[Objective] To compare the clinical efficacy of super pulse thulium laser enucleation of the prostate (SPThuLEP) with "open tunnel" and transurethral holmium laser enucleation of the prostate (HoLEP) in the treatment of benign prostatic hyperplasia (BPH), in order to provide reference for the treatment options of BPH. [Methods] The clinical data of 112 BPH patients treated in our hospital during Jan.2023 and Jul.2023 were retrospectively analyzed, including 65 treated with SPThuLEP with "open tunnel" and 57 with HoLEP.The operation time, postoperative hemoglobin decrease, postoperative bladder irrigation, catheter indwelling time, hospitalization time and complications were compared between the two groups.The changes of maximum urine flow rate (Qmax), international prostate symptom score (IPSS), quality of life score (QoL), postvoid residual (PVR) and prostate-specific antigen (PSA) were compared between the two groups before operation and one month after operation. [Results] All operations were successful without conversion to open or transurethral plasmakinetic resection.The postoperative decrease of hemoglobin in SPThuLEP group was lower than that in HoLEP group [(13.12±6.72) g/L vs. (21.02±6.51) g/L], with statistical difference (P<0.05). There were no significant differences in the operation time [(63.35±15.73) min vs.(61.02±17.55) min], postoperative bladder irrigation time [(1.07±0.45) d vs. (1.06±0.36) d], catheter indwelling time [(2.98±0.56) d vs. (3.01±0.63) d] and hospitalization time [(3.63±0.61) d vs.(3.79±0.76) d] between the two groups (P>0.05). No blood transfusion, secondary bleeding or unplanned hospitalization occurred, and there were no serious complications such as transurethral electroresection syndrome (TURS), urethral stricture and urinary incontinence.One month after operation, the Qmax, IPSS, QoL, PVR and PSA of the two groups were significantly improved compared with those before operation (P<0.05), but with no statistical difference between the two groups (P>0.05). [Conclusion] SPThuLEP with "open tunnel" has comparable efficacy as HoLEP in the treatment of BPH.With advantages of small amount of bleeding and high safety, this minimally invasive technique can be widely popularized in clinical practice.

Objective:To study the application value of refined centralized management combined with scientific preventive maintenance in the standardized management of clinical ventilators.Methods:The ventilator failure information wad collected,a ventilator information management database was established,the refined and centralized management and scientific preventive maintenance measures for ventilators was developed in terms of planning,implementing,and updating the ventilator management system as well as training and assessment.119 ventilators in clinical use in People's Hospital of the Xinjiang Uygur Autonomous Region from 2021 to 2022 were selected,the conventional management mode(referred to as conventional mode,50 units)and the refined centralized management combined with scientific preventive maintenance mode(referred to as joint mode,69 units)were adopted respectively for management.The maintenance status of ventilators in the two modes and the total amount of work in 2021 and 2022 were compared.Results:There were 85 ventilator failures in 2021 and 58 ventilator failures in 2022 in conventional mode.34 ventilator failures in 2021 and 44 ventilator failures in 2022 in joint mode.The number of failures,maintenance time and satisfaction of clinical department with the ventilators of the joint mode in 2021 were(3.25±1.06)times/month,(12.57±10.31)days and(91.50±1.73)% respectively,the number of failures and maintenance time were less than those of conventional mode,satisfaction of clinical department was higher than that of the conventional mode,the difference was statistically significant(t=14.458,2.501,2.563,P<0.05).The number of failures of ventilators of joint mode in 2022 was(3.08±2.02)times/month,which was less than that of conventional mode,the difference was statistically significant(t=4.655,P<0.05).The number of failures,number of times to contact the equipment department,consumable costs,adverse events,and number of terminal disinfections for 119 ventilators of the two modes in 2021 were(10.25±2.34)times/month,(16.75±6.54)times/month,and CNY(44,000±49,300)/month,(2.49±0.92)pieces/month and(382.58±83.67)times/month,which were higher than those in 2022,the equipment completeness rate and frequency of clinical training were(88.27±1.29)% and(3.42±1.51)times/month,respectively,which were lower than those of 2022,the difference was statistically significant(t=5.124,6.103,4.099,7.884,1.980,5.607,3.564,P<0.05).Conclusion:Refined centralized management combined with scientific preventive maintenance can effectively reduce the number of ventilator failures,maintenance time and costs,etc.,and improve the quality of standardized management of clinical ventilators.

