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 examine the effectiveness of revascularization of the deep femoral artery and its inflow vessels to treat critical limb ischemia in patients with thromboangiitis obliterans (TAO).Methods:The clinical data of 9 TAO patients with critical limb ischemia who underwent deep femoral artery and its inflow revascularization from January 2018 to October 2020 at Department of Vascular Surgery, the First Medical Center, People′s Liberation Army General Hospital were retrospectively analyzed.There were all males, aged from 26 to 50 years with onset time from 1 to 7 years.All patients had severe rest pain, and 4 had ischemic ulcers or gangrene.All patients had occlusion of the deep femoral artery origins and(or) its inflow tracts, including 2 ipsilateral common iliac artery occlusion, 4 ipsilateral external iliac artery occlusion, 7 common femoral artery occlusion, and 8 deep femoral artery origins, without the involvement of the contralateral common femoral artery or its inflow tracts.Surgical procedures included femoral endarterectomy with thrombectomy, merge suture, and bypass.Technical success rate, rest pain relief, ulcer healing, patency, amputation rate, and long-term prognosis were recorded.Results:The overall technical success rate was 9/9, including 8 femoral endarterectomies with thrombectomy (with 4 patch-angioplasty with the great saphenous vein, 1 merge suture, and 3 simple sutures), 4 femoral-femoral bypasses with artificial vessels, and 1 superficial femoral artery bypass with the great saphenous vein.Rest pain disappeared after the operation immediately.The follow-up time was 10 to 44 months.All patients survived.The semi-annual patency rate was 9/9, and the one-year patency rate was 6/8.Except for one patient with significantly reduced but unhealed dorsalis ulcer up to now due to continuous heavy tobacco exposure after surgery, all others had no rest pain occurred or recurrence of foot ulcers during the follow-up.Among the 8 patients, 3 cases with recent claudication had continuous moderate tobacco exposure (10 to 20 cigarettes per day or severe passive smoking).Conclusions:For patients with thromboangiitis obliterans involved in the deep femoral artery or its inflow vessels, revascularization should be the primary choice and a good long-term prognosis is promising.Postoperative tobacco exposure (including passive smoking) is of great impact on the prognosis of TAO patients, and smoking cessation education must be reemphasized and reinforced.

Objective:To examine the effectiveness of revascularization of the deep femoral artery and its inflow vessels to treat critical limb ischemia in patients with thromboangiitis obliterans (TAO).Methods:The clinical data of 9 TAO patients with critical limb ischemia who underwent deep femoral artery and its inflow revascularization from January 2018 to October 2020 at Department of Vascular Surgery, the First Medical Center, People′s Liberation Army General Hospital were retrospectively analyzed.There were all males, aged from 26 to 50 years with onset time from 1 to 7 years.All patients had severe rest pain, and 4 had ischemic ulcers or gangrene.All patients had occlusion of the deep femoral artery origins and(or) its inflow tracts, including 2 ipsilateral common iliac artery occlusion, 4 ipsilateral external iliac artery occlusion, 7 common femoral artery occlusion, and 8 deep femoral artery origins, without the involvement of the contralateral common femoral artery or its inflow tracts.Surgical procedures included femoral endarterectomy with thrombectomy, merge suture, and bypass.Technical success rate, rest pain relief, ulcer healing, patency, amputation rate, and long-term prognosis were recorded.Results:The overall technical success rate was 9/9, including 8 femoral endarterectomies with thrombectomy (with 4 patch-angioplasty with the great saphenous vein, 1 merge suture, and 3 simple sutures), 4 femoral-femoral bypasses with artificial vessels, and 1 superficial femoral artery bypass with the great saphenous vein.Rest pain disappeared after the operation immediately.The follow-up time was 10 to 44 months.All patients survived.The semi-annual patency rate was 9/9, and the one-year patency rate was 6/8.Except for one patient with significantly reduced but unhealed dorsalis ulcer up to now due to continuous heavy tobacco exposure after surgery, all others had no rest pain occurred or recurrence of foot ulcers during the follow-up.Among the 8 patients, 3 cases with recent claudication had continuous moderate tobacco exposure (10 to 20 cigarettes per day or severe passive smoking).Conclusions:For patients with thromboangiitis obliterans involved in the deep femoral artery or its inflow vessels, revascularization should be the primary choice and a good long-term prognosis is promising.Postoperative tobacco exposure (including passive smoking) is of great impact on the prognosis of TAO patients, and smoking cessation education must be reemphasized and reinforced.

