Obejective To explore whether it is possible to detect the 123I-prostate-specific membrane antigen(PSMA)radiation value of the puncture tissue during prostate biopsy to achieve real-time,rapid,and accurate identification of benign and malignant prostate tissues,so as to improve the current clinical biopsy strategy and achieve accurate diagnosis of prostate cancer during operation with fewer puncture needles.Method In this prospective,diagnostic trial,we included 29 patients with suspected prostate cancer.All patients underwent transperineal biopsy guided by ultrasound within 24 hours after injection of 123I-PSMA,a total of 435 punctures were performed.The radiation value of punctured tissue was measured in real-time with a gamma counter.Pearson test is used to correlate radiation value with histopathology.Result The median radiation value of prostate cancer tissue(1 906.50 cpm)was significantly higher than that of benign prostate tissue(415.00 cpm).The optimal cut-off value for distinguishing benign and malignant prostate tissues was 828.50 cpm.The median radiation value of clinically significant prostate cancer tissue(2 652.50 cpm)was significantly higher than that of clinically insignificant prostate cancer(1 386.00 cpm).The optimal cut-off value for distinguishing clinically significant and clinically insignificant prostate cancer tissues was 1 767.00 cpm.In additional,there was a significant positive correlation between the radiation value of puncture tissue and ISUP pathological grade(r=0.834).Conclusion It is preliminarily confirmed that detection of 123I-PSMA radiation value of prostate puncture tissue can realize real-time,rapid and accurate identification of benign and malignant prostate tissues during operation.

Metastatic castration-resistant prostate cancer（mCRPC）is the terminal stage of prostate cancer，often associated with poor prognosis and limited treatment options. Prostate-specific membrane antigen（PSMA），a type Ⅱ transmembrane glycoprotein，is highly expressed on the surface of most prostate cancer cells. The expression level of PSMA is significantly associated with tumor migration and invasion，making it a critical target in the diagnosis and treatment of prostate cancer. In recent years，radioligand therapy（RLT）targeting PSMA has rapidly advanced. 177Lu-PSMA-617 delivers beta radiation from 177Lu to selectively kill prostate cancer cells by inducing DNA damage. 177Lu-PSMA-617 has demonstrated promising efficacy and safety in mCRPC，gaining widespread endorsement in global prostate cancer guidelines. This review summarizes the mechanism，clinical evidence，and progress of RLT，with a focus on 177Lu-PSMA-617，offering insights for clinical practice and research.

Objective:To evaluate the efficacy and safety of utilizing bicarbonate derived from the metabolism of regional citrate anticoagulation (RCA) as the sole base source for replacement fluid in continuous veno-venous hemofiltration (CVVH).Methods:A retrospective analysis was conducted on ICU patients who underwent RCA combined with CVVH between July 2024 and February 2025, with pre-treatment serum bicarbonate levels ranging from 18 mmol/L to 27 mmol/L. Patients managed with the "traditional RCA protocol" (4% citrate initially set at 1.2–1.5 times blood flow rate), using commercial calcium-containing replacement fluid (4 L/bag) with additional sodium bicarbonate supplementation, were assigned to the control group. Those treated with the "fixed RCA protocol" (targeting an extracorporeal citrate concentration of approximately 4 mmol/L), with a total effluent-to-citrate flow ratio of 9–10:1 and no supplemental sodium bicarbonate, were assigned to the study group. Outcomes included the incidence of metabolic acid-base disorders, amount of sodium bicarbonate used, filter lifespan, adverse events (e.g., bleeding), and 28-day mortality.Results:A total of 86 patients were enrolled, with 42 in the control group and 44 in the study group. The incidence of metabolic alkalosis was significantly higher in the control group (30.9%) than in the study group (2.3%) ( P < 0.001), while no significant difference was observed in the incidence of metabolic acidosis. Three patients in the study group received additional sodium bicarbonate during CVVH. The median sodium bicarbonate usage in the study group was 0 (0–5.6) mL, significantly lower than that in the control group [15.3 ( 8.3–24.3)] mL, P = 0.002). Filter lifespan was significantly shorter in the control group (36.4 ± 19.2 hours) compared to the study group (51.2 ± 17.6) h; P < 0.001]. Post-filter ionized calcium was significantly higher in the control group [(0.39 ± 0.08) mmol/L) than in the study group [(0.32 ± 0.09) mmol/L; P < 0.001]. CVVH was discontinued due to filter clotting in 71.4% of control patients, compared to 36.4% in the study group ( P < 0.05). In contrast, 45.5% of study group patients discontinued CVVH due to meeting treatment goals, versus only 9.5% in the control group ( P < 0.05). No treatment-related bleeding or citrate accumulation events occurred in either group. The 28-day mortality was 28.6% in the control group and 29.5% in the study group, with no statistically significant difference. Conclusions:In relatively stable patients, RCA can serve as a safe and effective independent base source for CVVH replacement fluid. This approach not only ensures adequate anticoagulation but also significantly reduces the incidence of metabolic alkalosis.

