Objective To investigate the clinical application value of transrectal real-time tissue elastography(TRTE)guided targeted puncture in the diagnosis of prostate cancer.Methods A total of 52 patients with suspected prostate cancer who were treated in the First People's Hospital of Zhengzhou from January 2020 to December 2022 were selected as the study objects.Preoperative routine transrectal ultrasound and TRTE examination were performed to evaluate the benign and malignant prostates.For the 28 patients with suspected lesions found in TRTE,TRTE-guided targeted puncture(2 needles)+ systematic puncture(8 needles)were performed,for the 24 patients with no suspicious lesions found in TRTE,routine ultrasound-guided systematic puncture(12 needles)was performed.The efficacy of TRTE in the diagnosis of prostate cancer was analyzed and the positive rate of targeted puncture and systematic puncture was compared.Results In this study,25 cases of prostate cancer and 27 cases of benign lesions were ultimately pathologically diagnosed,while a total of 28 cases of prostate cancer and 24 cases of benign lesions were diagnosed with TRTE.The positive predictive value and negative predictive value of the diagnosis were 75.0%(21/28)and 83.3%(20/24),respectively.In 28 patients with suspected lesions found by TRTE,a total of 56 needles were targeted puncture,36 needles were diagnosed with prostate cancer,positive rate was 64.29%(36/56),and a total of 224 needles were systematic puncture,89 needles were diagnosed with prostate cancer,with a positive rate of 39.73%(89/224).The positive rate of prostate cancer by targeted puncture was significantly higher than that by systematic puncture(P<0.05).Conclusion TRTE can better diagnose prostate cancer,and its guided targeted puncture has a higher positive rate in the diagnosis of prostate cancer,which can maximize the positive rate of puncture while reducing the number of puncture needles.

BACKGROUND:Diabetic nephropathy is an important cause of end-stage renal disease,and intestinal barrier damage plays an important role in the occurrence and development of diabetic nephropathy. OBJECTIVE:To observe the protective effect of human umbilical cord mesenchymal stem cells on the intestinal barrier in rats with diabetic nephropathy. METHODS:Thirty 8-week-old male SD rats were randomly assigned to healthy control group,model group and human umbilical cord mesenchymal stem cell group,with 10 rats in each group.Rats in the human umbilical cord mesenchymal stem cell group were injected with 1×106 human umbilical cord mesenchymal stem cells through the tail vein once a week for 4 weeks after the model establishment of diabetic nephropathy.Rats in the healthy control group and the model group were injected with an equal volume of PBS at the same time.1 week after the last injection,the histomorphological changes in the kidney and colon were observed under a light microscope.The expressions of ZO-1 and Occludin in the colon tissue of rats were detected by immunohistochemistry.Serum D-lactic acid and lipopolysaccharide levels were detected by ELISA.In addition,the distribution of human umbilical cord mesenchymal stem cells labeled with DiR dye in rats was observed by in vivo imaging system.The expression of human mesenchymal stem cell surface marker antigens CD44 and CD90 in colon tissue was detected by immunohistochemistry. RESULTS AND CONCLUSION:(1)Compared with the model group,human umbilical cord mesenchymal stem cell transplantation significantly inhibited the increase of urea nitrogen,serum creatinine,24-hour urine protein level and urinary albumin/creatinine ratio in diabetic nephropathy rats(all P<0.05).(2)The expression of human mesenchymal stem cell surface markers CD44 and CD90 was found in the colon of diabetic nephropathy rats.(3)Compared with the healthy control group,the expression levels of tight junction proteins Occludin and ZO-1 in the colon tissue of the model group were significantly reduced,while the expressions of Occludin and ZO-1 were significantly increased after treatment with human umbilical cord mesenchymal stem cells.(4)Compared with the model group,human umbilical cord mesenchymal stem cell transplantation significantly reduced serum D-lactic acid and lipopolysaccharide levels in diabetic nephropathy rats.(5)The results suggest that human umbilical cord mesenchymal stem cells may protect the intestinal barrier function by enhancing the expression of intestinal tight junction proteins in diabetic nephropathy rats.