Objective:To discuss the effect of experiential diet education on the compliance of low-protein diet in patients with chronic kidney disease(CKD), provide basis for improving the compliance of low protein diet in patients with CKD.Methods:A total of 119 patients with CKD stage 3 who were hospitalized from March 2018 to September 2019 in the Division of Nephrology of Beijing Anzhen Hospital, Capital Medical University were selected. They were divided into the following two groups according to the admission time: the control group (58 cases) from March to December 2018 received traditional education, and the observation group(61 cases) from January to September 2019 received systematic experiential diet education on the basis of the control group. At the time of discharge, the eating experience of the observation group was investigated. Three months after discharge, the LPD compliance of the patients in the two groups were investigated by questionnaire, and statistical analyses were performed. And the reason why the observation group could not continue to use CKD nutrition package was analyzed.Results:The score of compliance was (49.44±6.38) points in the observation group and (45.50±6.45) points in the control group, the difference was statistically significant ( t value was 2.68, P<0.05). At the time of discharge, the satisfaction of the observation group was more than 70%, but only 6 patients (9.8%,6/61) adhered to the nutritional package after 3 months. The main reasons why 55 patients could not insist were expensive cost and inconvenient production. Conclusions:Experiential diet education for patients with CKD is a brand-new education model combining routine education and diet experience practice. It can effectively improve the compliance of patients with LPD, which is worth being popularized.

Objective:To explore the clinical efficacy of consolidation chemotherapy combined with microtransplantation in the treatment of elderly patients with acute myeloid leukemia (AML).Methods:The clinical data of 45 elderly patients with AML in Suzhou Yongding Hospital from January 2016 to December 2018 were retrospectively analyzed. After 1 or 2 courses of induced chemotherapy, the patients achieved complete response (CR). Among them, 20 patients were given consolidation chemotherapy (single group), and 25 patients were given consolidation chemotherapy combined with microtransplantation (combined group). After 3 courses of treatment, the minimal residual disease (MRD), quantitative expression of WT1 gene and adverse reactions were compared between 2 groups; the quality of life before treatment and after treatment was evaluated by quality of life-BREF (QOL-BREF). The patients were followed up to November 1, 2020, and the median follow-up was 30 months. The overall survival and progress-free survival (PFS) were recorded.Results:The MRD negative rate and WT1 gene negative rate after treatment in combined group were significantly higher than those in single group: 60.00% (15/25) vs. 25.00% (5/20) and 52.00% (13/25) vs. 20.00% (4/20), and there were statistical differences ( P<0.05). The recovery times of neutrophils and platelets in combined group were significantly shorter than those in single group: 10 (8, 12) d vs. 16 (13, 20) d and 14 (11, 17) d vs. 24 (19, 30) d, and there were statistical differences ( Z = 3.152 and 4.285, P<0.05). No adverse reactions such as liver and kidney abnormalities or gastrointestinal reactions occurred in 2 groups; and no specific graft versus host disease (GVHD) occurred in the combined group. The each item scores of QOL-BREF after treatment in combined group were significantly higher than those in single group, and there were statistical differences ( P<0.01). The 2-year overall survival rate and PFS rate in combined group were significantly higher than those in single group: 60.00% (15/25) vs. 35.00% (7/20) and 52.00% (13/25) vs. 25.00% (5/20), and there were statistical differences ( χ2 = 4.235 and 4.742, P = 0.040 and 0.029). Conclusions:Consolidation chemotherapy combined with microtransplantation is effective and safe in the treatment of elderly patients with AML. It can significantly improve the quality of life, and improve the overall survival rate and PFS rate.

Depressive disorder is a common mental disorder.At present, the diagnosis of depressive disorder mainly relies on patients' self-reported symptoms and clinical interviews which are relatively subjective.As one of the new technologies assisting diagnosis and therapeutic effect evaluation of depressive disorder, near-infrared spectroscopy (NIRS) has received a lot of attention in recent years.This article reviewed studies of using NIRS in the diagnosis and therapeutic effect evaluation of depressive disorder in the past five years.The review showed that NIRS could reflect abnormal hemodynamic activities of the prefrontal cortex and temporal cortex of patients with depressive disorder, especially the dorsolateral prefrontal cortex and inferior frontal gyrus.Changes of concentration of oxygenated hemoglobin in these areas showed higher accuracy in assisting the diagnosis of depression disorder.Until now, only a few longitudinal studies utilized NIRS to compare changes of cerebral hemodynamic activities at different time points of treatment which preliminarily confirmed the potential of NIRS in the evaluation of therapeutic effects of depressive disorder.In future, more large-scale studies will be needed to further determine the specific application standards for NIRS in the diagnosis and therapeutic effect evaluation of depressive disorder.

