 6 months after the operation in the observation group compared with those before the operation (all P>0.05), while in the control group, the ejaculation function score 6 months after the operation was lower than that before the operation, and the ejaculation distress score was higher than that before the operation (all P<0.05). The ejaculation function score and ejaculation distress score of the observation group 6 months after the operation were significantly better than those of the control group (all P<0.05). The incidences of retrograde ejaculation and reduced semen volume 6 months after the operation in the observation group were both lower than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of rapid ejaculation, ejaculation pain, hematospermia, etc. between the two groups of patients 6 months after the operation (all P>0.05). Conclusions:In holmium laser enucleation of the prostate, early complete transection of the urethral mucosa at the tip of the prostate has an improving effect on urinary control function and sexual function in patients with BPH, and increases the confidence in postoperative life and satisfaction with orgasm of BPH patients.

Objective To investigate the relationship between type 2 diabetes mellitus(T2DM)and cognitive decline.Methods Data were obtained from the cognitive impairment cohort of middle-aged and elderly population in rural areas of Xi'an City.The cohort consisted of residents aged 40 years and older in two villages of Huyi District,Xi'an.The baseline survey was completed between October 2014 and March 2015,with two follow-up visits in 2016 and 2018.The present study was conducted on cognitively normal people at baseline.Individual characteristics,lifestyle,and medical history were collected;physical and biochemical examinations were completed.According to medical history of T2DM and fasting blood glucose,the study population was divided into non-T2DM group,pre-existing T2DM group,and new-onset T2DM group.The Mini-Mental State Examination(MMSE)was used to assess global cognitive function.Participants with a drop of≥2 points in MMSE score from baseline after 4 years were defined as having cognitive decline.Chi-square test and multivariate Logistic regression analysis were employed to analyze the effect of T2DM status on the risk of cognitive decline.Results A total of 1 350 subjects completed the follow-up.In the follow-up population,1 096(81.2％)were free of T2DM,158(11.7％)already had T2DM at baseline,and 96(7.1％)developed new-onset T2DM during the follow-up.Cognitive decline was observed in 230 individuals after 4 years,representing 17.0％of the study population.The new-onset T2DM group had the highest 4-year incidence of cognitive decline(non-T2DM group vs.pre-existing T2DM group vs.new-onset T2DM group:15.7％vs.20.9％vs.26.0％,P=0.014),and the incidence of cognitive decline in the newly-onset T2DM group was significantly higher than that in the non-T2DM group(P=0.009).Multivariate Logistic regression analysis showed that the new-onset T2DM group had an increased risk of cognitive decline compared with the non-T2DM group within 4 years(OR=1.726,95％CI:1.029-2.896,P=0.039).However,no significant difference in 4-year risk of cognitive decline in the pre-existing T2DM group was observed(OR=1.402,95％CI:0.890-2.210,P=0.145).Conclusion Through the 4-year follow-up study of cognitively normal adults aged 40 and above in rural Xi'an,it was found that new-onset T2DM patients face a significantly elevated risk of cognitive decline,suggesting that cognitive decline may occur in the early stage of T2DM.

Objective To investigate the relationship between plasma homocysteine(Hcy)levels and cognitive impairment(CI).Methods From November 2018 to January 2019,baseline data and cognitive function were collected from the participants aged≥40 years who lived in two villages in Huyi District,Xi'an,China.Their global cognitive function was assessed by Mini-Mental State Examination(MMSE)and the diagnosis of cognitive impairment was based on international guidelines.Fasting blood was collected in the morning,and plasma Hcy level was measured by the chemiluminometric assay.Multivariate Logistic regression analysis,subgroup analysis,and interaction analysis were performed to investigate the relationship between plasma Hcy and CI.Results A total of 1 805 subjects were included in the analysis.There were 1 056 females(58.5％),age ranged from 40 to 88 years[mean(58.99±9.52)years],and 145 participants(8.0％)were diagnosed as CI.The median plasma Hcy level in the overall population was 14.1(11.6,17.8)μmol/L.There were 729(40.4％)subjects in the HHcy group(＞15.0 μmol/L)and 1 076(59.6％)in the normal group(≤15.0 μmol/L).Univariate analysis showed that the prevalence of CI was higher in the HHcy group than in the normal Hcy group(11.4％vs.5.8％,P＜0.001).In multivariable Logistic regression fully adjusted for potential confounders,each 1 μmol/L increase in plasma Hcy level was associated with a 3.0％increased risk of CI(OR=1.030,95％CI:1.012-1.048,P=0.001).Interaction analysis indicated that sex,age,BMI,systolic blood pressure,history of stroke,and diabetes did not significantly modify this association.Conclusion Elevated plasma Hcy levels are associated with an increased risk of CI in people aged≥40 years.This indicates that HHcy may be a risk factor for CI.

