Objective:To investigate the clinical outcomes of scrotal local flap combined with thick split-thickness skin grafting in the treatment of penoscrotal Paget’s disease.Methods:The clinical data of patients with penoscrotal Paget’s disease admitted to the Department of Plastic Surgery, the First Affiliated Hospital of Anhui Medical University, were retrospectively analyzed. For the defect wounds remaining after extended resection of penile and scrotal lesions, scrotal local flap combined with thick split-thickness skin grafting was used for repair. The central part of the scrotal local flap was fenestrated (for penile passage) to cover the wounds of the penile root and perineum, and thick split-thickness skin grafts harvested from the thigh were used to resurface penile defects. The thigh donor sites were managed with direct pressure dressing. Postoperatively, the flap vascularity, incision healing, and skin graft survival were observed. The appearance of the penis, scrotum, and perineum, as well as penile erectile function, were followed up, and patients’ satisfaction with the surgical results was investigated.Results:A total of 15 male patients, aged 55-81 years, were included. The clinical manifestations included erythema and papules on the local skin of the penis and scrotum, with partial ulceration or exudation and obvious pruritus. The lesions involved the lower segment of the penis and the upper skin of the scrotum. After extended resection of the lesions, the perineal defect area ranged from 6.0 cm×7.5 cm to 15.0 cm×10.0 cm, and the penile wound area ranged from 4.0 cm×7.0 cm to 9.0 cm×9.0 cm. The area of the scrotal skin flap was approximately 6.0 cm×7.5 cm to 12.0 cm×8.0 cm, and the area of the transplanted skin graft was about 5.0 cm×7.0 cm to 8.0 cm×9.0 cm. Postoperatively, all flaps demonstrated good perfusion, and all skin grafts survived. Primary healing occurred in 12 cases, while 3 cases had mild distal flap dehiscence due to early ambulation, which healed by secondary intention after dressing changes. The thigh donor sites healed primarily. During the 12-36 months follow-up, the perineal appearance was good, no obvious contracture was observed in the penile skin grafts, urination was normal, and penile erectile function was not affected. No recurrence of the lesions was found during the follow-up period. There was mild pigmentation or uneven texture in the thigh donor sites, and no obvious scar hyperplasia. All patients were satisfied with the surgical outcomes.Conclusion:Scrotal local flap combined with thick split-thickness skin grafting can effectively repair the composite defect wounds of the penis and scrotum after lesion resection in penoscrotal Paget’s disease. The postoperative scar at the incision is inconspicuous, with no obvious displacement of the penis and scrotum and no impact on penile erectile function, leading to high patient satisfaction.

Objective:To investigate the value of biparametric-MRI (bpMRI) based peritumoral radiomics for preoperative prediction of extraprostatic extension (EPE) in prostate cancer (PCa).Methods:In this cross-sectional study, consecutive bpMRI of patients undergoing prostatectomy for PCa were retrospectively collected from the First Medical Center (center 1) and the Third Medical Center (center 2) of Chinese PLA General Hospital. A total of 274 patients were finally enrolled. Patients at center 1 from January 2020 to December 2022 were randomly divided into a training set (149 cases) and an internal validation set (63 cases) by stratified random sampling. Patients at center 2 from January 2023 to March 2024 were assigned to the external test set (62 cases). Patients were categorized into EPE-positive group and EPE-negative group according to pathological assessment postoperatively. In the training set, there were 49 cases in EPE-positive group and 100 cases in EPE-negative group. In the internal validation set, there were 26 cases in EPE-positive group and 37 cases in EPE-negative group. In the external test set, there were 22 cases in EPE-positive group and 40 cases in EPE-negative group. Axial T 2WI and apparent diffusion coefficient (ADC) images were manually annotated to obtain index lesion regions of interest (ROIs), with the peritumoral ROIs subsequently delineated by semi-automatic segmentation technique. Radiomics features were extracted from intra-tumoral, peri-tumoral, and intra-tumoral plus peri-tumoral ROIs. The training set data was employed to select and optimize features to build the radiomics models. The logistic regression analysis was used to develop radiomics, clinical, and integrated models. The predictive performance was assessed by the area under the receiver operating characteristic curve (AUC) in the external test set, and compared by the DeLong test. The sensitivity and specificity were compared by the exact McNemar test. Results:In the external test set, the peri-tumoral radiomics model based on bpMRI showed the highest performance in evaluating EPE, with an AUC of 0.739 (95% CI 0.611-0.842), which was identified as the optimal radiomics model. EPE grade ( OR=6.151, 95% CI 3.371-11.226, P<0.001) was incorporated into the clinical model, with an AUC of 0.780 (95% CI 0.657-0.875) in the external test set. The integrated model had an AUC of 0.817 (95% CI 0.698-0.904) in the external test set. There was no statistically significant difference in comparisons of AUCs among the three models (all P>0.05). The sensitivity of the integrated model (68.2%) showed no significant difference from those of the clinical model and the optimal radiomics model (77.3% and 86.4%, respectively; P=0.500 and P=0.289). However, the specificity of the integrated model (85.0%) was significantly higher than those of the clinical model (67.5%, P=0.016) and the optimal radiomics model (50.0%, P<0.001). Conclusion:A bpMRI-based peritumoral radiomics integrating clinical model demonstrates high performance for preoperative prediction of EPE in PCa.

