Objective To explore the clinical efficacy and safety of immediate laparoscopic radical prostatectomy immediately following the diagnosis of locally advanced prostate cancer.Methods A retrospective analysis was performed for 63 patients with locally advanced prostate cancer who met the inclusion criteria diagnosed in The 1st People's Hospital of Qujing City,Yunnan Province from January 2018 to January 2023.All patients were diagnosed via ultrasound-guided transperineal prostate biopsy.The experimental group consisted of 37 patients who underwent immediate laparoscopic radical prostatectomy after pathological diagnosis,followed by postoperative adjuvant hormone therapy.The control group included 26 patients who first received 3 months of neoadjuvant hormone therapy before undergoing radical surgery,followed by adjuvant hormone therapy postoperatively.The two groups were compared in terms of surgical duration,intraoperative blood loss,length of hospital stay,duration of catheterization,positive surgical margin rate,rectal injury,positive lymph node rate,incidence of urinary fistula and lymphatic leakage,changes in PSA level,postoperative urinary control,biochemical recurrence and distant metastasis.Results In the control group,serum PSA levels,prostate volume,and clinical staging significantly decreased after neoadjuvant hormon therapy.The positive surgical margin rate in the experimental group was significantly higher than that in the control group,with a statistically significant difference(P<0.05).There were no statistically significant differences between the two groups in terms of surgical duration,intraoperative blood loss,length of hospital stay,duration of catheterization,rectal injury,positive lymph node rate,incidence of urinary fistula and lymphatic leakage(P>0.05).Follow-up at 18 to 36 months revealed no statistically significant differences between the two groups in terms of serum PSA levels at one month post-surgery,complete urinary control rate at six months post-surgery,and biochemical recurrence and distant metastasis at one and two years post-surgery(P>0.05).Conclusion Immediate laparoscopic radical prostatectomy following the diagnosis of locally advanced prostate cancer is a clinically safe and feasible treatment option.Noadjuvant hormone therapy reduces tumor staging,lowers the positive surgical margin rate,significantly decreases prostate volume,and provides greater operational space without increasing surgical risks.

Objective To evaluate the efficacy of complete pelvic floor peritoneal reconstruction in reducing postoperative ileus incidence and accelerating recovery following laparoscopic radical cystectomy with orthotopic neobladder construction.Methods A retrospective study was conducted to select 62 patients who underwent the operation in Qujing Hospital Affiliated to Kunming Medical University from January 2017 to September 2024.According to whether complete pelvic floor peritoneal reconstruction was performed during the operation,they were divided into the conventional group(n=25)and the reconstruction group(n=37).Postoperative ileus rates and recovery parameters were compared to assess the clinical value of complete pelvic floor peritoneal reconstruction.Results The reconstruction group showed better postoperative recovery compared to the routine group:gastrointestinal function recovery time[3(2,4)d vs 4(3,5)d,P=0.032],abdominal drainage time[12(10,13.5)d vs 14(12,15)d,P=0.006],pelvic drainage time[12(9,13.5)d vs 14(11,16)d,P=0.015],postoperative hospital stay[18(15.5,26)d vs 25(17,30.5)d,P=0.016],and hospital expenses[(53,695.67±10,182.43)yuan vs(60,803.73±14,449.24)yuan,P=0.027].Postoperative nutritional markers,including total protein[(64.49±6.82)g/L vs.(61.56±4.03)g/L,P=0.038]and albumin[(36.08±5.29)g/L vs.(33.40±3.57)g/L,P=0.020],were higher in the reconstruction group.No significant difference was found in ileus incidence(44.00%vs.32.43%,P=0.355).Other parameters—baseline characteristics,postoperative globulin and prealbumin levels,gastric tube retention,stent/catheter removal time,and complications(anastomotic leakage,urinary fistula,wound infection)—showed no intergroup differences(P>0.05).Conclusion The application of complete pelvic floor peritoneal reconstruction technique in laparoscopic radical cystectomy with orthotonic neobladder provides better protection for the intestine,reduces surgical area adhesions,promotes gastrointestinal function recovery,shortens abdominal and pelvic drainage times,accelerates patient rehabilitation,reduces hospital stay and expenses.However,whether it can effectively reduce postoperative intestinal obstruction rates still requires more data and experimental verification.

