Objective To explore the molecular mechanism of Jianfu mixture in the treatment of erectile dysfunction （ED） by network pharmacology and molecular docking techniques, and validate its core targets and mechanisms through in vitro experiments. Methods The active components and corresponding molecular targets of Jianfu mixture were searched by searching TCMSP and Batman-TCM databases, and the disease targets of ED were searched by using GeneCards database. Find the intersection of drug ingredient target and disease target. The interaction between intersected targets was described and analyzed by String database, and the analysis results were visualized by Cytoscape software to determine the core target and the corresponding active components. GO functional enrichment analysis and KEGG pathway enrichment analysis were performed for intersection targets; the core target within the intersection were found through MCODE plug-in on Cytoscape software and molecular docking was performed with the corresponding active ingredients. An endothelial dysfunction model was established by transfecting HUVECs with si-eNOS. Intervene with different concentrations of the Jianfu mixture for the model cells for 24 h. QPCR was used to detect mRNA expression of core targets （MAPK1, MAPK3, JUN, ESR1, MAPK8）; Western blot was used to analyze protein expression （eNOS, JUN, p-JUN, MAPK, p-MAPK） and phosphorylation levels. Results 144 effective active components and 168 active components target-disease targe intersection of Jianfu mixture were obtained. GO analysis revealed 200 5 biological processes, 151 molecular functions, and 63 cellular components. KEGG analysis yielded 181 pathways. 5 core targets including MAPK1, MAPK3, JUN, ESR1 and MAPK8 were screened out. The active components such as β-sitosterol, kaempferol, astapterocarpan had good binding affinity with the core target. In vitro experiments confirmed successful construction of the endothelial dysfunction model （eNOS expression significantly decreased after si-eNOS transfection）. Jianfu mixture dose-dependently inhibited mRNA expression of MAPK1, MAPK3, JUN, ESR1, and MAPK8. Additionally, it reduced phosphorylation levels of JUN and MAPK, indicating inhibition of the JNK/c-Jun and ERK/MAPK signaling pathways to improve endothelial function. Conclusion Jianfu mixture treats ED by suppressing abnormal activation of multi-target signaling pathways （MAPK/JUN/ESR1）, reducing endothelial apoptosis, and promoting NO synthesis. This mechanism aligns with the traditional Chinese medicine principle of “activating blood circulation, resolving stasis, tonifying Qi, and strengthening cardiovascular function.” The study provided molecular-level evidence for the therapeutic efficacy of Jianfu mixture in ED management.

Objective To explore the molecular mechanism of Jianfu mixture in the treatment of erectile dysfunction （ED） by network pharmacology and molecular docking techniques, and validate its core targets and mechanisms through in vitro experiments. Methods The active components and corresponding molecular targets of Jianfu mixture were searched by searching TCMSP and Batman-TCM databases, and the disease targets of ED were searched by using GeneCards database. Find the intersection of drug ingredient target and disease target. The interaction between intersected targets was described and analyzed by String database, and the analysis results were visualized by Cytoscape software to determine the core target and the corresponding active components. GO functional enrichment analysis and KEGG pathway enrichment analysis were performed for intersection targets; the core target within the intersection were found through MCODE plug-in on Cytoscape software and molecular docking was performed with the corresponding active ingredients. An endothelial dysfunction model was established by transfecting HUVECs with si-eNOS. Intervene with different concentrations of the Jianfu mixture for the model cells for 24 h. QPCR was used to detect mRNA expression of core targets （MAPK1, MAPK3, JUN, ESR1, MAPK8）; Western blot was used to analyze protein expression （eNOS, JUN, p-JUN, MAPK, p-MAPK） and phosphorylation levels. Results 144 effective active components and 168 active components target-disease targe intersection of Jianfu mixture were obtained. GO analysis revealed 200 5 biological processes, 151 molecular functions, and 63 cellular components. KEGG analysis yielded 181 pathways. 5 core targets including MAPK1, MAPK3, JUN, ESR1 and MAPK8 were screened out. The active components such as β-sitosterol, kaempferol, astapterocarpan had good binding affinity with the core target. In vitro experiments confirmed successful construction of the endothelial dysfunction model （eNOS expression significantly decreased after si-eNOS transfection）. Jianfu mixture dose-dependently inhibited mRNA expression of MAPK1, MAPK3, JUN, ESR1, and MAPK8. Additionally, it reduced phosphorylation levels of JUN and MAPK, indicating inhibition of the JNK/c-Jun and ERK/MAPK signaling pathways to improve endothelial function. Conclusion Jianfu mixture treats ED by suppressing abnormal activation of multi-target signaling pathways （MAPK/JUN/ESR1）, reducing endothelial apoptosis, and promoting NO synthesis. This mechanism aligns with the traditional Chinese medicine principle of “activating blood circulation, resolving stasis, tonifying Qi, and strengthening cardiovascular function.” The study provided molecular-level evidence for the therapeutic efficacy of Jianfu mixture in ED management.