Obejective To explore whether it is possible to detect the 123I-prostate-specific membrane antigen(PSMA)radiation value of the puncture tissue during prostate biopsy to achieve real-time,rapid,and accurate identification of benign and malignant prostate tissues,so as to improve the current clinical biopsy strategy and achieve accurate diagnosis of prostate cancer during operation with fewer puncture needles.Method In this prospective,diagnostic trial,we included 29 patients with suspected prostate cancer.All patients underwent transperineal biopsy guided by ultrasound within 24 hours after injection of 123I-PSMA,a total of 435 punctures were performed.The radiation value of punctured tissue was measured in real-time with a gamma counter.Pearson test is used to correlate radiation value with histopathology.Result The median radiation value of prostate cancer tissue(1 906.50 cpm)was significantly higher than that of benign prostate tissue(415.00 cpm).The optimal cut-off value for distinguishing benign and malignant prostate tissues was 828.50 cpm.The median radiation value of clinically significant prostate cancer tissue(2 652.50 cpm)was significantly higher than that of clinically insignificant prostate cancer(1 386.00 cpm).The optimal cut-off value for distinguishing clinically significant and clinically insignificant prostate cancer tissues was 1 767.00 cpm.In additional,there was a significant positive correlation between the radiation value of puncture tissue and ISUP pathological grade(r=0.834).Conclusion It is preliminarily confirmed that detection of 123I-PSMA radiation value of prostate puncture tissue can realize real-time,rapid and accurate identification of benign and malignant prostate tissues during operation.

Metastatic castration-resistant prostate cancer（mCRPC）is the terminal stage of prostate cancer，often associated with poor prognosis and limited treatment options. Prostate-specific membrane antigen（PSMA），a type Ⅱ transmembrane glycoprotein，is highly expressed on the surface of most prostate cancer cells. The expression level of PSMA is significantly associated with tumor migration and invasion，making it a critical target in the diagnosis and treatment of prostate cancer. In recent years，radioligand therapy（RLT）targeting PSMA has rapidly advanced. 177Lu-PSMA-617 delivers beta radiation from 177Lu to selectively kill prostate cancer cells by inducing DNA damage. 177Lu-PSMA-617 has demonstrated promising efficacy and safety in mCRPC，gaining widespread endorsement in global prostate cancer guidelines. This review summarizes the mechanism，clinical evidence，and progress of RLT，with a focus on 177Lu-PSMA-617，offering insights for clinical practice and research.

Objective:To evaluate the value of 18F-prostate specific membrane antigen (PSMA)-3Q PET/CT imaging in prostate cancer patients with serum prostate specific antigen (PSA) less than 1.00 μg/L after radical prostatectomy. Methods:From May 2021 to August 2022, 18F-PSMA-3Q PET/CT images and clinical data of 58 patients with prostate cancer (age 52-82 years) after radical prostatectomy with PSA less than 1.00 μg/L in Chinese PLA General Hospital were analyzed retrospectively. According to the level of PSA, patients were divided into three groups (0-0.19 μg/L group, 0.20-0.49 μg/L group, and 0.50-0.99 μg/L group). 18F-PSMA-3Q PET/CT images were analyzed according to the standardized evaluation criteria of molecular imaging, and lesions with the scores of molecular imaging PSMA (miPSMA)≥1 were defined as recurrent or metastatic lesions. The detection rates of 18F-PSMA-3Q PET/CT for patients in different PSA level groups were compared ( χ2 test). The PSA levels of patients with positive and negative scans were compared by using independent-sample t test. Results:Of the 58 patients, 36(62.1%, 36/58) patients and 85 lesions were found by 18F-PSMA-3Q PET/CT. There was 91.7%(33/36) with oligofocal lesions (1≤number of foci≤3) and 8.3%(3/36) with multiple lesions (number of foci>3). According to the location, 5.2%(3/58) of the recurrent lesions were found in the prostatic bed, 39.7%(23/58) in the bone lesions, 37.9%(22/58) in the pelvic lymph nodes, 12.0%(7/58) in the retroperitoneal lymph nodes and 5.2%(3/58) in the left clavicular lymph node metastases. There were 15 cases in 0-0.19 μg/L group, 22 cases in 0.20-0.49 μg/L group, and 21 cases in 0.50-0.99 μg/L group. The detection rates of 18F-PSMA-3Q PET/CT in the above groups were 5/15, 59.1%(13/22) and 85.7%(18/21), respectively ( χ2=10.33, P=0.006). There was significant difference in PSA level between patients with positive ( n=36) and negative ( n=22) 18F-PSMA-3Q PET/CT scans ((0.48±0.28) vs (0.28±0.25) μg/L; t=2.67, P=0.010). Conclusions:18F-PSMA-3Q PET/CT can be used to detect the recurrence or metastasis in prostate cancer patients with PSA level lower than 1.00 μg/L after radical prostatectomy. In this kind of patients, the common sites of lesions are bone, pelvic lymph nodes, retroperitoneal lymph nodes, left clavicular lymph nodes and prostatic bed, and oligofocal patients are more common.