Objective To explore the effect of esketamine combined with butorphanol on hemodynamics in painless gastroenteroscopy for elderly patients with obesity and the anesthetic efficacy and safety of this combined anesthesia regimen.Methods The subjects of this study,124 elderly patients with obesity who received painless gastroenteroscopy from January 2022 to March 2024,were randomly divided into two groups,each with 62 cases.Both groups were administrated with propofol 1.50 mg/kg for anesthesia induction.The observation group was given esketamine 0.20 mg/kg combined with butorphanol 10 μg/kg intravenously prior to propofol injection,while the control group was given saline of the same volume as esketamine combined with butorphanol 10 μg/kg intravenously before propofol injection.Vital signs indicators[mean arterial pressure(MAP),heart rate(HR),and percutaneous arterial oxygen saturation(SpO2)]were compared between the two groups at the time of entry(T0),immediately after anesthesia induction(T1),immediately after gastroscopy placement(T2),immediately upon completion of gastroscopy(T3),immediately after colonoscopy insertion(T4),and immediately upon completion of colonoscopy examination(T5).The anesthesia effect was evaluated for the two groups during painless gastroenteroscopy examination.The duration of gastroenteroscopy and propofol dosage were compared between the two groups as well.Visual analogue scale(VAS)score was used to evaluate the postoperative pain level for patients from the two groups 1,2,3,and 4 h after surgery.Intraoperative and postoperative adverse reactions in two groups were recorded.Results The MAP at T3,T4,and T5 time points in observation group were lower than that at T0 time point,the HR at T4 and T5 time point in observation group was lower than that at T0 time point,the differences were statistically significant(P＜0.05),there was no significant difference in SpO2 at each time point in observation group(P＞0.05).While the MAP,HR,and SpO2 at T1,T2,T3,T4,and T5 time points in control group were significantly lower than those at T0 time points,the differences were statistically significant(P＜0.05).The MAP,HR,and SpO2 at T1,T2,T3,T4,and T5 time points in control group were lower than those in observation group,the differences were statistically significant(P＜0.05).The excellent and good rate of anesthesia in observation group was better than that in control group,the difference was statistically significant(P＜0.05).The propofol dosage in observation group was less than that in control group,the recovery time in observation group was shorter than that in control group,the differences were statistically significant(P＜0.05).There were no significant differences in duration of gastroenteroscopy examination,postanesthesia care unit(PACU)stay and leave hospital time between the two groups(P＞0.05).1,2,3,and 4 h postoperative pain VAS scores in observation group were less than those in control group,the differences were statistically significant(P＜0.05).The incidence of respiratory depression was 3.23％,which was significantly lower than 19.35％in control group,the incidence of hypotension was 4.84％,which was significantly lower than 25.81％in control group,the incidence of bradycardia was 0.00％,which was significantly lower than 17.74％in control group,the incidence of nausea and vomiting was 1.61％,which was significantly lower than 12.90％in control group,the differences were statistically significant(P＜0.05).There were no significant differences in the incidence of tachycardia,coughing,body movement,and dizziness between the two groups(P＞0.05).Conclusion Application of esketamine combined with butorphanol in painless gastroenteroscopy for elderly patients with obesity can effectively improve sedative and analgesic effects,stabilize hemodynamics,and reduce adverse reactions.It is worthy clinical application.