Objective:To evaluate the rationality of the "Sandwich Principle teaching mode" adopted in our teaching of internal medicine and verify the necessity of its "Intergroup intersecting discussion".Methods:33 students majoring in traditional Chinese medicine were divided into control group (taught by standard process of sandwich principle) and experiment group (taught by simplified process of sandwich principle). The Dundee Ready Education Environment Measure (DREEM) was used to evaluate students' feelings toward the two teaching modes.Results:The total score of DREEM in the control group was higher than that in the experiment group, with statistically significant difference; the total score in the academic perception subscale in the control group was higher than that in the experiment group, among which the scores of "I have faith in passing the exam this year" and other 2 items were better than that in the experiment group, with statistically significant difference ( P<0.05); there were no statistical difference in the total scores of other perception subscales between the two groups( P>0.05), but the scores of the 9 items including "the atmosphere is very harmonious in the clinical teaching process" in the control group were significantly better than those in the experiment group, with statistically significant difference( P<0.05). Conclusion:The teaching mode of Sandwich Principle can create a positive and effective learning environment for supporting students. "Intergroup intersecting discussion" can encourage students to actively participate in the teaching process, and help increase their academic confidence and sense of achievement in learning. It is also helpful to build a harmonious teacher-student relationship and create a relaxing and pleasant learning environment so that students can gain a better learning experience. Therefore, "Intergroup intersecting discussion" is indispensable in medical teaching.

Objective? To investigate the health belief of colorectal cancer and its screening in relatives of patients with hereditary colorectal cancer,and to analyze its influencing factors. Methods? Totally 148 blood relatives of patients with hereditary colorectal cancer hospitalized in the Department of Colorectum of a Class ⅢGrade A hospital in Guangzhou from December 2016 to May 2018 were selected using convenient sampling, and investigated with the self-made general information questionnaire and Chinese Colorectal Cancer Health Belief Scale (CCCHBS). SPSS 20.0 was used for statistical analysis. Results? The colorectal cancer health belief of blood relatives of patients with hereditary colorectal cancer totaled (3.37±0.35) in which the perception and acceptance levels of screening benefits, health motives and self-efficacy of colorectal cancer were higher, while the perception levels of severity of colorectal cancer, barriers against colorectal screening and susceptibility were lower. Multivariate linear regression analysis revealed that household income per capita, educational background, with commercial medical insurance or not and the number of blood relatives with cancer were the influencing factors for health belief levels, which accounted for 41.9% of the total variance. Conclusions? The health belief in blood relatives of patients with hereditary colorectal cancer remain at a medium level. Medical and nursing workers should pay attention to the blood relatives of patients with hereditary colorectal cancer with lower educational background, lower household income and less blood relatives with cancer, take measures to improve their health belief levels, and facilitate colorectal cancer screening behaviors so as to prevent and control colorectal cancer in a better manner.

Objective: To study the specific killing effect of CD4 membrane protein targeted chimeric antigen receptor modified T (CAR-T) cell. Methods: The second generation CD4 targeted chimeric antigen receptor containing 4-1BB costimulation domain was insert into lentiviral vector through recombinant DNA technology. Lentivirus was prepared and packaged by 293T cells with four plasmids. Beads activated T cells were transduced with lentivirus and the transduction efficiency was checked with Protein L and flow cytometry. T cell subsets and IFN-γ concentrations were detected with probe-tagged antibody and cytometric bead assay. Results: ①The transduction efficiency of activated T cells with prepared lentivirus were 50.0%-70.0%. A subset of CD8⁺ T cell acquired dim expression of CD4 membrane protein after activation. CD4⁺T cell and CD8⁺CD4^dim T cell were gradually killed by CD4 targeted CAR-T post lentivirus transduction. ②The kill efficacy of CD4 targeted CAR-T cell and control T cell toward KARPAS 299 T cell at an E∶T ratio of 8∶1 for 24 h was (96.9±2.1)% and (11.2±3.1)%, CAR-T cell has a higher killing efficacy than control T cell (t=7.137, P=0.028). The IFN-γ concentrations in culture supernatant of CAR-T cell with K562-CD4 cell, CAR-T cell with K562 cell and CAR-T cell alone were (15 648±2 168), (1 978±354) and (1 785±268) pg/ml, CAR-T cell cocultured with K562-CD4 cell produced more IFN-γ than the other two controls (P<0.01). Conclusions CD4 targeted CAR-T has an immunophenotype of CD8⁺CD4^-T cell. CD4 targeted CAR-T cell has killing efficacy toward normal CD4⁺T cell and CD4⁺T lymphoma cell. CD4 targeted CAR-T cell also has a killing efficacy toward CD4^dim target cell.

