Objective To analyze the efficacy, safety, and learning curve of the three-lobe holmium laser enucleation of the prostate(HoLEP)in the treatment of benign prostatic hyperplasia(BPH)in a county-level hospital.Methods A retrospective analysis was conducted on the clinical data of 65 BPH patients who underwent the three-lobe HoLEP performed by a single surgeon at the Department of Urology, Yining County People's Hospital, during Dec.2023 and Jun.2024.The enucleation efficiency was calculated by dividing the weight of the enucleated prostatic tissue by the enucleation time.A case scatter diagram of enucleation efficiency was plotted according to the chronological order of the operations, and the learning curve was analyzed after fitting.Based on the inflection points of the learning curve, the learning process was divided into the initial learning, mastery, and proficiency phases.The basic clinical data, perioperative indicators, postoperative complications, and follow-up indicators were compared among the different learning phases.Results All 65 procedures were successfully completed.Marked by the enucleation efficiency reaching a plateau, cases 1-20 were defined as the initial learning phase, cases 21-40 as the mastery phase, and cases 41 onwards as the proficiency phase.The prostate volume in the proficiency phase was significantly larger than that in the initial learning and mastery phases(both P＜0.05).There were no statistically significant differences in other baseline characteristics among the three groups(all P＞0.05).The operation time [(105.50±19.12)min vs.(85.25±26.92)min vs.(69.00±23.58)min] and enucleation time [(76.90±14.19)min vs.(63.70±22.24)min vs.(48.80±20.48)min] showed a decreasing trend across the three groups(all P＜0.05).The enucleation efficiency in both the mastery and proficiency phases was significantly higher than that in the initial learning phase [(1.16±0.44)g/min vs.(0.85 ±0.25)g/min, P＜0.05;(1.36±0.49)g/min vs.(0.85±0.25)g/min, P＜0.05].The enucleation efficiency in the proficiency phase was slightly higher than that in the mastery phase, but the difference was not statistically significant(P= 0.389).There was no significant difference in the incidence of perioperative complications among the three groups(all P＞0.05).At the 6-month follow-up, the international prostate symptom score(IPSS), post-void residual(PVR), and maximum urinary flow(Qmax)were significantly improved compared to preoperative values in all three groups(all P＜0.05);however, no significant differences were observed among the three groups(all P＞0.05).Conclusion The three-lobe HoLEP for the treatment of BPH is safe and effective in a county-level hospital setting.Surgeons with some experience in endoscopic surgery can preliminarily master this technique after a learning period of approximately 20 procedures.

Objective To study the predictive value of serum soluble ST2 (sST2) in patients with sepsis.Methods A total of 63 patientswith sepsis and 30 healthy subjects as a control group in the emergency Department,Beijing Hospital,National Center of Gerontology,were enrolled in the study.Serum sST2 concentrations were measured by ELISA method.Patients were divided into sepsis group (n=44) and septic shock group (n=19).According to 28-day mortality after the diagnosis of sepsis,patients were divided into death group (n=18) and survival group (n=45).Respiratory rate,oxygenation index,white blood cell count,procalcitonin (PCT),C reactive protein (CRP),serum creatinine (CRE),total bilirubin (TBIL) of patients and control subjects were measured.SPSS 23.0 software was used for the statistical analyses.The measurement data was analyzed by t test and the enumeration data was analyzed by Chi square test.The survival status was analyzed by Logistic binary regression analysis and ROC curve analysis.Results The serum sST2 level (1 382.12±384.07) pg/mL in sepsis group was significantly higher than that in control group (569.28±163.46) pg/mL (P＜0.05).in septic shock group,28-day mortality rate (63.16％) and serum sST2 level (1 675.49±457.59) pg/mL was higher than those in sepsis group (13.64％) (1255.44 ± 265.70) pg/ml (P＜0.05).The PCT (16.37±16.36) ng/mL and serum sST2 level (1794.47±335.18)pg/mL in death group were higher than those in survival group (P＜0.05).The ROC curve showed that the AUC of sST2 was larger than that of PCT (0.917 vs.0.884),the sensitivity was higher than that of PCT (88.9％ vs.72.2％),and the specificity was lower than that of PCT (82.2％ vs.93.3％).The combination AUC of sST2 and PCT was 0.944.Conclusions Serum sST2 has a certain value in the diagnosis of sepsis,and can be used to predict the prognosis of patients with sepsis.The higher the sST2 value,the worse the prognosis.Compared with PCT,sST2 is more sensitive in the prognosis of sepsis,but the specificity is not high enouph.The measurement of sST2 level coupled with PCT level may be more useful.

