Objective: To investigate the clinical efficacy of transurethral 450 nm blue laser vaporization of prostate (BVP) and transurethral plasmakinetic resection of the prostate (PKRP) in the treatment of frail elderly patients with benign prostatic hyperplasia (BPH). Methods: A retrospective analysis was conducted on the clinical data of 62 frail elderly BPH patients undergoing BVP (n=32) or PKRP (n=30) in our hospital during Jan.2023 and Jun.2024.The two groups were compared in terms of postoperative hemoglobin drop, operation time, hospital stay, catheter indwelling time, bladder irrigation time, preoperative and postoperative 3-month postvoid residual (PVR), maximum urinary flow rate (Qmax), international prostate symptom score (IPSS), quality of life score (QoL), and postoperative complications. Results: The postoperative hemoglobin drop was lower in the BVP group than in the PKRP group [(1.62±1.04) g/L vs.(7.37±2.37) g/L, P＜0.001].The operation time [(24.53±7.52) min vs. (47.77±11.12) min], hospital stay [(2.78±1.62) d vs. (8.13±0.82) d], catheter indwelling time [(1.84±0.99) d vs. (5.40±0.81) d], and bladder irrigation time [(7.37±2.35) h vs. (51.60±19.72) h] were significantly shorter in the BVP group than in the PKRP group (all P＜0.001).At 3 months postoperatively, both groups showed significant improvements in IPSS, QoL, Qmax, and PVR compared to preoperative levels (P＜0.05), but there were no significant differences between the two groups (P>0.05).The overall incidence of early postoperative complications in the BVP group was lower than that in PKRP group (18.75% vs. 43.33%, P＜0.05).After 3 months of follow-up, there was no significant difference in the incidence of complications between the BVP group and PKRP group(3.13% vs. 13.33%, P=0.14). Conclusion: BVP for the treatment of frail elderly BPH patients is safe and reliable, associated with minimal bleeding, short operation time, catheterization time and hospital stay, and there is no need to discontinue anticoagulant drugs.

Objectives:To establish a risk prediction model for gastrointestinal bleeding after cardiopulmonary bypass heart surgery,and to verify the prediction efficacy. Methods:A total of 1 002 patients who underwent cardiopulmonary bypass heart surgery in the department of cardiac great vascular surgery of our hospital from January 2019 to November 2023 were collected by convenient sampling method.They were divided into gastrointestinal bleeding group(n=47)and non-gastrointestinal bleeding group(n=955).Logistic regression analysis was used to establish the risk prediction model,and the area under ROC curve test and Hosmer-Lemeshow χ2 test were used to compare the two groups of data Model prediction effect.Bootstrap method was used for internal validation. Results:The risk prediction model of gastrointestinal bleeding after cardiopulmonary bypass heart surgery included four predictors:time of aortic occlusion(OR=1.021,95%CI:1.012-1.030),history of digestive disease(OR=5.710,95%CI:1.697-19.212),use of intra-aortic balloon counterpulsation(OR=22.180,95%CI:5.870-83.808),and continuous kidney replacement therapy(OR=12.159,95%CI:5.066-29.181).Model formula:Logit(P)=-5.821+0.021×time of aortic occlusion+1.742×history of digestive disease+3.099×whether intra-aortic balloon counterpulsation was used+2.498×whether continuous renal replacement therapy was used.The area under ROC curve was 0.812(95%CI:0.746-0.877),sensitivity was 64.6%,specificity was 85.7%,and Youden index was 0.503.After internal validation by Bootstrap method,the consistency index after correction is 0.813. Conclusions:The risk prediction model constructed in this study cohort has a good auxiliary prediction performance for the occurrence of gastrointestinal bleeding after cardiopulmonary bypass surgery,which is helpful for risk stratification for gastrointestinal bleeding after cardiopulmonary bypass surgery and facilitate clinical decision-making in daily clinical work.