Aim To explore the possible regulatory effect of leptin on acyl-CoA synthetase long chain fami-ly member ACSL5 and their effect on migration and in-vasion of breast cancer cell,and to explore the underly-ing mechanism.Methods The expression of leptin receptor was detected by immunofluorescence assay.The migration and invasion ability of MCF-7 cells were detected by wound healing assay and Transwell assay respectively.The downstream target gene of leptin was analyzed by PCR microarray data.The expression of ACSL5 in breast cancer and its correlation with the staging and prognosis of breast cancer patients were as-sessed uing bioinformatics methods.The expression of ACSL5 in MCF-7 cells treated with different concentra-tions of leptin was detected using real time fluorescence quantitative polymerase chain reaction(RT-qPCR).Overexpressing ACSL5 was constructed by lentiviral transfection;the expressions of EMT related proteins,AMPK-α and p-AMPK-α were detected by Western blot.Results Leptin promoted breast cancer cell mi-gration and invasion and EMT.ACSL5 was significant-ly low expressed in breast cancer and related to progno-sis.Leptin downregulated the expression of ACSL5 through OBR.Leptin activated AMPK pathway to downregulate ACSL5 and promote migration,invasion and EMT of breast cancer cells.Conclusions Leptin may promote the migration,invasion and EMT of breast cancer by downregulating ACSL5 through activating AMPK pathway.

OBJECTIVE To explore the application of multiple hospital branches management mode in control of risk of hospital-acqueird infections in a general hospital so as to move forward the infection control threshold.METHODS The risk management closed loop,known as the infection index monitoring-risk assessment-risk re-sponse-effect evaluation-infection index monitoring,was adopted by People's Hospital of Ningxia Hui Autono-mous Region from Jan.to Jun.2024.The risk of infection at different levels of hospital zones,disciplines,clinical departments and risk indices was evaluated by risk matrix method.The correlation between the risk indices of clin-ical department and the risk scores was observed,and the dynamic monitoring was carried out for the change of risk of infection in the clinical departments.RESULTS The risk score was higher in the headquarter and Ningnan Branch than in the Xixia branch;the interquartile range(IQR)value from high to low was as follows:Xixia branch,hospital headquarter,Ningnan branch.The intensive care unit(ICU),nerve center and radiotherapy de-partment were the disciplines at extremely high risk of infection.The ICU,cardiac vascular surgery department and gastroenterology department of the hospital headquarters,the ICU,neurosurgery department and neurology department of Ningnan branch and the ICU and cardiac vascular surgery department of Xixia branch were the de-partments at extremely high risk of infection.The etiological submission rate before drug therapy,implementation of prevention measures for multidrug-resistant organisms(MDROs),cleaning and disinfection and missing report of hospital-acqueird infection cases were the major supervision indices.The absolute values of Spearman related co-efficient between clinical department risk scores and 4 indices-including the isolation rate of MDROs and the inci-dence of hospital-acqueird infection was greater than 0.5.CONCLUSION The risk management closed loop that is applied in the 'one hospital and multiple branches' medical institution may facilitate the dynamic monitoring,as-sessment and intervention the high-risk hospital branches,disciplines,departments and indices,and boost the ca-pability of risk management of infections in medical institutions.