Objective To analyze the research hotspots and frontiers in the field of cost management in Chinese hospitals and provide a reference for cost management research and practice in hospitals.Methods Based on the CNKI and Wanfang da-tabases,relevant literature up to May 31,2024 was retrieved and recorded,totaling 3 589 records,and then analyzed using Citespace visualization software.Results Literature reports have been seen since 1987,with a significant increase in 2000 and reaching its peak in 2010.A total of 16 core topics have been formed,including cost accounting,public hospitals,hospitals,ac-tivity-based costing,management,cost management,economic management,medical costs,hospital financial system,and medi-cal expenses.In recent years,emerging terms have been disease diagnosis related groups,operational management,medical sup-plies,refined management,cost control,and business finance integration.Conclusion External policies have promoted the pro-gress of research and practice in cost management in hospitals;disease diagnosis related groups and cost control are the latest hotspots in cost management research and practice in hospitals;and the importance of business finance integration in hospital op-erations management is gradually increasing.

Objective To explore the effect of esketamine combined with butorphanol on hemodynamics in painless gastroenteroscopy for elderly patients with obesity and the anesthetic efficacy and safety of this combined anesthesia regimen.Methods The subjects of this study,124 elderly patients with obesity who received painless gastroenteroscopy from January 2022 to March 2024,were randomly divided into two groups,each with 62 cases.Both groups were administrated with propofol 1.50 mg/kg for anesthesia induction.The observation group was given esketamine 0.20 mg/kg combined with butorphanol 10 μg/kg intravenously prior to propofol injection,while the control group was given saline of the same volume as esketamine combined with butorphanol 10 μg/kg intravenously before propofol injection.Vital signs indicators[mean arterial pressure(MAP),heart rate(HR),and percutaneous arterial oxygen saturation(SpO2)]were compared between the two groups at the time of entry(T0),immediately after anesthesia induction(T1),immediately after gastroscopy placement(T2),immediately upon completion of gastroscopy(T3),immediately after colonoscopy insertion(T4),and immediately upon completion of colonoscopy examination(T5).The anesthesia effect was evaluated for the two groups during painless gastroenteroscopy examination.The duration of gastroenteroscopy and propofol dosage were compared between the two groups as well.Visual analogue scale(VAS)score was used to evaluate the postoperative pain level for patients from the two groups 1,2,3,and 4 h after surgery.Intraoperative and postoperative adverse reactions in two groups were recorded.Results The MAP at T3,T4,and T5 time points in observation group were lower than that at T0 time point,the HR at T4 and T5 time point in observation group was lower than that at T0 time point,the differences were statistically significant(P＜0.05),there was no significant difference in SpO2 at each time point in observation group(P＞0.05).While the MAP,HR,and SpO2 at T1,T2,T3,T4,and T5 time points in control group were significantly lower than those at T0 time points,the differences were statistically significant(P＜0.05).The MAP,HR,and SpO2 at T1,T2,T3,T4,and T5 time points in control group were lower than those in observation group,the differences were statistically significant(P＜0.05).The excellent and good rate of anesthesia in observation group was better than that in control group,the difference was statistically significant(P＜0.05).The propofol dosage in observation group was less than that in control group,the recovery time in observation group was shorter than that in control group,the differences were statistically significant(P＜0.05).There were no significant differences in duration of gastroenteroscopy examination,postanesthesia care unit(PACU)stay and leave hospital time between the two groups(P＞0.05).1,2,3,and 4 h postoperative pain VAS scores in observation group were less than those in control group,the differences were statistically significant(P＜0.05).The incidence of respiratory depression was 3.23％,which was significantly lower than 19.35％in control group,the incidence of hypotension was 4.84％,which was significantly lower than 25.81％in control group,the incidence of bradycardia was 0.00％,which was significantly lower than 17.74％in control group,the incidence of nausea and vomiting was 1.61％,which was significantly lower than 12.90％in control group,the differences were statistically significant(P＜0.05).There were no significant differences in the incidence of tachycardia,coughing,body movement,and dizziness between the two groups(P＞0.05).Conclusion Application of esketamine combined with butorphanol in painless gastroenteroscopy for elderly patients with obesity can effectively improve sedative and analgesic effects,stabilize hemodynamics,and reduce adverse reactions.It is worthy clinical application.