Objective:To explore the effects of holmium laser enucleation of the prostate with early complete transection of the urethral mucosa at the tip of the prostate on urinary control function and sexual function in patients with benign prostatic hyperplasia (BPH).Methods:Eighty patients with BPH who underwent holmium laser enucleation of the prostate in the Affiliated Hospital of Yan′an University from January 2019 to January 2023 were collected as the research subjects. The patients were divided into the observation group and the control group by the random number table method, with 40 cases in each group. The observation group underwent early holmium laser enucleation of the prostate with early complete transection of the urethral mucosa at the tip of the prostate, while the control group underwent conventional holmium laser prostatectomy. The general conditions, urinary control function and sexual function of the two groups of patients after the operation were compared. The adverse ejaculation conditions 6 months after the operation were recorded.Results:There was no statistically significant difference in age and prostate volume between the two groups of patients (all P>0.05). The operation time, intraoperative blood loss, postoperative indwelling urinary catheter time and postoperative hospital stay in the observation group were significantly less than those in the control group (all P<0.05). The International Prostate Symptom Scale (IPSS) score, Quality of Life (QOL) score, the maximum flow rate (Qmax), and post void residual (PVR) in the bladder of the two groups of patients 6 months after the operation were compared with those before the operation, and the differences were statistically significant (all P<0.05), while there were no statistically significant differences between the groups (all P>0.05). There were no statistically significant differences in the International Index of Erectile Function (IIEF-5) scores and Erection Hardness Grading Scale (EHGS) grades of the two groups of patients 6 months after surgery compared with those before surgery (all P>0.05), and there were also no statistically significant differences between the groups (all P>0.05). There was no statistically significant difference in the ejaculation function score and ejaculation distress score 6 months after the operation in the observation group compared with those before the operation (all P>0.05), while in the control group, the ejaculation function score 6 months after the operation was lower than that before the operation, and the ejaculation distress score was higher than that before the operation (all P<0.05). The ejaculation function score and ejaculation distress score of the observation group 6 months after the operation were significantly better than those of the control group (all P<0.05). The incidences of retrograde ejaculation and reduced semen volume 6 months after the operation in the observation group were both lower than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of rapid ejaculation, ejaculation pain, hematospermia, etc. between the two groups of patients 6 months after the operation (all P>0.05). Conclusions:In holmium laser enucleation of the prostate, early complete transection of the urethral mucosa at the tip of the prostate has an improving effect on urinary control function and sexual function in patients with BPH, and increases the confidence in postoperative life and satisfaction with orgasm of BPH patients.

