ObjectiveThe lung mesenchymal stem cells （LMSCs） induced by D-galactose （D-gal） were intervened by Wenfei Huaxian decoction-containing serum to explore the mechanism of Wenfei Huaxian decoction in delaying the senescence of LMSCs through the nicotinamide phosphoribosyltransferase/silent information regulator 1 （NAMPT/SIRT1） signaling pathway. MethodWenfei Huaxian decoction-containing serum was prepared. LMSCs were isolated by gradient density centrifugation， and they were cultured and identified in vitro. The senescence model in vitro was established by stimulating cells via D-gal for 24 h. LMSCs cells were modeled after being treated with different volume fractions （5%， 10%， 20%， 40%， and 80%） of Wenfei Huaxian decoction-containing serum for 24 h， and the cell proliferation level was detected by methyl thiazolyl tetrazolium （MTT） method. The cells were randomly divided into blank serum group， model group， and high， medium， and low dose groups of Wenfei Huaxian decoction-containing serum. Senescence-associated β-galactosidase （SA-β-gal） staining was used to detect the senescence of LMSCs in each group. The content of NAD + was detected by colorimetry. The levels of senescence-associated factors （p16 and p53）， interleukin-6 （IL-6）， and tumor necrosis factor-α （TNF-α） in cell culture supernatant were detected by enzyme-linked immunosorbent assay （ELISA）. Western blot was used to detect the relative expression of senescence-associated proteins and NAMPT/SIRT1 signaling pathway-related proteins. ResultCompared with the blank serum group， the proliferation of LMSCs was significantly inhibited after D-gal stimulation for 24 h （P<0.01）. Compared with the model group， the proliferation of LMSCs could be promoted after intervention with the corresponding Wenfei Huaxian decoction-containing serum （P<0.05， P<0.01）. Compared with the blank serum group， the SA-β-gal staining of LMSCs in the model group after D-gal stimulation was enhanced， and the content of NAD⁺ was increased （P<0.01）. The expression levels of senescence factors p16 and p53， as well as SASP pro-inflammatory factors IL-6 and TNF-α in the cell culture supernatant， were significantly increased （P<0.01）. The expression of senescence-associated proteins p16， p21， and p53 increased （P<0.01）， and the protein expression of NAMPT， SIRT1， peroxisome proliferator-activated receptor γ coactivator 1α （PGC-1α）， and forkhead box family transcription factor O1 （FoxO1） decreased （P<0.01）. Compared with the model group， the SA-β-gal staining of LMSCs in each group of Wenfei Huaxian decoction-containing serum was significantly reduced， and the content of NAD⁺ was decreased （P<0.01）. The senescence factors （p16 and p53） and inflammatory factors （IL-6 and TNF-α） in the cell culture supernatant were significantly decreased （P<0.01）. The expression of senescence-associated proteins （P16， P21， and P53） decreased （P<0.05， P<0.01）. The protein expressions of NAMPT， SIRT1， PGC-1α， and FoxO1 were significantly up-regulated （P<0.05， P<0.01）. ConclusionWenfei Huaxian decoction can alleviate senescence and inflammatory response damage of D-gal-induced LMSCs， and its mechanism may be related to the regulation of the NAMPT/SIRT1 signaling pathway.

Objective To analyze the effects of vesicoprostatic muscle(VPM)reconstruction on the early urinary control recovery and safety of patients undergoing robot-assisted radical prostatectomy(RARP).Methods A total of 128 patients who underwent RARP in our hospital during Sep.1,2021 and Aug.31,2023 were enrolled and divided into the non-reconstruction group(n=64)and reconstruction group(n=64)using random number table method.The reconstruction group received Montsouris+VPM reconstruction surgery,while the non-reconstructive group underwent Montsouris surgery only.Urinary control and perioperative data were collected with telephone interview,outpatient follow-up and inpatient records.The two groups were matched using overlap weighting and the Kaplan-Meier method was used to calculate urinary incontinence rates at 1,2 and 3 months after extubation.Early urinary control(3 months after extubation),operation time,intraoperative bleeding,positive rate of incision margin,and incidence of early postoperative complications(＜30 days)(Clavien-Dindo scale)were compared between the two groups.Results The recovery rate of urinary control at 1,2 and 3 months after extubation was significantly higher in the reconstruction group than that in the non-reconstruction group(33.9％vs.11.2％;46.7％vs.16.1％;70.6％vs.45.6％,P＜0.05),but the positive rate of resection margin was lower(16.1％vs.41.7％,P＜0.05).There were no significant differences in operation time,intraoperative bleeding and early postoperative complications between the two groups(P＞0.05).Conclusion VPM reconstruction can improve urinary control recovery in RARP patients early after extubation without increasing the risk of surgery.