Objective:To retrospectively analyze the clinical efficacy and safety of biological agents in the treatment of psoriasis in the elderly.Methods:A retrospective study was conducted. A total of 124 patients aged ≥ 65 years with moderate-to-severe psoriasis (psoriasis area and severity index [PASI] score ≥ 3 points or body surface area [BSA] ≥ 3%), who were treated with biological agents at the Department of Dermatology and Venereology, People's Hospital of Xinjiang Uygur Autonomous Region, from June 2020 to December 2023, were collected. PASI, BSA, and dermatology life quality index (DLQI) scores were recorded at weeks 0 (pre-treatment), 4, 12, and 24 after the beginning of treatment to evaluate the efficacy. The proportions of patients achieving ≥ 75% and 90% improvements in PASI scores (PASI75 and PASI90, respectively) were calculated, and adverse reactions were recorded. Data were processed using SPSS 29.0 and GraphPad Prism 10.0 software. Normally distributed continuous variables were presented as mean ± standard deviation, while non-normally distributed continuous variables were presented as median with upper and lower quartiles ( Q1, Q3). Wilcoxon signed-rank test was used for comparisons of non-normally distributed data between groups, and chi-square test and Fisher's exact test were used for comparing categorical data. Results:Among the 124 patients, there were 72 males (58.1%) and 52 females (41.9%), and their ages ranged from 65 to 87 years. Treatment regimens included secukinumab for 86 patients (69.4%), ustekinumab for 15 (12.1%), ixekizumab for 14 (11.3%), guselkumab for 5 (4.0%), and adalimumab for 4 patients (3.2%). The pre-treatment PASI, BSA, and DLQI scores [ M ( Q1, Q3) ] were 12.2 (7.8, 19.6) points, 16.0% (10.2%, 25.0%), and 16 (11, 20) points respectively, which significantly decreased to 0.8 (0, 1.2) points, 1.0% (0, 2.0%), and 0 (0, 3) points respectively at week 24 after the start of treatment ( Z = 9.66, 9.66, 9.63, respectively, all P < 0.01). The proportions of patients achieving PASI75 at weeks 4, 12, and 24 were 42.7% (53/124), 80.6% (100/124), and 93.5% (116/124) respectively, and those achieving PASI90 were 13.7% (17/124), 48.4% (60/124), and 85.5% (106/124) respectively. There were no significant differences in the proportions of patients achieving PASI75 and PASI90 between the subgroups with and without comorbidities, as well as between the early-onset psoriasis subgroup and late-onset psoriasis subgroup at weeks 4, 12, and 24 (all P > 0.05). Among the 124 patients, 42 were followed up for over 2 years, and the proportions of patients achieving PASI75 and PASI90 after 2 years of treatment were 71.4% (30 cases) and 54.8% (23 cases), respectively. Adverse reactions occurred in 13 patients, including upper respiratory infections in 4 patients (3.2%), elevated aminotransferase levels in 3 patients (2.4%), eczematoid dermatitis in 2 patients (1.6%), pruritus in 2 patients (1.6%), nodular prurigo in 1 patient (0.1%), and vitiligo in 1 patient (0.1%) . Conclusion:Biological agents showed rapid and marked efficacy in the treatment of moderate-to-severe psoriasis in the elderly, with few and mild adverse reactions, suggesting high safety and overall marked efficacy.