Objective To observe the value of Node-RADS based on dynamic contrast-enhanced MRI(DCE-MRI)for assessing axillary lymph node metastasis of breast cancer.Methods A total of 308 patients with breast cancer were retrospectively enrolled and divided into metastasis group(n=153)and non-metastasis group(n=155)based on the presence of axillary lymph node metastasis or not.Two radiologists independently scored the axillary lymph nodes shown on DCE-MRI according to Node-RADS criteria.Inter-observer scores was assessed using Kappa test.Taken pathological result as the gold standard,receiver operating characteristic curves were plotted,and the area under the curve(AUC)was calculated to evaluate the efficacy of Node-RADS scores for diagnosing axillary lymph node metastasis.Results Good inter-observer consistency of Node-RADS scores was observed.When Node-RADS score＞2,the highest AUC of 2 radiologists was 0.928 and 0.921,respectively,being not significantly different(P＞0.05).Conclusion Node-RADS based on DCE-MRI had good efficacy for evaluating axillary lymph node metastasis of breast cancer.Node-RADS score higher than 2 strongly indicated possibility of lymph node metastasis.

Objective:To investigate and validate the performance of a dosiomics model that utilized 3D dose distribution to forecast radiation-induced temporal lobe injury (RTLI) in nasopharyngeal carcinoma (NPC) patients following intensity-modulated radiotherapy (IMRT).Methods:Clinical data of 3578 patients diagnosed with NPC admitted to Jiangsu Cancer Hospital from January 2011 to December 2021 were retrospectively analyzed. According to the inclusion and exclusion criteria, 97 NPC patients who developed RTLI were assigned into the case group. A 1:1 propensity score matching (PSM) method was used to match 97 NPC patients without RTLI as the control group. Patients were assigned into the training cohort ( n=135) and the validation cohort ( n=59) at a 7:3 ratio by simple random method. Dosiomics features were extracted from the patients' three-dimensional dose distribution maps. Spearman rho and the least absolute shrinkage and selection operator regression were used to select dosiomics features. Clinical features were collected and screened by univariate and multivariate analyses. Eight machine learning classifiers were then trained to build dosiomics models and clinical models, respectively. The area under the ROC curve (AUC), sensitivity, and specificity were calculated to compare the predictive performance of the dosiomics and clinical models. Multivariate analysis was conducted using logistic regression to assess the influencing factors, while comparisons of the ROC curves between two different models were performed using the DeLong test. Results:A total of 1130 dosiomics features were extracted from the three-dimensional dose distribution maps, and 14 features were retained for model building after feature selection. The model based on the support vector machine (SVM) classifier achieved the highest AUC value of 0.977 (95% CI: 0.949-1.000) in the validation cohort, with an AUC of 1.000 (95% CI: 1.000-1.000) in the training cohort. By conducting univariate and multivariate analyses of the patients' clinical features, 2 clinical features were retained to build the clinical model. The model based on the SVM classifier achieved the optimal AUC value of 0.667 (95% CI: 0.523-0.810) in the validation cohort, with an AUC of 0.804 (95% CI: 0.730-0.878) in the training cohort. DeLong test showed that the difference between the dosiomics and clinical models was statistically significant ( P<0.05). Conclusion:The dosiomics model based on 3D dose distribution yields high predictive performance for RTLI in NPC patients after IMRT, which surpasses the clinical feature model, providing a new approach for early clinical prediction of RTLI.

Objective To observe the value of Node-RADS based on dynamic contrast-enhanced MRI(DCE-MRI)for assessing axillary lymph node metastasis of breast cancer.Methods A total of 308 patients with breast cancer were retrospectively enrolled and divided into metastasis group(n=153)and non-metastasis group(n=155)based on the presence of axillary lymph node metastasis or not.Two radiologists independently scored the axillary lymph nodes shown on DCE-MRI according to Node-RADS criteria.Inter-observer scores was assessed using Kappa test.Taken pathological result as the gold standard,receiver operating characteristic curves were plotted,and the area under the curve(AUC)was calculated to evaluate the efficacy of Node-RADS scores for diagnosing axillary lymph node metastasis.Results Good inter-observer consistency of Node-RADS scores was observed.When Node-RADS score＞2,the highest AUC of 2 radiologists was 0.928 and 0.921,respectively,being not significantly different(P＞0.05).Conclusion Node-RADS based on DCE-MRI had good efficacy for evaluating axillary lymph node metastasis of breast cancer.Node-RADS score higher than 2 strongly indicated possibility of lymph node metastasis.