Objective: To investigate the incidence density of adult sleep disorders (SD) in Yinzhou District, Ningbo City, Zhejiang Province from 2017 to 2023, so as to provide insights into formulating the control measures of SD. Methods: The electronic health records of permanent residents aged 18 years and over in Yinzhou District from 2017 to 2023 were collected through the Yinzhou Regional Health Information Platform. New cases of SD were diagnosed for the first time a year after establishing health records. The incidence density was estimated using Poisson distribution. The temporal, population and regional distribution characteristics of new cases of SD were analyzed using a descriptively epidemiological method. Results: From 2017 to 2023, there were 1 255 129 permanent residents aged 18 years and over in Yinzhou District, with a total observed person-time of 6 292 884 person-years and a median of 5.67 (interquartile range, 3.74) person-years. There were 165 490 new cases of SD, including 67 095 males (40.54%) and 98 385 females (59.46%). The incidence density of SD in Yinzhou District from 2017 to 2023 was 26.30/1 000 person-years, with no significant trend observed (P>0.05). The incidence density of SD was higher in females than in males (29.63/1 000 person-years vs. 22.57/1 000 person-years, P<0.05). The highest incidence density of SD was observed in individuals aged 70 to <80 years (63.30/1 000 person-years), and the lowest was in individuals aged 18 to <30 years (7.24/1 000 person-years). The incidence density of SD in individuals aged 30 years and over was higher than that in individuals aged 18 to <30 years (all P<0.05). The incidence density of SD was 32.03/1 000 person-years in individuals with junior high school education or below, which was higher than individuals with senior high school/technical secondary school education (25.93/1 000 person-years) and college degree and above (18.87/1 000 person-years, all P<0.05). Dongliu Street, Dongjiao Street, and Baihe Street had relatively higher incidence densities of SD, at 45.11/1 000 person-years, 42.87/1 000 person-years and 40.16/1 000 person-years, respectively. Conclusions From 2017 to 2023, there was no significant trend in the incidence density of SD in Yinzhou District. Higher incidence density were observed in females, the elderly, and individuals living in central urban areas.

Objective To construct and verify a nomogram model for predicting social urinary control recovery in patients undergoing robot-assisted radical prostatectomy (RARP) immediately after extubation. Methods A retrospective analysis was conducted on the clinical data of 64 patients diagnosed with prostate cancer and treated by a single surgeon. The immediate urinary control status of the patients after removal of the catheter was evaluated, and LASSO regression was used for feature screening. Multiple Logistic regression was performed on the selected features to determine independent risk factors and establish a predictive model. And the discriminability, calibration, and clinical practicality of the model were evaluated using receiver operating curve (ROC), Hosmer Lemeshow test and calibration curve, and clinical decision curve (DCA) analysis. Results The variables in the outcome prediction model include D'Amico grading and distance of the levator muscle. The area under the ROC curve (AUC) was 0.742 (95%CI, 0.500 to 0.913, P < 0.001), indicating that the model had good discriminability. The calibration curve indicated that the model had good calibration ability. The DCA curve showed good clinical practicality. Conclusion The clinical predictive model developed inthis study can predict the recovery of immediate social urinary control in patients with RARP after surgery, which can further quantify the probability of achieving immediate social continence.

