[Objective] To analyze the clinicopathological characteristics of treatment-naive patients with highly suspected prostate cancer (PCa) with prostate-specific antigen (PSA) level ≥20 ng/mL, to provide reference for promoting early screening of PCa. [Methods] A retrospective analysis was conducted on the clinical data of treatment-naive patients with PSA level ≥20 ng/mL, undergoing prostate biopsy for highly suspected PCa at the Department of Urology, Tianjin Medical University Second Hospital during Jan.2013 and Jun.2023. The correlation between patients' age, body mass index (BMI), PSA, prostate volume (PV), prostate cancer-specific antigen density (PSAD), prostate imaging reporting and data system (PI-RADS) score, and International Society of Urological Pathology (ISUP) grade with highly suspected PCa metastasis and PSA stratification were analyzed. [Results] A total of 1778 suspected patients were enrolled. Pathological findings confirmed PCa in 1465 cases (82.4%), with 487(33.2%) diagnosed as metastatic PCa. Over the past decade, the number of patients undergoing prostate biopsy for highly suspected PCa and being confirmed has been increasing annually, with the proportion of metastatic cases remaining at around 30%. Compared with those with PSA level being 20-50 ng/mL, patients with PSA level >50 ng/mL had older age, lower BMI, higher PSAD, higher PI-RADS, higher ISUP, more diverse pathological types, and a higher incidence of metastasis (P<0.05) with lower proportion of urban residents. Additionally, analysis of metastatic PCa cases showed that 46.8%(228/487) had oligometastasis (≤5 metastatic lesions), including 99.0% bone metastasis, 4.1% extraregional lymph node metastasis, and 4.3% other organ metastasis. [Conclusion] Over the past 10 years, there has been a continuous increase in the number of treatment-naive biopsied cases and newly diagnosed cases of highly suspicious PCa with PSA level ≥20 ng/mL, while the proportion of metastatic cases remains high. Therefore, proactive efforts should be made to promote early screening of high-risk suspected cases.

Objective:To investigate the effect of pretreatment with butorphanol on perineal discomfort caused by intravenous injection of dexamethasone sodium phosphate.Methods:Using the method of prospective study, ninety patients undergoing elective gynecological surgery in Dalian Women And Children′s Medical Group from June to December 2021 were randomly divided into three groups: butorphanol 0.5 mg pretreatment group (group B1), butorphanol 1.0 mg pretreatment group (group B2) and normal saline control group (group C), with 30 cases in each group. Patients in groups B1 and B2 were given butorphanol 0.5 mg and 1.0 mg intravenously, respectively, prior to induction of anesthesia, while those in group C were given 0.9% sodium chloride injection. 3 minutes later, all patients in the three groups were given dexamethasone sodium phosphate injection 10 mg, and the incidence, grade and adverse reactions of their perineal discomfort symptoms were recorded.Results:The incidence of perineal discomfort and moderate perineal discomfort of patients in group B1 and group B2 was lower than that in group C: 20.00%(6/30)and 10.00%(3/30)vs. 60.00%(18/30), 3.33%(1/30)and 3.33(1/30)vs. 30.00%(10/30), with a statistically significant differences ( P<0.05). The incidence of adverse reactions such as dizziness was increased in the group B2:26.67%(8/30)and 10.00%(3/30)vs. 40.00%(12/30), with a statistically significant difference ( χ2 = 7.13, P = 0.028). Conclusions:Butorphanol 0.5 mg and 1.0 mg pretreatments are touted as effective in inhibiting perineal discomfort caused by intravenous injection of dexamethasone sodium phosphate. However, the butorphanol 0.5 mg pretreatment group have fewer adverse reactions.