ObjectiveTo analyze and determine the differential components of freeze-dried and sun-dried Panacis Quinquefolii Radix（PQR）， and to compare the differences in their pro-angiogenic activities. MethodFingerprints of freeze-dried and sun-dried PQR were established based on ultra performance liquid chromatography（UPLC）， and chemometrics methods such as principal component analysis（PCA） and orthogonal partial least squares-discriminant analysis（OPLS-DA） were combined to determine the differential saponin composition of the two decoction pieces， and six representative saponins were selected and their contents in freeze-dried and sun-dried PQR were determined by UPLC. Transgenic zebrafish line Tg（fli1a∶EGFP） embryos fertilized for 24 h were selected， and different doses of 70% methanol extracts of freeze-dried and sun-dried PQR（10， 30 mg·L^-1） were used to intervene in normal zebrafish and in a zebrafish model of intersegmental vascular（ISV） injury induced by vascular endothelial growth factor（VEGF） receptor tyrosine kinase inhibitor Ⅱ（PTK787）， then the development of subintestinal vein（SIV） and ISV of zebrafish was observed， SIV diameter， mean number of crossings and mean number of germinations were determined， and the ISV vascular index was calculated， in order to compare the pro-angiogenic activities of the two decoction pieces. ResultThe similarity of the fingerprints of freeze-dried and sun-dried PQR decoction pieces was>0.950， and 17 common peaks were identified， of which 6 common peaks were designated as peak 6（ginsenoside Rg₁）， peak 7（ginsenoside Re）， peak 8（ginsenoside Rb₁）， peak 11（ginsenoside Rc）， peak 13（ginsenoside Rb₂）， and peak 16（ginsenoside Rd）， respectively. A total of 11 differential saponin components were screened by PCA and OPLS-DA， indicating that there were some differences in the contents of the components in the two decoction pieces. The results of determination showed that the contents of ginsenosides Rg₁， Re， Rb₁ and Rb₂ in freeze-dried PQR were higher than those in sun-dried PQR， while the contents of ginsenosides Rc and Rd were lower than those in sun-dried PQR（P<0.05， P<0.01）. In the study of the pro-angiogenic effect on normal zebrafish embryos， compared with the blank group， and the SIV vessel diameter， mean germination rate and mean crossover rate were significantly higher in the high-dose groups of freeze-dried and sun-dried PQR（P<0.01）， and the vessel diameter， mean numbers of crossings and germinations in the freeze-dried PQR group were higher than those of the sun-dried PQR group（P<0.05）. In the study of the pro-angiogenic effect on zebrafish embryos with ISV injury， the development of ISV in the model group was significantly inhibited when compared with the blank group， compared with the model group， different dose groups of freeze-dried and sun-dried PQR could promote the growth and sprouting of ISV， and the number of normal blood vessels in the freeze-dried PQR group was significantly higher than that in the sun-dried PQR group at the same dosage（P<0.05）. ConclusionFreeze-drying can effectively avoid the loss and secondary transformation of ginsenosides in PQR， and its angiogenic activity is better than that of sun-dried PQR， which can provide a reference for the production and development of high-quality PQR decoction pieces.