Objective:To investigate the effect of local anesthesia in patients with a PI-RADS score of 5 and ECOG score ≥2 for prostate puncture.Methods:Retrospective analysis of case data of 33 patients admitted to the Subei People's Hospital for prostate puncture from April 2020 to April 2022. Age (82.5±3.6) years. There were 18 cases with hypertensive disease, 8 cases with diabetes mellitus, and 6 cases with both diabetes mellitus and hypertensive disease. Body mass index (25.2±3.5) kg/m 2. prostate-specific antigen (PSA)(131.5±69.7) ng/ml. prostate volume (38.5±21.4) ml. all patients had a PI-RADS score of 5 on multiparametric magnetic resonance (mpMRI) and an Eastern Cooperative Oncology Group (ECOG) score ≥2. All 33 cases in this group underwent trans-perineal targeted prostate puncture using local anesthesia at the tip of the prostate. The visual analog score (VAS) and visual numeric score (VNS) were applied by the same surgeon to assess the patient's pain level and satisfaction at the time of puncture (VAS-1 and VNS-1) and 30 min after puncture (VAS-2 and VNS-2), and to record the duration of the procedure and the occurrence of postoperative complications. Results:In this group of 33 cases, the VAS-1 score was (1.9±0.3) and the VAS-2 score was (0.1±0.2); the VNS-1 score was (2.9±0.2) and the VNS-2 score was (3.9±0.1). Postoperative pathological results indicated that one of the 33 patients had a negative puncture result (pathology report indicating interstitial inflammation), while the rest of the patients had a positive puncture pathology report (puncture pathology report indicating prostate cancer), with a positive rate of 97%. One case of postoperative carnal haematuria occurred, which gradually improved after the patient was advised to drink water and take alpha-blockers. No perineal hematoma occurred, and all patients did not suffer complications such as urinary tract infection, urinary retention, azoospermia, vagal reaction, and infectious shock.Conclusion:In patients with a PI-RADS score of 5 and ECOG score ≥2, the use of single-hole local anesthesia for performing trans-perineal targeted puncture biopsy has the advantages of good paroxysmal pain and high safety.

Objective:To investigate the factors affecting the effect of periprostatic nerve block (PNB), establish a prediction model of pain degree, and verify the prediction efficiency.Methods:The clinical data of 314 patients who underwent transperineal prostate biopsy in our hospital from June 2022 to January 2023 were retrospectively analyzed. The median age was 71 (65, 76) years, the median prostate-specific antigen (PSA) was 14.6 (10.70, 24.65) ng/ml, and the median puncture needle number was 21 (19, 23) needles, median prostate volume 45.86 (31.52, 67.96) ml, median body mass index (BMI)24.02(22.97, 25.33)kg/m 2, including 109 patients with a history of diabetes, 90 patients with a history of surgery, and 57 patients with a history of severe trauma. The patients were divided into mild pain group (1-3 points), moderate pain group (4-6 points) and severe pain group (7-10 points) according to the intraoperative visual analogue scale (VAS). According to the clinical characteristics, the factors affecting the effect of PNB were analyzed by univariate analysis and multiple ordered logistic regression method. R language was used to construct a nomogram model for predicting PNB effect, receiver operating characteristic (ROC) curve and calibration curve were drawn, and Hosmer-Lemeshow test was carried out to verify the prediction efficiency of the model. Results:The results of univariate analysis showed that 171 patients in the mild pain group had a median age of 71 (65, 75) years, a median PSA14.5 (9.6, 24.6) ng/ml, a median number of puncture needles of 20 (18, 22), and a median prostate volume of 34.94 (26.36, 45.12) ml, median BMI24.17(23.14, 25.79)kg/m 2, including 74 patients with a history of diabetes, 51 patients with a history of surgery, and 40 patients with a history of severe trauma; There were 110 patients in the moderate pain group, the median age was 71 (65, 76) years, the median PSA14.8 (11.03, 24.27) ng/ml, the median number of puncture needles was 23 (20, 24) needles, median prostatic volume 63.24 (49.14, 78.72) ml, median BMI23.91(22.58, 24.88)kg/m 2, including 26 patients with a history of diabetes, 29 patients with a history of surgery, and 10 patients with a history of severe trauma; In the severe pain group, 33 patients had a median age of 73 (67, 78) years, a median PSA14.6 (10.85, 34.80) ng/ml, and a median puncture needle number of 23 (22.5, 24) needles, median prostate volume 70.64 (61.50, 104.51) ml, median BMI24.32(23.00, 26.06)kg/m 2, including 9 patients with a history of diabetes, 10 patients with a history of surgery, and 7 patients with a history of severe trauma. The results of univariate analysis showed that the number of puncture needles ( P<0.01), prostate volume ( P<0.01), history of diabetes ( P=0.002) and history of major trauma ( P= 0.009) were the factors affecting the effect of PNB. Multiple logistic regression analysis showed that puncture needle number ( P=0.009), prostate volume ( P<0.01) and diabetes history ( P=0.041) were independent risk factors for PNB effect. The area under ROC curve (AUC) of the moderate and above pain prediction model was 0.872, P<0.01; the area under ROC curve of the severe pain prediction model was 0.817, P<0.01; the result of Hosmer-Lemeshow test of the moderate and above pain prediction model was χ2=5.001, P=0.757. The results of the severe pain prediction model were χ2=4.452 and P=0.814. The calibration curve was established, which showed that the prediction probability of pain degree was in good agreement with the actual risk. Conclusions:The number of puncture needles, prostate volume and history of diabetes are the risk factors affecting the effect of PNB. The prediction model of PNB effect based on this model can be used to predict the pain degree of patients undergoing prostate biopsy after PNB.