AIM: To explore the control effects of wearing orthokeratology lens for 1 a on adolescent myopia patients with different diopters.METHODS: Prospective non-randomized controlled study. A total of 120 adolescent myopic patients(224 eyes), with an average age of 11.00±2.08 years old, who were fitted with orthokeratology lenses in the optometry department of our hospital from November 2022 to May 2023 were collected. There were 3 groups according to the spherical equivalent, including 86 eyes in the group of -0.50--2.00 D, 99 eyes in the group -2.25--4.00 D, and 39 eyes in group -4.25--6.00 D. Patients were followed up for 1 a to observe the changes of uncorrected visual acuity, axial length, corneal curvature, corneal central thickness and corneal endothelial cells density in the three groups after wearing lens for 1 a.RESULTS:A total of 113 cases(212 eyes)were followed up for 1 a, including 82 eyes in the group of -0.50--2.00 D, 95 eyes in the group of -2.25--4.00 D, and 35 eyes in the group of -4.25--6.00 D. There was no statistical difference in corneal central thickness and corneal endothelial cell density among the three groups of patients after wearing lens for 1 a(all P>0.05). Uncorrected visual acuity was significantly improved, and flat kerotometry(FK)and steep kerotometry(SK)were significantly flatter(both P<0.01). Furthermore, the growth of axial length in the three groups of patients after wearing lens for 1 a was 0.21±0.26, 0.13±0.21 and 0.09±0.10 mm, respectively(P<0.05). There were differences between the -0.50--2.00 D group and the -2.25--4.00 D group and -4.25--6.00 D group(P=0.028, 0.010), and there were no differences between the -2.25--4.00 D group and the -4.25--6.00 D group(P=0.344).CONCLUSION:It is safe and effective for young myopia patients to wear orthokeratology lenses, which can prevent the non-benign growth of the axial length and effectively delay the development of myopia, and the myopia control effect is better especially for myopia patients of above -2.0 D.

Objective To analyze the research hotspots and frontiers in the field of cost management in Chinese hospitals and provide a reference for cost management research and practice in hospitals.Methods Based on the CNKI and Wanfang da-tabases,relevant literature up to May 31,2024 was retrieved and recorded,totaling 3 589 records,and then analyzed using Citespace visualization software.Results Literature reports have been seen since 1987,with a significant increase in 2000 and reaching its peak in 2010.A total of 16 core topics have been formed,including cost accounting,public hospitals,hospitals,ac-tivity-based costing,management,cost management,economic management,medical costs,hospital financial system,and medi-cal expenses.In recent years,emerging terms have been disease diagnosis related groups,operational management,medical sup-plies,refined management,cost control,and business finance integration.Conclusion External policies have promoted the pro-gress of research and practice in cost management in hospitals;disease diagnosis related groups and cost control are the latest hotspots in cost management research and practice in hospitals;and the importance of business finance integration in hospital op-erations management is gradually increasing.

Objective:To retrospectively analyze the clinical efficacy and safety of biological agents in the treatment of psoriasis in the elderly.Methods:A retrospective study was conducted. A total of 124 patients aged ≥ 65 years with moderate-to-severe psoriasis (psoriasis area and severity index [PASI] score ≥ 3 points or body surface area [BSA] ≥ 3%), who were treated with biological agents at the Department of Dermatology and Venereology, People's Hospital of Xinjiang Uygur Autonomous Region, from June 2020 to December 2023, were collected. PASI, BSA, and dermatology life quality index (DLQI) scores were recorded at weeks 0 (pre-treatment), 4, 12, and 24 after the beginning of treatment to evaluate the efficacy. The proportions of patients achieving ≥ 75% and 90% improvements in PASI scores (PASI75 and PASI90, respectively) were calculated, and adverse reactions were recorded. Data were processed using SPSS 29.0 and GraphPad Prism 10.0 software. Normally distributed continuous variables were presented as mean ± standard deviation, while non-normally distributed continuous variables were presented as median with upper and lower quartiles ( Q1, Q3). Wilcoxon signed-rank test was used for comparisons of non-normally distributed data between groups, and chi-square test and Fisher's exact test were used for comparing categorical data. Results:Among the 124 patients, there were 72 males (58.1%) and 52 females (41.9%), and their