Objective:To explore the effects of holmium laser enucleation of the prostate with early complete transection of the urethral mucosa at the tip of the prostate on urinary control function and sexual function in patients with benign prostatic hyperplasia (BPH).Methods:Eighty patients with BPH who underwent holmium laser enucleation of the prostate in the Affiliated Hospital of Yan′an University from January 2019 to January 2023 were collected as the research subjects. The patients were divided into the observation group and the control group by the random number table method, with 40 cases in each group. The observation group underwent early holmium laser enucleation of the prostate with early complete transection of the urethral mucosa at the tip of the prostate, while the control group underwent conventional holmium laser prostatectomy. The general conditions, urinary control function and sexual function of the two groups of patients after the operation were compared. The adverse ejaculation conditions 6 months after the operation were recorded.Results:There was no statistically significant difference in age and prostate volume between the two groups of patients (all P>0.05). The operation time, intraoperative blood loss, postoperative indwelling urinary catheter time and postoperative hospital stay in the observation group were significantly less than those in the control group (all P<0.05). The International Prostate Symptom Scale (IPSS) score, Quality of Life (QOL) score, the maximum flow rate (Qmax), and post void residual (PVR) in the bladder of the two groups of patients 6 months after the operation were compared with those before the operation, and the differences were statistically significant (all P<0.05), while there were no statistically significant differences between the groups (all P>0.05). There were no statistically significant differences in the International Index of Erectile Function (IIEF-5) scores and Erection Hardness Grading Scale (EHGS) grades of the two groups of patients 6 months after surgery compared with those before surgery (all P>0.05), and there were also no statistically significant differences between the groups (all P>0.05). There was no statistically significant difference in the ejaculation function score and ejaculation distress score 6 months after the operation in the observation group compared with those before the operation (all P>0.05), while in the control group, the ejaculation function score 6 months after the operation was lower than that before the operation, and the ejaculation distress score was higher than that before the operation (all P<0.05). The ejaculation function score and ejaculation distress score of the observation group 6 months after the operation were significantly better than those of the control group (all P<0.05). The incidences of retrograde ejaculation and reduced semen volume 6 months after the operation in the observation group were both lower than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of rapid ejaculation, ejaculation pain, hematospermia, etc. between the two groups of patients 6 months after the operation (all P>0.05). Conclusions:In holmium laser enucleation of the prostate, early complete transection of the urethral mucosa at the tip of the prostate has an improving effect on urinary control function and sexual function in patients with BPH, and increases the confidence in postoperative life and satisfaction with orgasm of BPH patients.

Objective To investigate the relationship between type 2 diabetes mellitus(T2DM)and cognitive decline.Methods Data were obtained from the cognitive impairment cohort of middle-aged and elderly population in rural areas of Xi'an City.The cohort consisted of residents aged 40 years and older in two villages of Huyi District,Xi'an.The baseline survey was completed between October 2014 and March 2015,with two follow-up visits in 2016 and 2018.The present study was conducted on cognitively normal people at baseline.Individual characteristics,lifestyle,and medical history were collected;physical and biochemical examinations were completed.According to medical history of T2DM and fasting blood glucose,the study population was divided into non-T2DM group,pre-existing T2DM group,and new-onset T2DM group.The Mini-Mental State Examination(MMSE)was used to assess global cognitive function.Participants with a drop of≥2 points in MMSE score from baseline after 4 years were defined as having cognitive decline.Chi-square test and multivariate Logistic regression analysis were employed to analyze the effect of T2DM status on the risk of cognitive decline.Results A total of 1 350 subjects completed the follow-up.In the follow-up population,1 096(81.2％)were free of T2DM,158(11.7％)already had T2DM at baseline,and 96(7.1％)developed new-onset T2DM during the follow-up.Cognitive decline was observed in 230 individuals after 4 years,representing 17.0％of the study population.The new-onset T2DM group had the highest 4-year incidence of cognitive decline(non-T2DM group vs.pre-existing T2DM group vs.new-onset T2DM group:15.7％vs.20.9％vs.26.0％,P=0.014),and the incidence of cognitive decline in the newly-onset T2DM group was significantly higher than that in the non-T2DM group(P=0.009).Multivariate Logistic regression analysis showed that the new-onset T2DM group had an increased risk of cognitive decline compared with the non-T2DM group within 4 years(OR=1.726,95％CI:1.029-2.896,P=0.039).However,no significant difference in 4-year risk of cognitive decline in the pre-existing T2DM group was observed(OR=1.402,95％CI:0.890-2.210,P=0.145).Conclusion Through the 4-year follow-up study of cognitively normal adults aged 40 and above in rural Xi'an,it was found that new-onset T2DM patients face a significantly elevated risk of cognitive decline,suggesting that cognitive decline may occur in the early stage of T2DM.

Objective To investigate the relationship between plasma homocysteine(Hcy)levels and cognitive impairment(CI).Methods From November 2018 to January 2019,baseline data and cognitive function were collected from the participants aged≥40 years who lived in two villages in Huyi District,Xi'an,China.Their global cognitive function was assessed by Mini-Mental State Examination(MMSE)and the diagnosis of cognitive impairment was based on international guidelines.Fasting blood was collected in the morning,and plasma Hcy level was measured by the chemiluminometric assay.Multivariate Logistic regression analysis,subgroup analysis,and interaction analysis were performed to investigate the relationship between plasma Hcy and CI.Results A total of 1 805 subjects were included in the analysis.There were 1 056 females(58.5％),age ranged from 40 to 88 years[mean(58.99±9.52)years],and 145 participants(8.0％)were diagnosed as CI.The median plasma Hcy level in the overall population was 14.1(11.6,17.8)μmol/L.There were 729(40.4％)subjects in the HHcy group(＞15.0 μmol/L)and 1 076(59.6％)in the normal group(≤15.0 μmol/L).Univariate analysis showed that the prevalence of CI was higher in the HHcy group than in the normal Hcy group(11.4％vs.5.8％,P＜0.001).In multivariable Logistic regression fully adjusted for potential confounders,each 1 μmol/L increase in plasma Hcy level was associated with a 3.0％increased risk of CI(OR=1.030,95％CI:1.012-1.048,P=0.001).Interaction analysis indicated that sex,age,BMI,systolic blood pressure,history of stroke,and diabetes did not significantly modify this association.Conclusion Elevated plasma Hcy levels are associated with an increased risk of CI in people aged≥40 years.This indicates that HHcy may be a risk factor for CI.