Objective:To determine the 50% effective concentration (EC 50) of ropivacaine plus sufentanil for labor analgesia using the dural puncture epidural technique. Methods:Using the method of prospective study, sixty parturients requiring labor analgesia in Dalian Women and Children′s Medical Group from May 2021 to May 2022 were divided into six groups using a random number table and administered 0.3 mg/L sufentanil and ropivacaine at different concentrations: 0.05% (group D1), 0.06% (group D2), 0.07% (group D3), 0.08% (group D4), 0.09% (group D5), and 0.1% (group D6). A probit model was constructed to compute the EC 50 values and 95% confidence intervals (95% CI) of ropivacaine plus sufentanil in dural puncture epidural analgesia (DPEA) for labor. The pain intensity of uterine contractions before labor analgesia and 30 min after administration was recorded and assessed on a numeric rating scale (NRS), and decreases in blood pressures and heart rates, vomiting and nausea, postpartum headaches, and fetal bradycardia were documented. Results:When using ropivacaine plus sufentanil for labor analgesia via DPE, the EC 50 was 0.061%, and the 95% CI ranged from 0.051 to 0.067; the 90% effective concentration (EC 90) was 0.081%, and the 95% CI was between 0.074 and 0.098. Among the six groups, there was one case of fetal bradycardia in group D3 and one case of decreased heart rates in group D4. No decreased blood pressure, vomiting and nausea, or postpartum headaches were reported. Conclusions:In DPEA for labor, ropivacaine plus sufentanil has an EC 50 of 0.061%, with the 95% CI falling between 0.051 and 0.067, similar to the EC 50 value in epidural analgesia.

This article explains the concept, emotional recovery process, and coping strategies of the second victim after the occurrence of medical adverse events, in order to effectively identify and manage the second victim and obtain effective support. This article aims at providing a theoretical reference for constructing a positive patient safety culture and organizational support system under China's national conditions to reduce the second victim's injury.

Objective To compare the analgesic effect and adverse reactions of oxycodone versus morphine after transcervical resection of adhesions (TCRA). Methods Sixty patients undergoing hysteroscopic TCRA under general anesthesia in Dalian Municipal Woman and Children′s Medical Center were randomly assigned to the test group or control group with 30 patients in each group; the test group received oxycodone 0.1 mg/kg (Q group), and the control group received morphine 0.1 mg/kg (M group). Both group was followed by propofol 2—3 mg/kg, as well as laryngeal mask airway (LMA) insertion after loss of consciousness to maintain ventilation. Propofol 6—10 mg/kg/h and remifentanil 0.1—0.2 μg/kg min were administered intraoperatively to maintain anesthesia. The visual analogue scale (VAS) score, sedation score and number of rescue medications were recorded immediately and 1 h, 2 h after the patient was sent to postoperative recovery room. The incidences of body movement, nausea and vomiting and pruritus after LMA insertion were recorded. Results There were no statistically significant differences between the two groups in VAS score, sedation score ,nausea and vomiting, itchy skin or the number of rescue medications at any post-recovery time point (P > 0.05); the incidence of body movements during LMA insertion was lower in M group: 13.3%(4/30) vs 36.7%(11/30), with statistically significant difference (P < 0.05). Conclusions Oxycodone could provide favorable postoperative analgesia for patients with intrauterine adhesion, with low incidence of adverse reactions.

Transient central nervous system symptoms and reversible white matter lesions have been rarely reported in X-linked Charcot-Marie-Tooth disease type 1.We reported two cases of X-linked CharcotMarie-Tooth disease type 1 associated with reversible white matter lesions.Patient 1 is a 15-year old boy who presented with paroxysmal speech disorders and limb weakness at the beginning of the illness.He still walked unsteadily after discharge.Patient 2 is a 13-year old girl with transient numbness and weakness in her left extremities and slurred speech.She completely recovered.Both of them presented pes cavus without obvious family history or personal history.Both of them showed primary symptom of central nervous system with MRI abnormal findings in corpus callosum and periventricular areas.The electrophysiological studies showed a mixed demyelinating and axonal sensorimotor neuropathy in patient 1 but no significant abnormalities in patient 2.The genetic analysis of both patients showed a pathogenic mutation in GJB1 gene.Clinicians should improve the recognition of X-linked Charcot-Marie-Tooth disease type 1.This type of disorders can behave as symptoms of nervous system firstly even if there is no other typical characteristics,such as peripheral nervous system involvement.

The severe fever with thrombocytopenia syndrome virus (SFTSV),a new RNA virus,was discovered in recent years,which can lead to fever,thrombocytopenia and multiple organ dysfunction.Picks is the main media A case of a SFTSV-related encephalitis diagnosed by second-generation gene sequencing was reported here.The patient had fever,disturbance of consciousness,convulsions,with thrombocytopenia and enzymatic indicators increased significantly.After active anti-virus and supportive treatment,the prognosis was good.It is our aim to suggest that,in the epidemic season,when you meet thesimilar patients like this,you should consider the possibility of SFTSV-related encephalitis.Virus nucleic acid detection and second-generation gene sequencing technology are helpful for timely diagnosis and treatment and reducing mortality of the disease.