Alzheimer's disease (AD) is a complex neurodegenerative disease. Its pathogenesis involves many factors such as environment, heredity, aging, diet, personal preference and underlying diseases. And the complex pathogenic factors of AD lead to many social and economic problems such as delayed diagnosis, difficulty of drug research and development, low cure rate and high cost of care. In this paper, the relationship between AD disease progression and its risky diseases such as metabolic diseases, chronic inflammatory diseases and cardiovascular diseases was analyzed based on energy metabolism abnormalities. The role of energy metabolism signal/path abnormality activity in the course of risk disease to AD disease was analyzed. Finally, it is suggested that the prevention and treatment of risk disease evolution and adjustment of abnormal energy metabolism signals may be effective strategies for the treatment of AD.

Objective: To investigate the effects of EI injection on learning and memory ability and brain energy of two-way Meynert basal injection of Ibotenic acid (IBO) dementia model rats. Methods: A rat model of dementia wasestablished by bilateral meynert basal injection of IBO. After 8 weeks of EI injection, Morris water maze was used todetect the learning and memory ability of rats. Congo red staining was used to observe the deposition of Aβ plaque inhippocampal CA1 and cortical areas of rats. The changes of ATP, ADP and AMP in brain tissue of each group weredetermined by HPLC. The content of insulin in rat brain tissue was detected by ELISA kit. The expression of key proteinin PI3K/AKT signaling pathway was detected by Western blot. Results: Compared with the sham operation group, theescape latency of the model group was significantly prolonged, the number of entering the platform, the time andpercentage of crossing the platform quadrant decreased significantly (P ＜ 0.05); Aβ plaque deposition was observed inthe hippocampus and cortex; ATP/AMP ratio and insulin content were significantly decreased (P ＜ 0.05); brain tissue PI3 K and AKT protein were low expression (P＞ 0.05) . After intervention with EI injection, the escape latency of themodel rats was significantly shortened, the number of entering the platform and the time of crossing the platform quadrantincreased significantly (P ＜ 0.05); the hippocampus and cortex red staining was alleviated; the brain tissue ATP/AMPratio and insulin content increased significantly (P ＜ 0.05) . Conclusion: EI injection can improve the learning andmemory function of IBO-induced dementia model rats, which is related to the improvement of brain energy.