Objective:To explore the effects of holmium laser enucleation of the prostate with early complete transection of the urethral mucosa at the tip of the prostate on urinary control function and sexual function in patients with benign prostatic hyperplasia (BPH).Methods:Eighty patients with BPH who underwent holmium laser enucleation of the prostate in the Affiliated Hospital of Yan′an University from January 2019 to January 2023 were collected as the research subjects. The patients were divided into the observation group and the control group by the random number table method, with 40 cases in each group. The observation group underwent early holmium laser enucleation of the prostate with early complete transection of the urethral mucosa at the tip of the prostate, while the control group underwent conventional holmium laser prostatectomy. The general conditions, urinary control function and sexual function of the two groups of patients after the operation were compared. The adverse ejaculation conditions 6 months after the operation were recorded.Results:There was no statistically significant difference in age and prostate volume between the two groups of patients (all P>0.05). The operation time, intraoperative blood loss, postoperative indwelling urinary catheter time and postoperative hospital stay in the observation group were significantly less than those in the control group (all P<0.05). The International Prostate Symptom Scale (IPSS) score, Quality of Life (QOL) score, the maximum flow rate (Qmax), and post void residual (PVR) in the bladder of the two groups of patients 6 months after the operation were compared with those before the operation, and the differences were statistically significant (all P<0.05), while there were no statistically significant differences between the groups (all P>0.05). There were no statistically significant differences in the International Index of Erectile Function (IIEF-5) scores and Erection Hardness Grading Scale (EHGS) grades of the two groups of patients 6 months after surgery compared with those before surgery (all P>0.05), and there were also no statistically significant differences between the groups (all P>0.05). There was no statistically significant difference in the ejaculation function score and ejaculation distress score 6 months after the operation in the observation group compared with those before the operation (all P>0.05), while in the control group, the ejaculation function score 6 months after the operation was lower than that before the operation, and the ejaculation distress score was higher than that before the operation (all P<0.05). The ejaculation function score and ejaculation distress score of the observation group 6 months after the operation were significantly better than those of the control group (all P<0.05). The incidences of retrograde ejaculation and reduced semen volume 6 months after the operation in the observation group were both lower than those in the control group (all P<0.05). There was no statistically significant difference in the incidence of rapid ejaculation, ejaculation pain, hematospermia, etc. between the two groups of patients 6 months after the operation (all P>0.05). Conclusions:In holmium laser enucleation of the prostate, early complete transection of the urethral mucosa at the tip of the prostate has an improving effect on urinary control function and sexual function in patients with BPH, and increases the confidence in postoperative life and satisfaction with orgasm of BPH patients.

Objective:To evaluate the relevant factors to optimize the learning curve and the impact of the basic skills of endoscopic technology on the learning curve of gasless transaxillary posterior endoscopic thyroidectomy.Methods:A retrospective analysis was performed to evaluate the clinical outcomes of 50 patients who underwent Glandular Ultrasound-Assisted (GUA) thyroid surgery by a surgeon with a background in endoscopic thyroid surgery via the thoracic-areolar approach, and 50 patients operated on by a surgeon without such experience at the Thyroid Surgery Department of Jilin University China-Japan Union Hospital from Apr. to Dec. 2023. The patients were divided into two groups: the Endoscopic Experience Group and the Non-Endoscopic Experience Group. The Cumulative Sum Control Chart (CUSUM) was applied to construct learning curves for both groups, dividing the technical exploration period from the mastery period. The analysis compared the surgical time, postoperative first-day drainage volume, number of central lymph nodes dissected rates, and postoperative complications between the two groups and across the two phases.Results:The analysis of the learning curve revealed that the inflection point of the Endoscopic Experience Group was 15, while of the Non-Endoscopic Experience Group was 18. The learning curve was divided into the technical exploration stage and the proficient mastery stage. The operative time of technical exploration stagde was significantly longer than of proficient mastery stage of both group (183.46±36.13min vs.144.40±26.14min, P<0.001; 186.89±48.91min vs.131.59±22.90min; P<0.001) . The operative time in the proficient mastery stage of the Endoscopic Experience Group was longer than that of the Non-Endoscopic Experience Group (144.40±26.15min vs. 131.59±22.90min, P<0.05) . The postoperative drainage volume in the Endoscopic Experience Group was lower than that in Non-Endoscopic Experience Group in both stages (65.40±32.48mL vs.93.22±30.67mL, 57.40±15.35mL vs.78.50±28.30mL, P<0.05) , and the postoperative drainage volume in the proficient mastery stage of the Non-Endoscopic Experience Group was significantly lower than in the technical exploration stage (93.22±30.67mL vs.78.50±28.30mL, P<0.05) .No significant differences in central lymph node dissection numbers or postoperative complications were observed between the groups at both stages. Conclusions:There is a specific learning curve in the early stage of gasless transaxillary posterior endoscopic thyroidectomy. After crossing the learning curve, the operation time is obviously shortened with the improvement of the operator's surgical technique.Having a basic understanding of endoscopic technology in the early stage can reduce the occurrence of postoperative drainage, but has a minimal impact on the learning curve.