Objective:To investigate the association between CITP/MMP-1 ratio and the severity of Myocardial fibrosis (MF) in patients with Chronic Heart failure (CHF) and its diagnostic and prognostic value in patients with MF.Methods:A retrospective study was conducted to select 110 cases [86 males, (56.60±11.15) years old;24 females, (60.06±12.02) years old] who were hospitalized in the Department of Cardiology, Teda International Cardiovascular Hospital from May 18, 2021 to February 30, 2022 and underwent magnetic magnetic examination. Serum CITP and MMP-1 were detected by enzyme-linked immunoassay and CITP/MMP-1 ratio was calculated. Plasma brain natriuretic peptide (BNP) was detected by automatic chemiluminescence analyzer. Anova and non-parametric test were used to compare the difference of indexes among all groups. Spearman analysis was used to analyze the correlation between serum collagen metabolites and the severity of myocardial fibrosis. Logistic regression analysis was performed for multivariate analysis, and ROC curve was used to evaluate the auxiliary diagnostic value of related indexes. Major adverse cardiac events within 1 year after discharge were recorded, including cardiogenic death, HF rehospitalization, malignant arrhythmia, and myocardial infarction. The risk factors of poor prognosis were analyzed by Cox regression. Patients were divided by the median value of CITP/MMP-1 ratio or the median value of CITP/MMP-1 ratio and BNP. Survival analysis was performed by Kaplan-Meier and Log Rank test was performed.Results:Serum MMP-1 and BNP in LGE (+) group were higher than those in LGE (-) group (1.79 ng/ml > 0.91 ng/ml, Z=-2.924; 503 pg/ml > 367 pg/ml, Z=-1.932; P<0.05); The CITP/MMP-1 ratio in the LGE (+) group was lower than that in the LGE (-) group (3.84 < 10.85, Z=-3.601, P<0.001). MMP-1 in CHF with arrhythmia group was higher than that in CHF group (1.98 ng/ml > 1.25 ng/ml, Z=-2.016), while CITP/MMP-1 ratio was lower than that in CHF group (3.25 < 5.73, Z=-2.751), all P<0.05. CITP/MMP-1 ratio in CHF patients was negatively correlated with the severity of MF ( r=-0.363, P<0.001), and BNP and MMP-1 were positively correlated with the severity of MF ( r=0.267, r=0.264, P<0.05). Serum BNP was positively correlated with collagen metabolite MMP-1 and negatively correlated with CITP/MMP-1 ratio (all P<0.05). Logistic multivariate regression analysis showed that only CITP/MMP-1 was a predictor of myocardial fibrosis, with an OR value of 0.624 ( P=0.005). ROC curve was used to evaluate serum BNP, MMP-1 and CITP/MMP-1 ratio in the diagnosis of myocardial fibrosis in HF patients, with AUC of 0.653, 0.696 and 0.754, respectively. The accuracy of CITP/MMP-1 ratio in diagnosing fibrosis was better than that of BNP by comparing their AUC, and the difference was statistically significant ( Z=-3.808, P<0.001). Cox regression analysis showed that CITP/MMP-1 ≤3.84 was a risk factor for poor prognosis, OR=2.647 ( P=0.009). Kaplan-Meier survival analysis at 1-year follow-up showed that the survival rate of the group with lower CITP/MMP-1 ratio was significantly lower than that of the group with higher CITP/MMP-1 ratio ( P=0.014). The survival rate of CITP/MMP-1 increased and BNP decreased group was higher than that of CITP/MMP-1 decreased and BNP increased group ( P=0.011). Conclusions:The ratio of CITP/MMP-1 can be used as a negative correlation indicator of the degree of cross-linking, which is better than BNP in the evaluation of MF, and has a good auxiliary diagnostic value for myocardial fibrosis in patients with chronic heart failure, and is expected to become a protective indicator for patients with chronic heart failure and be used in clinical evaluation of myocardial fibrosis. CITP/MMP-1 ratio is associated with the incidence of major adverse cardiac events, and CITP/MMP-1 ≤3.84 can be used as a predictor of prognostic adverse cardiovascular events in CHF patients.