Objective:To investigate and validate the performance of a dosiomics model that utilized 3D dose distribution to forecast radiation-induced temporal lobe injury (RTLI) in nasopharyngeal carcinoma (NPC) patients following intensity-modulated radiotherapy (IMRT).Methods:Clinical data of 3578 patients diagnosed with NPC admitted to Jiangsu Cancer Hospital from January 2011 to December 2021 were retrospectively analyzed. According to the inclusion and exclusion criteria, 97 NPC patients who developed RTLI were assigned into the case group. A 1:1 propensity score matching (PSM) method was used to match 97 NPC patients without RTLI as the control group. Patients were assigned into the training cohort ( n=135) and the validation cohort ( n=59) at a 7:3 ratio by simple random method. Dosiomics features were extracted from the patients' three-dimensional dose distribution maps. Spearman rho and the least absolute shrinkage and selection operator regression were used to select dosiomics features. Clinical features were collected and screened by univariate and multivariate analyses. Eight machine learning classifiers were then trained to build dosiomics models and clinical models, respectively. The area under the ROC curve (AUC), sensitivity, and specificity were calculated to compare the predictive performance of the dosiomics and clinical models. Multivariate analysis was conducted using logistic regression to assess the influencing factors, while comparisons of the ROC curves between two different models were performed using the DeLong test. Results:A total of 1130 dosiomics features were extracted from the three-dimensional dose distribution maps, and 14 features were retained for model building after feature selection. The model based on the support vector machine (SVM) classifier achieved the highest AUC value of 0.977 (95% CI: 0.949-1.000) in the validation cohort, with an AUC of 1.000 (95% CI: 1.000-1.000) in the training cohort. By conducting univariate and multivariate analyses of the patients' clinical features, 2 clinical features were retained to build the clinical model. The model based on the SVM classifier achieved the optimal AUC value of 0.667 (95% CI: 0.523-0.810) in the validation cohort, with an AUC of 0.804 (95% CI: 0.730-0.878) in the training cohort. DeLong test showed that the difference between the dosiomics and clinical models was statistically significant ( P<0.05). Conclusion:The dosiomics model based on 3D dose distribution yields high predictive performance for RTLI in NPC patients after IMRT, which surpasses the clinical feature model, providing a new approach for early clinical prediction of RTLI.