Objective:To investigate the status and diagnostic reference levels (DRLs) of adult CT radiation dose based on survey result from some hospitals in Beijing.Methods:From September to December 2023, the survey results for 50 hospitals were collected in Beijing, including 47 tertiary hospitals and 3 second grade general hospitals. The CT data sets in total of 20 items including head (sequential scanning), head (spiral scanning), head perfusion, sinus, neck, chest, chest (low dose scanning), abdomen, pelvis, abdomen-pelvis, chest-abdomen-pelvis, lumbar spine, CT urography, coronary CTA (retrospective), coronary CTA (prospective), head CTA, neck CTA, aorta CTA, leg CTA and knee were collected on clinical commonly used CT scanners with annual qualified state inspection. For each item, radiation dose data was collected continuously and randomly for up to 50 cases for every CT scanner. Using the volume CT dose index (CTDI vol) and dose length product (DLP) as dose parameters, the median value of each item in each hospital was obtained. The median CTDI vol and DLP values of all hospitals were arranged, and the local DRL of each item was set as the 75th percentile of the median values. The obtained DRLs were compared with the DRLs issued by domestic and international radiological protection organizations. Results:A total of 26 031 dose values of adult patients were collected and 25 996 dose values were left while 35 invalid values removed.For different CT users, CTDl vol, DLP and scanning phases were different for the same item. The five items with the highest CTDI were head perfusion, head sequential scanning, head spiral scanning, coronary CTA (retrospective mode), and sinus. The five items with the highest DLP were CTU, head perfusion, leg CTA, chest-abdomen-pelvis and aortic CTA. The CTDI vol of CTU was only 16.9 mGy (75th percentile), while the DLP was as high as 2 394.9 mGy·cm (75th percentile). The survey showed that the DRLs of most items in Beijing was lower than the national DRLs of domestic and foreign standards, and the DRLs of a small number of items were slightly higher. Conclusion:The current CT dose level in Beijing is not consistent with national DRLs released at home and abroad, so it is necessary to establish local DRLs according to the clinical status in Beijing.

Objective:To investigate the radiation dose levels of digital radiography (DR) in adult patients and explore the diagnostic reference level (DRL) of radiation dose in Beijing.Methods:Radiation dose data were collected from 39 medical institutions in Beijing on 18 930 DR examinations of chest anterior and lateral view, abdomen anterior and posterior view, abdomen standing view, cervical spine anterior and lateral view, lumbar spine anterior and lateral view, knee joint anterior and lateral view as well as 5 266 digital mammography (CC view and MLO view). For ordinary DR examinations, the incident air kinetic energy ( Ka, i), incident air specific kinetic energy area product ( PKA) and effective dose ( E) to the examined individuals were used for the investigation and estimation of radiation dose. For digital mammography, the average glandular dose (AGD) was calculated. DRLs should be set at the 75 th percentile of median values obtained in each medical institution. Results:The Ka, i, PKA and E of DRL for Chest (PA), Chest (lateral), abdominal(PA), abdominal (AP), Pelvic(AP), Cervical (AP), Cervical (lateral), Lumbar (AP), Lumbar (lateral), Knee joint (AP) and Knee joint (lateral) of conventional DR were 0.14, 0.31, 1.25, 2.18, 1.86, 0.51, 0.14, 2.97, 8.39, 0.37, 0.37 mGy, 159, 259, 1 917, 2 336, 2 867, 312, 301, 3 500, 3 359, 269, 255 mGy·cm 2, 0.03, 0.05, 0.20, 0.43, 0.23, 0.03, 0.02, 0.47, 0.35, <0.001, <0.001 mSv. The DRLs for digital mammography were calculated to be 1.87 mGy (CC view), 1.94 mGy (MLO view) and 3.99 mGy (accumulated for one examination). Conclusions:The radiation dose from DR examinations is relatively low. In clinical practice, the selection of imaging parameters should be further standardized on the basis of the local DRL.