Objective To assess the median effective dose (ED50) of patient- controlled intravenous remifentanil labor analgesia. Methods Forty primiparas were selected and randomly divided into 5 groups with 8 cases in each group. Patient-controlled intravenous administration of remifentanil was performed among the 5 groups with differrent doses:0.80μg/kg(R1 group), 0.67μg/kg (R2 group), 0.56μg/kg (R3 group), 0.47μg/kg (R4 group), and 0.39μg/kg(R5 group). Probit regression method was adopted to calculate the ED50 and 95% confidence interval of the patient-controlled intravenous remifentanil labor analgesia. The visual analogue scales (VAS) scores following the labor analgesia, pulse oxygen saturation, maternal heart rate, sedation scores and newborn Apgar scores were recorded. Results The ED50 remained at 0.576 μg/kg and the 95% confidence interval was 0.390-0.701μg/kg. The blood pressure and heart rate remained at normal limits, and there were no significant differences among five groups (P>0.05). The newborn 1, 5 min Apgar scores and umbilical arterial pH were no significant differences among five groups (P>0.05). The second stage of labor time, rate of using oxytocin were showed no significant differences among five groups (P>0.05). The VAS scores and sedation scores were no significant differences among five groups (P>0.05). Conclusion The ED50 of patient-controlled intravenous remifentanil labor analgesia is 0.576 μg/kg, and the 95% confidence interval remains at 0.390-0.701μg/kg.

Objective To explore the clinicopathological significance of the presence of lymphovascular invasion (LVI) in the high-grade stage pT1 bladder cancer (BC) after first transurethral resection of bladder tumor (TURBT).Methods The retrospective study was performed with 27 patients of high-grade stage pT1 BC after first TURBT from January 2006 to December 2011,and another 54 patients were matched as negative control in terms of gender,age,pathological pattern,grading and staging.All the data were calculated by using SPSS17.0 software.Qualitative variables were compared by using chi-square test.The Kaplan-Meier method was used to calculate total survival and cancer-specific survival and differences were assessed with the Log-rank statistic.Results Twenty-four patients (89％) experienced cancer recurrence in LVI group,while 19 cases (35％) experienced recurrence in control group.Progress developed in 56％ (15/27) and 24％ (13/54) in the 2 groups respectively.LVI was detected to be a prognostic factor for overall recurrence (x2 =20.845,P＜0.001) and progress (x2 =7.887,P =0.005) in patients with high-grade T1 stage BC.Furthermore,overall survival and recurrence-free survival according to the presence or absence of LVI was 54±6 months and 84±3 months,17±5 months and 67±5 months,respectively.LVI was proved to be associated with worse overall survival (x2=13.443,P＜0.001) and recurrence free survival (x2=33.094,P＜0.001).Conclusion In patients with high-grade T1 stage BC,LVI in first TURBT specimens predicts disease recurrence,progression and overall recurrence and recurrence free survival.

Objective To observe the effect of MAP4K4 targeted shRNA on biological characteristics such as proliferation,invasiveness,and apoptosis in human bladder cancer cell.Methods Differentially expressed genes was screened out through cDNA microarray analysis in 5 pairs of fresh-frozen muscle-invasive bladder cancer(MIBC) and adjacent normal tissue obtained from radical cystectomy.Combining the results of genechip and literature review,MAP4K4 was picked up for further analysis.To verify the result of microarray analysis,16 pairs of fresh muscle-invasive bladder cancer (MIBC) and adjacent tissues were assessed for the expression of MAP4K4 mRNA and protein through RT-PCR,qRT-PCR and Western-blot.T24 cell line was stably trasfected with MAP4K4 targeted shRNA and control shRNA,respectively.The effects of MAP4K4 silencing on proliferation,invasiveness and apoptosis of T24 cells transfected with MAP4K4 targeted shRNA and control shRNA were assessed by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT),transwell and flowcytometry (FCM) assay.Results MAP4K4 was overexpressed in muscle invasive bladder cancer than in normal tissue.Down regulation of MAP4K4 expression decreased bladder cancer cell proliferation(MAP4K4-targeted versus control,P＜0.001),invasiveness(MAP4K4-targeted versus control,P=0.004)and promoted cell apoptosis(MAP4K4-targeted versus control,P=0.023).Conclusions MAP4K4 is overexpressed in muscle invasive bladder cancer than in normal tissue.Down-regulation of MAP4K4 expression inhibits the invasive ability of bladder cancer.Therefore,MAP4K4 might be a potential therapeutic target for bladder cancer.