ages ranged from 65 to 87 years. Treatment regimens included secukinumab for 86 patients (69.4%), ustekinumab for 15 (12.1%), ixekizumab for 14 (11.3%), guselkumab for 5 (4.0%), and adalimumab for 4 patients (3.2%). The pre-treatment PASI, BSA, and DLQI scores [ M ( Q1, Q3) ] were 12.2 (7.8, 19.6) points, 16.0% (10.2%, 25.0%), and 16 (11, 20) points respectively, which significantly decreased to 0.8 (0, 1.2) points, 1.0% (0, 2.0%), and 0 (0, 3) points respectively at week 24 after the start of treatment ( Z = 9.66, 9.66, 9.63, respectively, all P < 0.01). The proportions of patients achieving PASI75 at weeks 4, 12, and 24 were 42.7% (53/124), 80.6% (100/124), and 93.5% (116/124) respectively, and those achieving PASI90 were 13.7% (17/124), 48.4% (60/124), and 85.5% (106/124) respectively. There were no significant differences in the proportions of patients achieving PASI75 and PASI90 between the subgroups with and without comorbidities, as well as between the early-onset psoriasis subgroup and late-onset psoriasis subgroup at weeks 4, 12, and 24 (all P > 0.05). Among the 124 patients, 42 were followed up for over 2 years, and the proportions of patients achieving PASI75 and PASI90 after 2 years of treatment were 71.4% (30 cases) and 54.8% (23 cases), respectively. Adverse reactions occurred in 13 patients, including upper respiratory infections in 4 patients (3.2%), elevated aminotransferase levels in 3 patients (2.4%), eczematoid dermatitis in 2 patients (1.6%), pruritus in 2 patients (1.6%), nodular prurigo in 1 patient (0.1%), and vitiligo in 1 patient (0.1%) . Conclusion:Biological agents showed rapid and marked efficacy in the treatment of moderate-to-severe psoriasis in the elderly, with few and mild adverse reactions, suggesting high safety and overall marked efficacy.

Objective:To investigate the clinical outcomes of scrotal local flap combined with thick split-thickness skin grafting in the treatment of penoscrotal Paget’s disease.Methods:The clinical data of patients with penoscrotal Paget’s disease admitted to the Department of Plastic Surgery, the First Affiliated Hospital of Anhui Medical University, were retrospectively analyzed. For the defect wounds remaining after extended resection of penile and scrotal lesions, scrotal local flap combined with thick split-thickness skin grafting was used for repair. The central part of the scrotal local flap was fenestrated (for penile passage) to cover the wounds of the penile root and perineum, and thick split-thickness skin grafts harvested from the thigh were used to resurface penile defects. The thigh donor sites were managed with direct pressure dressing. Postoperatively, the flap vascularity, incision healing, and skin graft survival were observed. The appearance of the penis, scrotum, and perineum, as well as penile erectile function, were followed up, and patients’ satisfaction with the surgical results was investigated.Results:A total of 15 male patients, aged 55-81 years, were included. The clinical manifestations included erythema and papules on the local skin of the penis and scrotum, with partial ulceration or exudation and obvious pruritus. The lesions involved the lower segment of the penis and the upper skin of the scrotum. After extended resection of the lesions, the perineal defect area ranged from 6.0 cm×7.5 cm to 15.0 cm×10.0 cm, and the penile wound area ranged from 4.0 cm×7.0 cm to 9.0 cm×9.0 cm. The area of the scrotal skin flap was approximately 6.0 cm×7.5 cm to 12.0 cm×8.0 cm, and the area of the transplanted skin graft was about 5.0 cm×7.0 cm to 8.0 cm×9.0 cm. Postoperatively, all flaps demonstrated good perfusion, and all skin grafts survived. Primary healing occurred in 12 cases, while 3 cases had mild distal flap dehiscence due to early ambulation, which healed by secondary intention after dressing changes. The thigh donor sites healed primarily. During the 12-36 months follow-up, the perineal appearance was good, no obvious contracture was observed in the penile skin grafts, urination was normal, and penile erectile function was not affected. No recurrence of the lesions was found during the follow-up period. There was mild pigmentation or uneven texture in the thigh donor sites, and no obvious scar hyperplasia. All patients were satisfied with the surgical outcomes.Conclusion:Scrotal local flap combined with thick split-thickness skin grafting can effectively repair the composite defect wounds of the penis and scrotum after lesion resection in penoscrotal Paget’s disease. The postoperative scar at the incision is inconspicuous, with no obvious displacement of the penis and scrotum and no impact on penile erectile function, leading to high patient satisfaction.