Objective:To analyze the necessity of anastomosis of the cutaneous nerve by comparing anterolateral femoral flaps with versus without anastomosis of the anterolateral femoral cutaneous nerve in the repair of extremity soft tissue defects.Methods:A retrospective analysis was made of the clinical data of 30 patients with extremity soft tissue defects who had been admitted to Department of Orthopedics, The Sixth People＇s Hospital affiliated to Shanghai Jiaotong University School of Medicine from September 2019 to March 2022. The patients were assigned into 2 groups according to whether the anterolateral femoral cutaneous nerve was anastomosed or not in the repair of extremity soft tissue defects using anterolateral femoral flaps. In the anastomosis groups of 14 cases, there were 7 males and 7 females, with an age of (46.4±15.2) years and a flap size of (22.4±7.3) cm×(8.5±1.3) cm. In the non-anastomosis group of 16 cases, there were 11 males and 5 females, with an age of (39.9±15.8) years and a flap size of (23.0±6.4) cm×(9.0±2.1) cm. The 2 groups were compared in terms of flap survival, Semmes-Weinstein recovery degree and area of monofilament tactile sensation, and time periods for temperature sensation and two-point discrimination.Results:There was no statistically significant difference between the 2 groups in the preoperative general data, showing they were comparable ( P>0.05). All the flaps survived completely without vascular crisis. In the anastomosis group, the time periods required for Semmes-Weinstein recovery of monofilament tactile sensation to the areas of 20.0%, 50.0%, and 80.0% [(2.5±0.7) months, (6.7±1.1) months, and (11.0±1.2) months] were significantly shorter than those in the non-anastomosis group [(3.6±1.3) months, (8.6±1.4) months, and (15.0±2.2) months], the recovery area at the last follow-up [100.0% (100.0%, 100.0%)] was significantly larger than that in the non-anastomosis group [84.6% (81.7%, 89.9%)], and the time period for recovery of temperature sensation [(3.9±0.7) months] significantly shorter than that in the non-anastomosis group [(6.1±1.1) months] (all P<0.05). The time for recovery of two-point discrimination in the 14 patients in the anastomosis group was (10.4±1.7) months while only 7 of the 16 patients in the non-anastomosis group recovered two-point discrimination after (14.7±1.4) months, showing a significant difference between the 2 groups ( P<0.05). Conclusion:In the repair of extremity soft tissue defects using anterolateral femoral flaps, compared with no anastomosis of the cutaneous nerve, anastomosis of the anterolateral femoral cutaneous nerve may ensure more or less the sensory recovery of the flaps.