Objective:To investigate the effects and significance of α-synuclein(α-syn)on the expression level of β-arrestin 2 in Parkinson's disease(PD)in a mouse model.Methods:Twenty-eight C57BL/6J mice with similar motor skills were randomly divided into a model group and a control group, with 14 mice in each group.A PD model was established by injecting preformed fibrils of α-syn into the striatum of the brain, and behavioral changes were monitored after 4 weeks.The expression levels of α-syn, the dopamine receptor(DR), tyrosine hydroxylase(TH), inflammatory factors, β-arrestin 2 and the nuclear transcription factor-κB(NF-κB)signaling pathway-related proteins were determined by Western blotting.The interaction between α-syn and β-arrestin 2 was detected by fluorescence resonance energy transfer(FRET), and the regulation of α-syn on β-arrestin 2 transcriptional activation was detected by the dual luciferase report assay.Results:After 4 weeks of modeling, compared with the control group, the average movement speed of mice in the model group was significantly reduced( t=9.415, P<0.001), the movement track was sparse and concentrated around the open field, and the time needed to climb the pole was significantly prolonged( t=16.412, P<0.001). Compared with the control group, the relative expression of α-synin in astrocytes in the model group increased significantly, the relative expressions of D1DR and TH decreased significantly[(1.14±0.18) vs.(0.53±0.16), (0.67±0.13) vs.(1.15±0.11), (0.46±0.05) vs.(0.81±0.06)]( t=9.810, 10.917 and 17.356, all P<0.001), the relative expression of tumor necrosis factor-α, interleukin-1β, interleukin-6 and NF-κB signaling pathway-related proteins increased significantly( t=3.583, 4.284, 5.396, 11.747, 16.375 and 18.294, all P<0.001), and the relative expression of β-arrestin 2 protein[(0.42±0.11) vs.(1.33±0.14)]in astrocytes decreased significantly( t=19.795, P<0.001). The FRET results suggested a possible direct interaction between α-syn and β-arrestin 2.The results of the dual luciferase report assay showed that the transcription activity of β-arrestin 2 was significantly increased after α-syn gene knockout. Conclusions:The α-syn may induce inflammation in astrocytes by activating the NF-κB signaling pathway and participate in the pathogenesis of PD by reducing dopamine biosynthesis and inhibiting its physiological function through negative regulation of β-arrestin 2.

Objective:To observe the expression level of β-arrestin 1/2 in mice with Parkinson's disease(PD)and its relationship with pathogenesis of PD.Methods:PD model was prepared by using 1-methyl-4-phenyl-1, 2, 3, 6-tetrahydropyridine hydrochloride(MPTP). The mice were killed at 3 days after the last administration and the brain tissue was taken for observing brain histopathological changes.The colocalization of β-arrestin1/2 with microglia was detected by using immunofluorescence double-labeling of β-arrestin1/2 and microglia.Tyrosine hydroxylase(TH)and Iba-1 were used to label cells, and then the loss of dopaminergic neurons and the activation of microglia were observed by immunohistochemistry.Results:As compared with the blank control group, the relative expression level of β-arrestin1 protein in brain tissue of PD mice was increased significantly, while the relative expression level of β-arrestin2 protein was decreased significantly( t=11.535, 9.948, both P=0.000), and β-arrestin1/2 shared cell localization with microglia.After MPTP induced PD, the number of Th + neurons in SNc area of midbrain was decreased significantly in β-arrestin1 + /+ group and β-arrestin1 -/- group( t=4.098, 3.571, P=0.000, 0.001), while the number of Iba-1 + cells in SNc area of midbrain was increased significantly( t=10.097、6.448, both P=0.000). After MPTP induced PD, the number of Th + neurons in SNc area of midbrain was decreased significantly in β-arrestin2 + /+ group and β-arrestin2 -/- group( t=3.512, 5.237, P=0.001, 0.000), while the number of Iba-1 + cells in SNc area of midbrain was increased significantly( t=5.816、8.402, P=0.000). Compared with β-arrestin1 + /+ group, the expressions of TRAF6, NF-κB and COX-2 in mouse microglia were significantly increased in β-arrestin1 -/- group( t=5.324, 5.837, 9.350, all P=0.0000). Compared with β-arrestin2 + /+ group, the expressions of TRAF6, NF-κB and COX-2 in mouse microglia were significantly down-regulated in β-arrestin2 -/- group( t=5.094, 6.318, 9.466, all P=0.000). Conclusions:The expression of β-arrestin1 is up-regulated and β-arrestin2 is down-regulated in brain tissue of PD mice.β-arrestin1/2 may affect the proliferation and activation of microglia and the loss of dopaminergic neurons through TRAF6/NF-κB/COX-2 pathway, and participate in the pathological process of PD.