Background: and Purpose To evaluate whether the thrombus enhancement sign (TES) can be used to differentiate embolic large vessel occlusion (LVO) from in situ intracranial atherosclerotic stenosis (ICAS)-related LVO in the anterior circulation of patients with acute ischemic stroke (AIS). Methods: Patients with LVO in the anterior circulation who underwent both non-contrast computed tomography (CT) and CT angiography and mechanical thrombectomy were retrospectively enrolled. Both embolic LVO (embo-LVO) and in situ ICAS-related LVO (ICAS-LVO) were confirmed by two neurointerventional radiologists after reviewing the medical and imaging data. TES was assessed to predict embo-LVO or ICAS-LVO. The associations between occlusion type and TES, along with clinical and interventional parameters, were investigated using logistic regression analysis and a receiver operating characteristic curve. Results: A total of 288 patients with AIS were included and divided into an embo-LVO group (n=235) and an ICAS-LVO group (n=53). TES was identified in 205 (71.2%) patients and was more frequently observed in those with embo-LVO, with a sensitivity of 83.8%, specificity of 84.9%, and area under the curve (AUC) of 0.844. Multivariate analysis showed that TES (odds ratio [OR], 22.2; 95% confidence interval [CI], 9.4–53.8; P<0.001) and atrial fibrillation (OR, 6.6; 95% CI, 2.8–15.8; P<0.001) were independent predictors of embolic occlusion. A predictive model that included both TES and atrial fibrillation yielded a higher diagnostic ability for embo-LVO, with an AUC of 0.899. Conclusion TES is an imaging marker with high predictive value for identifying embo- and ICAS-LVO in AIS and provides guidance for endovascular reperfusion therapy.

Objective:To report the experience of the application of internal carotid artery stent in skull base surgery, and to clarify the important role of internal carotid artery stent in skull base surgery.Methods:A retrospective study of 22 cases with skull base neoplasms implanted with internal carotid artery stents in the Department of ENT Head and Neck Surgery at the Sixth People′s Hospital affiliated with Shanghai Jiao Tong University between July 2019 and January 2021 was conducted. Among them, 17 were male and 5 were female, aged between 33 and 75 years. There were 5 cases on the left, 16 cases on the right, and 1 case on both sides. Of these, there were 4 cases of jugular paraganglioma, 1 case of chondrosarcoma in the jugular foramen, 1 case of carotid body paraganglioma, and 16 cases of nasopharyngeal carcinoma after radiotherapy.Results:The degree of internal carotid artery erosion was assessed by computed tomography angiography (CTA), magnetic resonance imaging and digital subtraction angiography (DSA) images in 22 patients before surgery. It was found that the internal carotid artery was involved to varying degrees in all patients, so internal carotid artery stents were implanted before surgery. Tumor tissue was found to surround the internal carotid artery to varying degrees. Total or subtotal tumor resection was performed in all patients, and no intraoperative and postoperative complications occurred. The postoperative follow-up was 5 months to 2 years, and all patients had no complications such as spontaneous bleeding and pseudo aneurysm. There were no signs of stenosis or occlusion of the internal carotid artery stent segment in all cases.Conclusions:For patients with skull base tumors, preoperative imaging indicates the limited involvement of the internal carotid artery, and internal carotid artery stent implantation before surgery is a safe and effective treatment.