Objective To develop a predictive model for postoperative mortality risk in patients with acute aortic dissection(AAD)using the Extreme Gradient Boosting(XGBoost)algorithm combined with Shapley Additive Explanation(SHAP),and to establish a prediction website to serve as a diagnostic and therapeutic support platform for clinicians and patients.Methods A retrospective cohort study design was adopted.Data from 782 AAD patients who underwent surgical treatment at the Fourth Hospital of Hebei Medical University from January 2013 to December 2023 were collected,including basic information and initial serum biomarker test results.Patients were randomly divided into training and test sets at a 7:3 ratio.An external validation set consisting of 313 AAD patients admitted to the Second Hospital of Hebei Medical University from January 2020 to December 2023 was also established for further model validation.Variables were screened using LASSO regression,and an XGBoost machine learning model was constructed and interpreted using SHAP.The predictive performance of the model was evaluated using receiver operating characteristic(ROC)curve analysis.Using the Shiny package,the XGBoost model was deployed to shinyapps.io to create a prediction website for postoperative mortality risk in AAD patients.One patient was selected by simple random sampling from the test set and the external validation set respectively for the prediction example on the Shiny webpage.Results The XGBoost model demonstrated high predictive performance for postoperative mortality in AAD patients,with area under the ROC curve(AUC)values of 0.928(95%CI 0.901-0.956)in the training set,0.919(95%CI 0.891-0.949)in the test set,and 0.941(95%CI 0.915-0.967)in the external validation set.SHAP values indicated the following order of variable importance in the model(from highest to lowest):"lactate dehydrogenase""blood chlorine""multiple organ injury""carbon dioxide combining power""prothrombin time""α-hydroxybutyric acid""creatine kinase isoenzyme""Stanford classification""combined use of bedside blood purification""gender""acute kidney injury""gastrointestinal bleeding""brain injury"and"shock".A risk prediction website for adverse postoperative outcomes in AAD patients was developed using XGBoost-SHAP method(https://dun-dunxiaolu.shinyapps.io/document/)and validated with examples.One randomly selected patient from each of the test and external validation sets was applied:the predicted mortality risk value for patient 1(who died postoperatively)was 0.9539,and that for patient 2(who survived postoperatively)was 0.0206.Conclusions The XGBoost-SHAP model demonstrates high accuracy in predicting postoperative mortality risk for AAD patients.The online prediction tool established based on this model enhances the identification efficiency of high-risk postoperative mortality patients.

Objective To investigate the association of digit ratio with single nucleotide polymorphism(SNP)at three loci(rs17576,rs3918249,rs9509)of matrix metallopeptidase 9(MMP-9)gene.Methods A total of 804 Ningxia Han youths(399 males and 405 females)were used as the study subjects.A digital camera was used to take frontal photographs of the hands,and image analysis software was used to mark the anatomical points and measure the lengths of each finger of both hands(2D,3D,4D,5D);Multiplexed PCR was used to detect the three polymorphic sites of the MMP-9 gene,SPSS 25.0 and R Studio software were used for data analysis and plotting.Results The 2D/3D(P＜0.05)and 2D/4D(left,P＜0.01,right,P＜0.05)of both hands,2D/5D(P＜0.01),3D/5D,4D/5D(P＜0.05)of the right hand,and 3D/4D(P＜0.05)of the left hand in female youths of Ningxia Han were significantly higher than those in males,Differences in genotypes and allele frequencies at all 3 loci of the MMP-9 gene were not statistically significant between genders(P＞0.05).Right hand 2D/4D was significantly associated with genotypes at the rs17576 and rs3918249 loci in male youths(P＜0.05).Conclusion MMP-9 gene SNPs(rs17576 and rs3918249)may be associated with the formation of 2D/4D of Ningxia Han male youths.