Objective:To explore the clinical significance of multi-sample next-generation sequencing (NGS) in detecting gene mutations in non-small cell lung cancer (NSCLC), so as to provide a basis for individualized targeted treatment.Methods:The data of 51 patients with NSCLC in the First Affiliated Hospital of Zhejiang University Medical College from June 2016 to February 2019 was retrospectively analyzed. The patients' age, gender, smoking status, pathological type, tumor staging, pleural invasion status and meningeal invasion status were collected, and the tissues, cerebrospinal fluid, pleural effusion and plasma samples were detected by NGS. The correlations between the driver gene mutations [epidermal growth factor receptor (EGFR), anaplastic lymphoma kinase (ALK), and ROS proto-oncogene 1, receptor tyrosine kinase (ROS1)] and the clinicopathological features of patients were analyzed by χ 2 test or Fisher exact probability method. Cohen Kappa coefficient analysis was used to compare the consistency of NGS detection results in different samples. Results:Among the 51 patients, 3 different types of specimens were examined in 7 patients. Of which, the driver gene mutations were all positive in 3 cerebrospinal fluid samples and double gene mutations were found in 2 hydrothorax samples. Driver gene mutations were more common in female [90.48% (19/21) vs. 50.00% (15/30), χ 2 = 9.107, P = 0.003], non-smokers [80.00% (24/30) vs. 47.62 (10/21), χ 2 = 5.829, P = 0.016], adenocarcinoma patients [72.34% (34/47) vs. 0, P = 0.017] and patients with malignant pleural effusion [92.86% (13/14) vs. 56.76% (21/37), χ 2 = 4.443, P = 0.035], and the differences were statistically significant. However, there was no statistically significant difference in mutations of driver gene among patients with different age or tumor stages (both P > 0.05). The consistency rate of genetic test results of the driver gene mutations in 37 plasma samples and matched tissue samples was 70.27% (26/37), κ value was 0.430, which suggested a good consistency between them. Conclusions:In patients with advanced NSCLC, gene detection of cerebrospinal fluid is of high application value for patients with meningeal metastasis; for patients with pleural invasion, gene detection of pleural effusion is an effective means to screen targeted therapy drugs. NGS detection of multiple specimens can better reflect the status of gene mutations and guide the individualized targeted therapy of lung cancer patients.

Objective:To investigate the gap between the health education and the best evidence among nurses and patients with postdialysis fatigue (PDF) , find out the problems and analyze the reasons, and provide a reference and basis for future clinical nursing decisions among the dialysis room nurses.Methods:By searching the evidence-based guideline websites and integrating the best evidence comprehensively, a health knowledge questionnaire for dialysis room nurses and patients with PDF was made. In December 2018, a total of 7 nurses and 56 patients in the dialysis room of Dongzhimen Hospital, Beijing University of Chinese Medicine were selected by purpose sampling method, and they were investigated by the health knowledge questionnaire for dialysis room nurses and patients.Results:The score of the PDF knowledge questionnaire for the 7 nurses was (56.43±4.37) , with a highest score of 64 and a lowest score of 51, and the standard-reaching rate was 28.57% (2/7) . The score of the PDF knowledge questionnaire for the 56 patients was (52.41±9.54) , with a highest score of 70 and a lowest score of 20, and the standard-reaching rate was 28.57% (16/56) . Patients and nurses received verbal health education and small lectures in the department, and there was no unified education content.Conclusions:There is no unified and scientific education content nor standardized education model. Evidence-based health education should be carried out for nurses to improve the awareness of nurses and patients in this regard, thereby reducing patients' fatigue.