Objective: To study the prognostic significance of the subtype of SYT-SSX fusion gene, E-cadherin, β-Catenin and clinicopathologicel parameters for the metastasis of synovial sarcomas. Methods: A total of 98 synovial sar-coma patients with complete clinical and follow-up data were reviewed. RT-PCR was used to detect the subtype of SYT-SSX fusion geneo The expression of E-cadherin and β-catenin was detected by immunohistochemistry. Univariate and multivariate analyses were performed to analyze the influence of the above factors and clinicopathological parameters on the metastasis free survival to explore the factors affecting the metastasis of synovial sarcoma. Results: Of all the pa-tients, 69.4% (68/98) had metastasis during follow-up. The median metastasis free survival was 48 months. The metastasis free 1-, 2-, 3-, 4-, and 5-year survival rate after surgery was 97.5%, 75.5%, 63.5%, 54.0%, and 48.5%, respectively; 31.6% (31/98) patients were found with SYT-SSX1 and 68.4% (67/98) patients with SYI-SSX2. The positive rate of E-cadherin ex-pression was 38.8% (38/98), the positive rate of β-catenin expression was 39.8% (39198) on cellular membrane and 53.1% (52/98) in cellular nucleus/cytoplasm. Univariate analysis showed that age (P=0.003), mitotic figure (P=0.002), histological grade (P=0.001), the subtype fusion gene of SYT-SSX (P=0.014), E-cadherin expression (P=0.015) and β-catenin expres-sion on cellular membrane (P=0.020) were significantly correlated with metastasis free survival of synovial sarcoma pa-tients. Sex (P=0.190), tumor location (P=0.105), tumor size (P=0.180), histological type (P=0.354), necrosis (P=0.451), β-catenin expression in cell nucleus/cytoplasm (P=0.911), radiotherapy (P=0.193), and chemotherapy (P=0.249) had no sig-nificant correlation with metastasis free survival of synovial sarcoma patients. Multivariate analysis revealed that the sub-type of SYT-SSX1 fusion gene (RR=2.505, P=0.003), negative expression of E-cadherin (RR=3.282, P=0.000), patient age (RR=2.157, P=0.004), and grade Ⅲ (RR=1.784, P=0.030) were independent risk factors for metastasis of synovial sarco-ma. Conclusion: The subtype of SYT-SSX, expression of E-cadherin, histological grade and the age of patients are impor-tant factors for evaluating the metastasis and prognosis of synovial sarcoma.

Objective: To study the prognostic significance of cell proliferation and apoptosis, MVD and clinicopathologi-cal parameters for the recurrence of synovial sarcoma. Methods: We analyzed the clinical and follow-up data of 56 synovial sarcoma patients without metastasis. RT-PCR was used to detect the subtype of SYT-SSX fusion gene. The expression of Ki67 and MVD was detected by immunohistochemistry. Univariate analysis was employed to analyze the influence of the above factors and clinicopathological parameters on the recurrence free survival and to explore the influencing factors for the recurrence of synovial sarcoma. Results: Of all the patients, 73.2% (41/56) had recurrence during the follow-up. The median recurrence free survival was 19.5 months. The recurrence free 1-, 2-, 3-, 4-, and 5-year survival rates after surgery were 45.0%, 41.0%, 34.0%, 28.0%, and 28.0%, respectively. Ki-67 labeling index (LI) was 19.98%±11.64% and MVD was 51.83±21.92 per ×400. There was no significant difference in apoptotic index (AI) between the two groups (P=0.607). Χ~2 analysis showed that histological type (P=0.000) and MVD (P=0.045) were significantly correlated with the recurrence of sy-novial sarcoma. Univariate analysis showed that Ki67 LI (P=0.009), histological type (P=0.012) and radiotherapy (P= 0.014) were significantly correlated with the recurrence free survival of synovial sarcoma patients. Sex (P=0.015), tumor lo-cation (P=0.411), tumor size (P=0.801), necrosis (P=0.486), MVD (P=0.454), chemotherapy (P=0.272), and apoptotic grade (P=0.899) were not correlated with the recurrence free survival of synovial sarcoma patients. Multivariate analysis re-vealed that higher expression of Ki67 (RR=1.944, P=0.045), radiotherapy (RR=0.482, P=0.04), and histological type (RR= 0.207, P=0.031) were independent risk factors for the recurrence of synovial sarcoma. Conclusion: The expression of Ki67, radiotherapy and histological type are important factors for evaluating the recurrence and prognosis of synovial sarcoma.