Objective:To investigate devices for radiodiagnosis used in medical institutions in Beijing, China, as well as radiation workers and the devices′ application frequencies, in order to provide data support for determining radiation protection measures and allocating resources for clinical radiodiagnosis.Methods:In October 2023, questionnaires were distributed to the members of the Radiation Technology Branch of the Beijing Medical Association who work in medical institutions at different levels across varying districts of Beijing. The collected data included information about devices for radiodiagnosis and radiation workers, as well as the application frequencies of various medical X-ray imaging devices during 2018-2022, in 38 medical institutions of Level 3 Grade A, Level 3, and Level 2 in 14 municipal districts of Beijing. Then, the collected data were organized using the Microsoft Power BI software to form report models, followed by the statistical analysis of data on the devices, radiation workers, and application frequencies were using the RStudio software.Results:The 38 medical institutions in Beijing possess 591 devices for radiodiagnosis and 2 018 staff in the departments of radiology, including 1 037 radiologic technologists and 738 physicians, with 1.77 technologists and 1.26 physicians arranged for a single device on average. From 2018 to 2022, among all examinations of radiodiagnosis, computed tomography (CT) scans showed the highest frequencies, with total and average annual growth rates of 138.06% and 108.40%, respectively. Specifically, chest CT scans exhibited total and average annual growth rates of 225.20% and 122.50%, respectively. X-ray imaging ranked second in application frequency, with total average annual growth rates of 70.20% and 91.53%, respectively. Notably, chest X-ray imaging showed total and average annual growth rates of 63.89% and 89.41%, respectively.Conclusions:From 2018 to 2022, X-ray imaging examinations displayed significantly fluctuating frequencies with an overall decline trend in the 38 medical institutions. In contrast, the CT scans showed increased frequencies, with chest CT scans displaying an increased frequency and proportion. This necessitates ensuring the justification of CT scans.

As the number of CT scans continues to rise, the contribution rate of CT to the cumulative radiation dose to the public has exceeded 60%. During CT scanning, a shorter distance to the surface of the human body result in a higher radiation dose. Both the development of new CT imaging techniques and the selection of scanning parameters influence the dosage to superficial radiosensitive organs (e.g., eye lens, thyroid, and mammary glands). Effectively reducing the radiation dose to superficial radiosensitive organs has emerged as a hot research topic. This review aims to summarize the factors influencing the radiation dose to superficial radiosensitive organs and the dose reduction strategies, thus providing a reference for clinical practice and research on dose optimization.

There exist risks of ionizing radiation in radiodiagnosis examinations. Implementing shielding protection following the optimization and as low as reasonably achievable (ALARA) principles represents a measure to reduce radiation doses to patients. The implementation of shielding protection in clinical practices should meet high requirements due to variations in the modalities and items in radiodiagnosis examinations, the characteristics and irradiation method of X-ray beams, the method of automatic selection of image quality and radiation dose-related parameters by imaging equipment, the radiation sensitivity of human tissues and organs. This review introduced the shielding products, methods and effects in various radiodiagnosis examinations, as well as the current status and challenges in their applications, aiming to provide a reference for future related research and clinical practices.