Objective To analyze the echocardiographic findings , associated anomalies and chromosomal characteristics in fetuses with pulmonary atresia with ventricular septal defect ( PA/VSD ) . Methods T he echocardiographic data and follow‐up materials were retrospectively reviewed in 30 256 fetuses from December 2012 to M arch 2018 in the consultation center of fetal heart disease in maternal‐fetal medicine in Anzhen hospital . Of all the fetuses ,59 cases ( 0 .19% ) had PA/VSD . T he echocardiographic findings ,associated anomalies and chromosomal characteristics were retrospectively analyzed in all the 59 fetuses with PA/VSD . Based on w hether the presence of the native pulmonary arteries and the major aortopulmonary collateral arteries ( M APCAs) or not ,the PA‐VSD was classified into type A ,type B ,and type C . Results A large ventricular defect was demonstrated in five‐chamber view with 61 .7% of the mean ratio of the aortic overriding . O ther fetal echocardiographic features of all the 59 fetuses with PA/VSD included :the right aortic arch ( n ＝19 ) ,reversal flow in the ductus arteriosus ( n ＝40 ) ,M APCAs ( n ＝24) . T he classification of the PA/VSD included :type A ( n ＝35) ,type B ( n ＝5) and type C ( n ＝19) . Associated anomalies :persistent left superior vena cava ( n ＝ 13 ) ,anomalous pulmonary vein connection ( n＝5 ) ,complete atrioventricular septal defect ( n ＝ 5 ) ; single umbilical artery ( n ＝ 3 ) ,right atrial isomerism ( n ＝3) . Of all the 30 cases performed chromosomal test ,3 cases had aneuploidy and 7 cases had microdeletion of chromosome . Conclusions The fetal echocardiographic findings of the PA/VSD are characteristic . For prenatal diagnosis of PA/VSD ,the type of PA/VSD should be defined and chromosomal test should be performed ,w hich can be helpful for prenatal consulting .

Objective: To investigate the hearing loss and speech disorders in the elderly, to analyze the risk factors of the elderly deafness, as well as to provide reference for the clinical research of the elderly deafness. Methods: From March 2016 to March 2018, 913 elderly people, who were tested for hearing and speech disorders, were examined by a unified questionnaire to investigate the demographic data of the subjects and the related factors of deafness, and the hearing and speech recognition tests were carried out. According to the hearing loss, the hearing impaired group was divided into the hearing impaired group (500, 1 000, 2 000 and 4 000 Hz, the average hearing threshold>25 dBHL) and the non hearing impaired group (the average hearing threshold of the four frequencies ≤25 dBHL), and then the single factor analysis and the unconditional Logistic regression analysis were used. Finally, the risk factors of senile deafness were analyzed. Results: Of the 913 elderly subjects in the survey, 389 (42.61%, 389/913) had no hearing impaired, 345 (37.79%, 345/913) were mild hearing impaired, and 149 (16.32%, 149/913) had moderate hearing loss. Twenty-six patients were severe hearing loss (2.85%, 26/913); 4 patients had severe hearing loss (0.44%, 4/913). Among the 524 hearing-impaired elderly, there were 244 speech-recognition disorders (46.56%, 244/524), of whom 106 were mild hearing-impaired, accounting for 30.72% (106/345), 108 were moderate hearing loss, accounting for 72.48% (108/149), 26 were severe hearing loss, accounting for 100% (26/26), and 4 were the profound hearing loss, accounting for 100% (4/4). Statistical analysis showed that the age, job status, history of hypertension, history of hyperglycemia, and smoking history were independent risk factors for senile hearing loss (P<0.05). Conclusions High incidences of hearing and speech recognition obstacle are found in health examination for the elderly patients. Noise exposure, age, history of hypertension, high blood sugar, and smoking history are high-risk factors for senile deafness, therefore, prevention and rehabilitation programs are urgent to be developed.