Objective To investigate the expression of histone deacetylase(HDAC)isoforms in the frontal lobe,hippo-campus and liver of offspring rats delivered by rats with maternal immune activation and their correlation with the efficiency of prepulse inhibition(PPI％).Methods Ten pregnant Sprague-Dawley rats were randomly divided into the model group(n=5)and control group(n=5).The rats in the model group were injected with 10 mg·kg-1 polyinosinic-polycytidylic acid(Poly I:C)via the caudal vein on the 9th day of pregnancy,while rats in the control group were given the same volume of sterile physiological saline.After 3 h,blood was collected from the caudal vein,and the levels of interleukin(IL)-1 β,IL-6 and tumor necrosis factor-α(TNF-α)in the plasma of pregnant rats were detected by enzyme-linked immunosorbent assay to evaluate the immune activation status.The pregnant rats in the two groups were fed until natural delivery,the offspring rats were weaned on the 21st day after birth,and the male offspring rats were fed continuously.A prepulse inhibition test was performed at puberty(the 40th day after birth)to evaluate the spatial recognition memory and sensory gating function of the offspring rats.The expression levels of the HDAC gene family in the hippocampus,frontal lobe and liver of offspring rats were detected by real-time fluorescence quantitative polymerase chain reaction.Results The plasma IL-6,IL-1 β and TNF-α levels in the model group were significantly higher than those in the control group(P＜0.05).When the prepulse stimulation was 75 dB,the PPI％of the offspring rats at puberty in the model group was significantly lower than that in the control group(P＜0.05).When the prepulse stimulation was 80 and 85 dB,there was no significant difference in PPI％between the model group and the control group(P＞0.05).In the frontal lobe,the expression levels of HDAC3,HDAC4,HDAC8,HDAC9,HDAC10 and Sirt mRNA in the offspring rats in the model group were significantly lower than those in the control group(P＜0.05),while the expression level of HDAC5 mRNA was significantly higher than that in the control group(P＜0.05);there were no significant differences in the expression levels of HDAC1,HDAC2,HDAC6,HDAC7 and HDAC11 mRNA between the model group and the control group(P＞0.05).In the hippocampus,the offspring rats in the model group had significantly lower expression levels of HDAC1,HDAC8 and HDAC10 mRNA and significantly higher expression levels of HDAC2 and HDAC5 mRNA than those in the control group(P＜0.05);there were no significant differences in the expression levels of HDAC3,HDAC4,HDAC6,HDAC7,HDAC9,HDAC11 and Sirt mRNA between the model group and control group(P＞0.05).In the liver tissue,the expression levels of HDAC6 and HDAC10 mRNA of the offspring rats in the model group were significantly lower than those in the control group(P＜0.05);there were no significant differences in the expression levels of HDAC1,HDAC2,HDAC3,HDAC4,HDAC5,HDAC7,HDAC8,HDAC9,HDAC11 and Sirt mRNA between the model group and the control group(P＞0.05).The expression level of HDAC2 mRNA in the hippocampus of offspring rats in the two groups was negatively correlated with PPI％at 75 dB(r=-0.965,P＜0.05),the expression levels of HDAC10 and Sirt mRNA in frontal lobe tissues were positively correlated with PPI％at 75dB(r=0.946,0.925;P＜0.05).Conclusion Pregnancy Poly I:C infection has significant effects on the expression of HDAC family proteins in offspring rats,and which is related to the impairment of early sensory gating,this may provide new ideas for the research in pathogenesis and drug treatment of schizophrenia.

[Objective] To explore the efficacy and safety of retrograde intrarenal surgery (RIRS) using a flexible negative pressure suction sheath in the treatment of upper urinary tract stones >2 cm in diameter, to provide reference for the diagnosis and treatment of such disease. [Methods] Clinical data of 155 patients who underwent surgery for upper urinary tract stones during Nov.2022 and Nov.2023 at the Second Affiliated Hospital of Shaanxi University of Chinese Medicine were retrospectively analyzed.The patients were divided into 3 groups: percutaneous nephrolithotripsy (PCNL) group (n=54), conventional sheath RIRS group (n=41), and flexible sheath RIRS group (n=60). The general and clinical data of the 3 groups were compared. [Results] The PCNL group had more patients with severe hydronephrosis (22.22% vs. 4.88%, 5.00%, P=0.027) and smaller IPA involving the lower calyx [(36.17±17.6)° vs. (48.57±17.56)°, (47.41±10.82)°, P=0.014] than the conventional sheath RIRS group and flexible sheath RIRS group.Three days after operation, the stone-free rate (SFR) was 90.74%, 53.66% and 78.33% in the PCNL, conventional sheath RIRS, and flexible sheath RIRS groups, respectively (P<0.05). At 1 month postoperatively, the SFR was 92.59%, 73.17%, and 81.67%, with no statistically significant difference between the PCNL and flexible sheath RIRS groups (P>0.05), but was higher than that in the conventional sheath RIRS group (P<0.05). The PCNL group had shorter operation time than the two RIRS groups [(65.22±17.67) min vs. (91.73±20.57) min, (94.38±24.75) min, P<0.001], longer postoperative hospital stay [(5.0(4.0, 7.0) d vs.3.0(2.0, 4.0) d, 3.0(2.0, 4.0) d, P<0.001], greater decrease in hemoglobin level [(18.00±5.78) g/L vs. (5.57±5.16) g/L, (7.42±5.09) g/L, P<0.001], and higher visual analogue scale (VAS) score [(4.83±1.48) min vs. (2.95±1.07) min, (3.05±1.21) min, P<0.001], while there was no difference between the two RIRS groups (P>0.05). The costs were lower in the flexible sheath RIRS group than in the conventional sheath RIRS group but higher than in the PCNL group [(23 311.19±1 341.20)yuan vs.(24 550.49±1 172.51)yuan, (15 351.97±1 101.4)yuan, P<0.001]. The overall incidence of complications was similar among the three groups, but stone street occurred only in the conventional sheath RIRS group. [Conclusion] For the treatment of patients with upper urinary tract stones >2 cm, RIRS has shorter postoperative hospital stay, lower hemoglobin decrease, and lower VAS score compared to PCNL; the early postoperative SFR of flexible sheath RIRS is superior to that of conventional sheath RIRS, and the 1-month SFR is comparable to that of PCNL, with a low incidence of stone street.