Objective To discuss the surgical strategy and clinical effects of robotic assisted laparoscopic antegrade inguinal lymphadenectomy for penile cancer.Methods We retrospectively analyzed the clinical data and surgical strategy on the 7 cases,who undergoing robotic assisted laparoscopic antegrade inguinal lymphadenectomy,from August of 2016 to August of 2017.The mean age of 7 patients was (49.7 ± 7.5) years old,ranged from 40 to 62 years old,the mean BMI was (27.97 ± 3.86) kg/m2,ranged from 21.76 to 33.21 kg/m2 . There were 4 cases of T1,2 cases of T2,1 case of T3,1 case of N1,3 cases of N2,3 cases of N3 according to TNM stages.Preoperative preparation was as follows,preoperative cardiopulmonary assessment,inguinal and pelvic CT or MRI,ultrasound of lower extremity venous,bowel preparation.The patients were placed in a supine position,with an indwelling catheter,with the head positioned lower than the hip at an angle of about 15 degrees,legs were spread apart around 45 degrees,and both knees were slightly bent and externally rotated.The da Vinci robotic patient cart was pushed forward between legs of the patient.A blunt separation was carried out between Scarpa's fascia and the surface of the aponeurosis of the obliquus externus abdominis prior,then subcutaneous space was established by a self-made balloon dilatation.Results 7 cases were completed successfully without robot reposition without any conversion.Operative time of each side ranged from 50 to 90 min (70.0 ± 12.5)min.The blood loss of each side was less than 10 ml.In the 7 cases,the number of nodes removed from left inguinal region ranged from 7 to 18 (14.0 ±3.3).The number of nodes removed from right ranged from 5 to 21 (11.0 ± 3.3).Pelvic lymphadenectomy was completed in the meantime by original trocar site on 4 cases.Till now,no perioperative complications,such as flap necrosis,delayed healing of incision,cellulitis,occurred in inguinal region,except lymphorrhagia in 3 cases.During a follow-up within 3-14 months,there was no recurrence or metastasis in 6 cases except one died from tumor progression with systemic metastasis.Conclusions Antegrade inguinal lymphadenectomy for penile cancer by using Da Vinci robotic surgical system is safe and effective.This technique also appears to diminish the wound related complications associate with the standard open approach.Compared with the similar surgery,we conducted bilateral inguinal lymphadenectomy without patient cart reposition,which simplify the procedure and reduce the using of trocar.According to individual clinical conditions,pelvic lymphadenectomy also can be completed in the meantime by original trocar.

Objective To summarize our experience with surgical management of renal neoplasm involving inferoir veno cava.Methods We review the data of 115 patients,including 74 male patients and 41 female patients,with renal neoplasm involving venous system between March 1993 and December 2015.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.There were 15 patients (13.0％) with renal vein thrombus,38 (33.1％) with infrahepatic thrombus,29 (25.2％) with low retrohepatic thrombus,20 (17.4％) with high retrohepatic thrombus,and 13 (11.3％) with supradiaphragmatic thrombus.The mean age was 52 years old,ranging 22 to 77 years old.The tumor was found in right side in 77 cases and left side in 38 cases.All patients accepted the radical nephrectomy.Primary outcomes were overall survival (OS),and cancer special survival (CSS) in patients with renal cell carcinoma (RCC) estimated by Kaplan-Meier method.Secondary outcome included operative and oncological features,past-operative complications and hospital mortality.Cox proportional hazard model was used to univariate and multivariate analysis for risk factor impacting on OS of RCC patients.Results Complete resections of renal neoplasm with tumor thrombus were achieved in 113 patients (98.3％),2 patients died intraoperatively due to the dropping of thrombus.Postoperative complication rate was 16.8％.Hospital mortality was 2.6％.Mean follow-up interval was 48 months.OS rates at 5-,and 10-year in RCC patients were 66.5％,and 61.8％,respectively.Metastasis was an independent risk factor affecting on OS (P =0.000).However,the level of thrombus was not an risk factor affecting the prognosis.Conclusions Radical resection of renal tumor and caval thrombus is an effective treatment for prolonging survival in patients with RCC extending into venous system.Retrohepatic caval tumor thrombus below or above the main hepatic vein should be dichotomized and managed respectively with diverse techniques.Metastatic rather than the level of thrombus was a risk factor impacting on RCC patient survival.

Objective To evaluate the risk of locoregional recurrence (LRR) and the influencing factors for long-term survival in patients with epithelial-myoepithelial carcinoma (EMCa).Methods A retrospective analysis was performed for 18 EMCa patients, who received initial therapy or initial adjuvant therapy in our hospital from 1999 to 2015, to investigate their survival.Among these patients, 8(44%) underwent surgery alone, 9(50%) received adjuvant radiotherapy, and 1(6%) received radical concurrent chemoradiotherapy.Locoregional recurrence-free survival (LRFS) and overall survival (OS) rates were compared between these groups.The Kaplan-Meier mtthod was used to calculated survival rates and log-rank test was used to compare the LRFS.Results With a median follow-up time of 46 months, 5 patients developed LRR, and the 5-year LRFS and OS rates were 69% and 93%, respectively.The patients treated with radiotherapy had a significantly higher 5-year LRRFS rate than those not treated with radiotherapy (71% vs.57%, P=0.569).Conclusions LRR is the main failure mode of EMCa treatment, and further improving local control is the key to improved survival.