Objective: To assess the prevalence and related factors of HIV infection among male clients of the female sex workers in Hekou Yao autonomous county of Honghe Hani Yi autonomous prefecture (Hekou county) in Yunnan province in China, 2014-2015. Methods: Serial cross-sectional survey was conducted during June 2014 to November 2015. Convenience sampling methods were used to recruit the male clients for this study. Self-reported information on social-demographic characteristics, with sexual and drug behavior patterns, was gathered. Both blood and urine samples were collected for HIV, with for opiate testing. Multivariate logistic regression and Exhaustive CHAID method were used to determine the correlated factors associated with HIV infection. Statistical analysis was used by SPSS 22.0 software and Clementine 12.0 software. Results: The overall HIV prevalence of male clients was 2.06% (16/776). Male clients who keep using condom with female sex worker was estimated as 68.81% (534/776). The last commercial sexual partner of Vietnamese male clients was all Vietnamese female sex workers. Compared with Chinese male clients, Vietnamese male clients have a higher rate of morphine positive. Factors as: age ≥50 years vs. age <30 years (OR=8.11, 95%CI: 1.26-52.16) and testing for morphine positive vs. morphine negative (OR=7.35, 95%CI: 1.42-38.06) were significantly associated with HIV infection through multiple logistic regression analysis. Through Exhaustive CHAID, it confirmed that age was the primary factor that associated with HIV infection of male clients. Conclusions Relationship between morphine and HIV infection indicated that HIV prevalence of male clients in Hekou county was influenced by the combined effect of both illegal drug use and commercial sexual behavior. Special attention should be paid to male clients over 50 years of age, on HIV intervention.

Objective To study the mechanical properties and degradation behavior of biodegradable silicon-covered magnesium alloy stent in vitro,to investigate the technical feasibility of its implantation into rabbit esophagus and to observe the tissue reaction in vivo.Methods The mechanical compression recovery properties and the degradation behavior of biodegradable silicon-covered magnesium alloy stent were tested in vitro.A total of 30 healthy Holland rabbits were randomly divided into silicon-covered magnesium alloy stent group (n=15) and control group (n=15).For rabbits in the silicon-covered magnesium alloy stent group fluoroscopy-guided insertion of the stent into the lower third segment of esophagus was conducted,while for rabbits in the control group no intervention was adopted.One,2 and 4 weeks after the implantation of the stent,esophagography was performed for all rabbits of both groups,and each time every 5 rabbits from both groups were sacrificed,the specimens were collected and sent for histological examinations.Results In vitro test indicated that biodegradable silicon-covered magnesium alloy stent had good flexibility and elasticity,and in phosphate-buffered saline with pH 4.0 or pH 7.4 it degraded more slowly than bare magnesium alloy stent.In vivo test showed that the stent implantation could be well tolerated by all experimental rabbits.Before stent insertion the esophageal diameter was(9.2±0.8) mm,and at one,2 and 4 weeks after stent insertion the esophageal diameters were (9.7±0.7) mm,(9.6±0.8) mm and (9.6±0.5) mm respectively (P＞0.05).In the silicon-covered magnesium alloy stent group,stent displacement occurred in 6 rabbits in one week (n=l),2weeks (n=1) and 4 weeks (n=4).After stent implantation,the tissue reactions such as esophageal wall injury,collagen deposition,etc.were not obviously different from those in the control group (P＞0.05).Conclusion It is technically feasible to insert silicon-covered magnesium alloy stent into the rabbit's esophagus,the stent can provide sufficient support for at least 2 weeks,the stent displacement rate is low and acceptable,and no severe esophageal wall injury and collagen deposition are observed.