In recent years,with in-depth study of bladder sensation related mechanisms,numerous ion channels,neurotransmitters and nerve receptors have been found to participate in the regulation of bladder sensation,including TRPV,P2X and Piezo,as well as CBR and HCN.Thanks to the relevant research on the neural signal pathway from the cerebral cortex to the bladder wall and the maturity of clinical measurement methods for bladder sensation,we can further study the abnormal bladder sensation in patients with overactive bladder(OAB),so as to explore its mechanism.Bladder hypersensitivity,as one of the current research hotspots,is receiving increasing attention from researchers.This article reviews the mechanism of bladder hypersensitivity from the aspects of clinical measurement methods of bladder sensation,ion channel,neurotransmitters and nerve receptors related to bladder sensation,in order to explore its significance in the pathogenesis of OAB.

Objective To investigate the effects of dapagliflozin combined with glucagon-like peptide-1 receptor agonists (GLP-1 RAs) on hemorheology and insulin resistance in patients with type 2 diabetes mellitus. Methods A total of 102 patients with type 2 diabetes mellitus in Quanzhou City Hospital of Traditional Chinese Medicine from November 2020 to October 2022 were randomly divided into two groups, with 51 cases in each group. Control group was treated with dapagliflozin, while study group received a combination therapy of dapagliflozin and GLP-1 RAs (liraglutide). The clinical efficacy, blood glucose indicators[fasting blood glucose (FBG), 2-hour postprandial glucose (2 hPG), glycated hemoglobin (HbA1c)], fasting insulin (FINS) and insulin resistance[homeostasis model assessment of insulin resistance (HOMA-IR), homeostasis model assessment of β-cell function (HOMA-β)], lipid indicators[total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-densitylipoprotein cholesterol (LDL-C)], hemorheological indicators[erythrocyte aggregation index (EAI), hematocrit (HCT), erythrocyte deformation index (EDI), plasma viscosity (PV)], and adverse reactions were compared between the two groups. Results The total effective rate was 94.12% in the study group, which was significantly higher than 80.39% in the control group (P<0.05). After treatment, FBG, 2 hPG, HbA1c and BMI were significantly lower than those before treatment in both groups, and levels of FBG, 2 hPG and HbA1c in the study group were significantly lower than those in the control group (P<0.05). After treatment, FINS and HOMA-β in the study group were significantly higher than those in the control group, while HOMA-IR was significantly lower than that in the control group (P<0.05). After treatment, HDL-C level was significantly higher than that before treatment in both groups, while TC, TG and LDL-C levels were significantly lower in both groups; additionally, HDL-C level after treatment in the study group was significantly higher than that in the control group, while TC, TG and LDL-C levels were significantly lower than those in the control group (P<0.05). After treatment, EAI, HCT, EDI and PV levels were significantly lower than those before treatment in both groups, and levels of indexes mentioned above in the study group were significantly lower than those in the control group (P<0.05). The total incidence of adverse reactions in the study group was 11.76%, which showed no significant difference when compared to 9.80% in the control group (P>0.05). Conclusion The combination therapy of dapagliflozin and GLP-1 RAs (liraglutide) is effective in the treatment of patients with type 2 diabetes mellitus, which can effectively regulate blood glucose and lipid levels, alleviate insulin resistance, and improve hemorheological indicators.