Objective: To analyze the causes of preoperative miscarriage of pancreatic serous cystadenoma (SCN) and find the ways to improve it. Methods: Clinical data of 425 pancreatic cystic neoplasm patients who underwent surgical resection from January 2006 to December 2016 in Department of Pancreatic Surgery in Huashan Hospital were retrospectively analyzed.Excel database was created which covered 128 fields of 7 fields: general information of patients, preoperative blood biochemical indexes, tumor markers, surgical related data, postoperative complications, imaging findings and pathology.One hundred and sixty-one cases of SCN were analyzed in depth, mainly in three aspects: surgical benefit, preoperative imaging diagnostic value and interference factors in preoperative judgement.The classification data were analyzed by χ² test and the quantitative data were analyzed by t test.The Logistic regression model was used for multiple factor analysis. Results: Of the 425 PCN cases surgically removed, 161 cases (37.9%) were SCN, the incidence of operative complications was 40.4%(65/161), the hospitalization days was (20.7±12.1)days and the medical cost was (75 267±37 866) yuan.Only 3 of 161 cases of SCN were accurately diagnosed by preoperative imaging methods, 61 cases were diagnosed as "cystic lesions of pancreas" (37.9%) and 52 cases were diagnosed as "pancreatic cystadenoma" (32.3%). SCN was misdiagnosed as MCN(32.3%) and IPMN(28%) before operation.25.5% of them were diagnosed as SCN before operation, but still underwent radical operation.The rate of preoperative imaging diagnosis for identifying SCN was 62.8%.The lack of preoperative endoscopy and the lack of understanding of the image characteristics and biological behavior of SCN were the most important factors affecting the accuracy of preoperative judgment.Statistics found that gender, age, CA125 and tumor location can be used as independent factors contribute to the clinical identification(χ²=8.995, P=0.003; χ²=10.019, P=0.007; t=3.157, P=0.002; χ²=6.790, P=0.009). Logistic analysis showed that women, older than 60 years old, the tumors located in the pancreatic body and tail were the independent factors of SCN classification and diagnosis (OR=0.481, 0.376, 0.577, 0.666, 95% CI: 0.305-0.759, 0.199-0.710, 0.361-0.924, 0.433-1.024, P=0.002, 0.003, 0.022, 0.064). Conclusions SCN has more benign biological behavior.Although surgical excision is acceptable for clinical safety, the corresponding benefit is very limited.It is possible to improve the rationality of SCN clinical operation decisions to some extent by performing endoscopic examination, imaging doctors to improve the SCN feature recognition and surgeons to enhance the awareness of SCN.

Objective To study the effect of postoperative rehabilitation of meditation training on repeat cesarean section patients. Methods A total of 86 cases of repeat cesarean section from October 1st, 2014 to October 1st, 2016 were collected. The patients were divided into the observation group (43 cases) and the control group (43 cases) by random digits table method. The observationgroup received meditation therapy by a well-trained nurse based on the routine treatment. The control group was treated with routine treatment. The two groups were compared by postoperative pain score, anxiety and depression scores, the first breastfeeding time, the first urination time and satisfaction. Results After intervention, the postoperative pain visual scores of the observation group and the control group were 3.21 ± 1.51 and 5.41±1.45 respectively, the difference was statistically significant (t=3.817, P<0.01). After intervention, the scores of Hamilton Anxiety Scale (HAMA) and Hamilton Depression Scale (HAMD) of the observation group were 10.86±1.95,9.22±2.76, and 16.88±2.09,14.02±3.79 in the control group, the differences were statistically significant (t=11.518, 6.317, P<0.01). The first out-of-bed time of the observation group were as follows:<4 h:9.30%(4/43), 4-6 h:88.37%(38/43),>6 h/failure:2.32%(1/43). While the data of the control group were <4h: 18.60%(8/43), 4-6 h: 67.44%(29/43), >6 h/failure: 13.95%(6/43), the differences were statistically significant (t=6.114, P<0.05). The satisfaction of the observation group and the control group were 98.47% (42/43) and 91.69% (39/43) respectively, the difference was statistically significant. (χ2=7.679, P<0.01). ConclusionsMeditation can effectively reduce the postoperative pain, reduce the incidence of anxiety, shorten the first time of breastfeeding and urination, and improve patients′satisfaction.