Objective:To investigate the characteristics of 18F-DCFPyL PET/CT imaging in castration-resistant prostate cancer (CRPC) patients with different PSA levels. Methods:The imaging and clinical data of 50 patients with CRPC who underwent 18F-DCFPyL PET/CT examination in Chinese PLA General Hospital from January 2018 to December 2020 were analyzed retrospectively. The average age was 72 (54-95) years old. Serum total PSA was 92.28(0.36-2000.00) ng/ml. According to the total PSA level, the patients were divided into low PSA group(total PSA ≤ 1 ng/ml, n=9), medium PSA group (1 ng/ml10ng/ml, n=23). According to the standardized evaluation standard of molecular imaging, the suspicious tumor lesions on 18F-DCFPyL PET/CT imaging were scored by molecular imaging PSMA(miPSMA), and the miPSMA score ≥2 was defined as positive lesions. According to the number of lesions displayed by 18F-DCFPyL PET/CT, patients were divided into oligofocal group (the number of lesions ≤3) and multiple lesions group (the number of lesions >3). The imaging characteristics of patients in different groups were summarized. Results:The 18F-DCFPyL PET/CT imaging results of 50 cases in this study were all positive, including oligofocal group (n=27) and multiple lesions group (n=23). Of the 30 patients with unresected prostate, 18 had local recurrence of the prostate, while the other 12 patients with unresected prostate and 20 patients with resected prostate had no signs of local recurrence. The oligofocal group showed local recurrence, regional lymph node metastasis or bone metastasis. Patients with multiple lesions showed multiple lymph nodes and/or bone metastasis with or without local recurrence. There were 9, 18 and 4 patients with oligofoci in low, middle and high PSA groups, respectively.There were 27 patients in the oligonucleogenous group, and 21 of the 22 patients receiving local treatment were effective. All 3 patients treated with systemic treatments were effective. PSA progressed in 2 untreated patients. In the multi-foci group of 23 patients, 6 of 9 patients treated with abiraterone were effective. Two patients treated with enzalumide were ineffective. One of the 4 patients with chemotherapy was effective. One of the two patients treated with 177 Lu-PSMA nuclide was effective. One case did not respond to treatment with 89SrCl 2. Radiotherapy failed in 2 cases. PSA progressed in 3 untreated patients. Conclusions:18F-DCFPyLPET/CT imaging has a high detection rate of lesions in patients with CRPC and has potential guiding significance for follow-up treatment. The number of lesions in CRPC patients with different PSA levels was different, and the patients with low PSA levels were mainly oligofoci.

Objective To evaluate the outcomes of internal fixation combined with bone grafting in the treatment of distal humeral nonunion.Methods This retrospective study included 48 patients who had undergone internal fixation combined with iliac bone grafting for distal humeral nonunion between January 2011 and December 2015 at Department of Orthopedic Surgery,The Sixth People's Hospital of Shanghai.They were 31 males and 17 females,with a mean age of 35.4 years (from 22 to 49 years).The outcomes were evaluated by clinical examination,X-ray film,Mayo elbow performance score (MEPS) and visual analogue scale (VAS) during follow-up.Results All the 48 patients were followed up for 18 to 60 months (mean,36 months).No wound-related complications were reported in this cohort.Solid bone union was achieved at 3 to 8 months (mean,4.2 months) after surgery.At the last follow-up,the range of elbow flexion-extension was improved from preoperative 66° to 101°,and the ranges of pronation and supination were enhanced from 65° and 45° preoperatively to 82° and 75°,respectively.The MEPS increased from 54 points preoperatively to 82 points postoperatively.The results were excellent in 26,good in 16 and fair in 6 cases (with an excellent to good rate of 87.5％).The VAS decreased from 4.5 points preoperatively to 1.2 points postoperatively,indicating notable relief of the elbow pain due to distal humeral nonunion.Follow-ups revealed no ulnar nerve injury,nonunion,heterotopic ossification,implant loosening or breakage,or instability of the elbow joint.Conclusion Internal fixation combined with bone grafting is reliable in treatment of distal humeral nonunion,leading to satisfactory outcomes.

Objective? To explore the method and effects of construction of operating room information management system based on Healthcare Information and Management Systems Society 7 (HIMSS 7) standards. Methods? There were problems in traditional operating room information management system analyzed by department of anesthesiology and operating, Xuanwu Hospital, Capital Medical University. The operating room information management system was reconstructed and applied based on HIMSS 7. The process included nursing recording electronically, completing tripartite check and confirmation by using USB key or digital authentication software, viewing electronic medical record in nurse operator interface, realizing drug closed-loop management by importing intelligent medicine cabinet, informationalized pathology management, landing integration platform by single-point and so on. Results? Reconstruction of system met the demands of HIMSS 7 hospital level judgment, reduced the workload of medical staff and improved work efficiency. Conclusions? Reconstruction of operating room information management system based on HIMSS 7 standards can improve the work efficiency of staff in operating room and enhance perioperative safety factor of patients.