Objective To study the relationship between hair selenium content and arsenism among population from endemic arsenism area caused by coal combustion in the southern of Shaanxi Province.Methods Four high-arsenic-exposed villages in southern Shaanxi Province were selected as the study area,and the nonarsenic-exposed villages nearby were selected as the control area,90 hair samples of residents exposed to high arsenic in the study area and 14 hair samples of residents in the control area were collected.Inductively Coupled Plasma Mass Spectrometry (ICP-MS) was used to determine the contents of arsenic and selenium in hair samples.Selenium/hair arsenic (Se/As) value was calculated,and the relationship between selenium content in hair samples and arsenicosis was analyzed.Results The geometric mean of selenium concentration in hair from the study area was 8.72 mg/kg,which was significandy higher than that from the control area (0.54 mg/kg,t =9.811,P ＜ 0.05).However,selenosis case was not found in the study area.Selenium content in hair was not obviously correlated with arsenism (r =0.075,P ＞ 0.05),while the Se/As value was negatively associated with the grade of arsenism (P ＞ 0.05).The geometric mean of selenium content in hair of female from the study area was 12.79 mg/kg,which was higher than that in hair of male (6.5 mg/kg,t =1.738,P ＜ 0.01).Meanwhile,the Se/As value in hair of female from the study area (1.15) was significantly higher than that in hair of male (0.65,t =3.218,P ＜ 0.05).Conclusions The environment of the study area is polluted by arsenic and selenium derived from stone-coal burning.Antagonism between arsenic and selenium might reduce the toxicity of selenium.Therefore,selenosis is not found in the study area.In addition,antagonism between arsenic and selenium might also induce lower prevalence of arsenism for female in the studly area.

Objective To evaluate the value of SUVmax/ADCmin obtained by 11 C?choline PET/MR imaging in the differential diagnosis of benign and malignant prostate disease. Methods Suspicious prostate cancer patients who underwent PET/MR before transperineal prostate biopsy in People′s Liberation Army General Hospital from April 2014 to January 2015 were observed. Prostate gland was divided into five dis?tricts. A ROI with the diameter of 1 cm was drawn at the highest radioactivity concentration and/or lowest ADC signal area in each district, and SUVmax , ADCmin and SUVmax/ADCmin were then calculated. Taking the pathological results as the gold standard, malignant and benign prostate disease districts were separated. Pearson correlation analysis and two?sample t test were used for statistical analysis. Results Biopsy pathol?ogy showed 9 cases were malignant ( 25 prostate cancer districts, and 20 benign prostate disease districts) , and 6 cases were benign (30 benign prostate disease districts). The SUVmax had a negative correlation with ADCmin( r=-0.521, P<0?05) . The SUVmax/ADCmin of benign and malignant districts was significantly dif?ferent(5.67±3.03 and 13?76±7.13; t=6.9, P<0.01). The ROC AUC for ADCmin, SUVmax and SUVmax/ADCmin were 0?880, 0?809 and 0.898. Using SUVmax/ADCmin of 7.78 as a cutoff, the sensitivity, specificity and accuracy of 11 C?choline PET/MR imaging for differentiating the benign and malignant prostate lesions were 84.0%(21/25), 86.0%(43/50) and 85.3%(64/75), respectively. Conclusions Simultaneous 11C?choline PET/MR could be used for detecting prostate cancer. SUVmax/ADCmin may serve as an effective diag?nostic indicator for differentiating benign and malignant prostate lesions.