Male ; Humans ; Liquid Chromatography-Mass Spectrometry ; Chromatography, Liquid ; Tandem Mass Spectrometry ; Varicocele/diagnosis* ; Biomarkers

BACKGROUND: LY01005 (Goserelin acetate sustained-release microsphere injection) is a modified gonadotropin-releasing hormone (GnRH) agonist injected monthly. This phase III trial study aimed to evaluated the efficacy and safety of LY01005 in Chinese patients with prostate cancer. METHODS: We conducted a randomized controlled, open-label, non-inferiority trial across 49 sites in China. This study included 290 patients with prostate cancer who received either LY01005 or goserelin implants every 28 days for three injections. The primary efficacy endpoints were the percentage of patients with testosterone suppression ≤50 ng/dL at day 29 and the cumulative probability of testosterone ≤50 ng/dL from day 29 to 85. Non-inferiority was prespecified at a margin of -10%. Secondary endpoints included significant castration (≤20 ng/dL), testosterone surge within 72 h following repeated dosing, and changes in luteinizing hormone, follicle-stimulating hormone, and prostate specific antigen levels. RESULTS: On day 29, in the LY01005 and goserelin implant groups, testosterone concentrations fell below medical-castration levels in 99.3% (142/143) and 100% (140/140) of patients, respectively, with a difference of -0.7% (95% confidence interval [CI], -3.9% to 2.0%) between the two groups. The cumulative probabilities of maintaining castration from days 29 to 85 were 99.3% and 97.8%, respectively, with a between-group difference of 1.5% (95% CI, -1.3% to 4.4%). Both results met the criterion for non-inferiority. Secondary endpoints were similar between groups. Both treatments were well-tolerated. LY01005 was associated with fewer injection-site reactions than the goserelin implant (0% vs . 1.4% [2/145]). CONCLUSION: LY01005 is as effective as goserelin implants in reducing testosterone to castration levels, with a similar safety profile. TRIAL REGISTRATION ClinicalTrials.gov, NCT04563936.
Humans ; Male ; Antineoplastic Agents, Hormonal/therapeutic use* ; East Asian People ; Gonadotropin-Releasing Hormone/agonists* ; Goserelin/therapeutic use* ; Prostate-Specific Antigen ; Prostatic Neoplasms/drug therapy* ; Testosterone

OBJECTIVE To compare the similarities and differences of the two methods in analyzing the use of opioids in third grade class A medical institutions and provide a reference for the management of opioids in medical institutions. METHODS Two methods， Defined Daily Dose （DDD） and Oral Morphine Equivalent （OME）， were used to count the opioid prescription data of five comprehensive medical institutions of third grade class A （named H1-H5） in Shanxi province in 2020， calculate consumption sum of opioid， annual per capita consumption sum， patient cost burden and drug consumption sum ratio， compare the index results presented by the two analysis methods， and explore the application scenarios of the advantages of each of the two evaluation methods. RESULTS The ranking of consumption sum of opioid and patient cost burden calculated by the two methods was the same in the five sample medical institutions， but the ranking of per capita consumption sum was different. Taking the 5 medical institutions as a whole， the top 4 rankings of consumption sum ratio for each species of opioid compared by both methods were the same， i. e. remifentanil＞sufentanil＞oxycodone＞morphine. The ratio of remifentanil was close to 50%. When comparing the ranking of consumption sum ratio in each medical institution， the ranking calculated by the two methods was different for those medical institutions except for H1 medical institutions. The consumption sum ratio of fentanyl calculated by DDD method was significantly higher than that of OME method； whereas consumption sum ratio of remifentanil calculated by OME method was significantly higher than that of DDD method. Perioperative patients had the highest consumption sum ratio， about 50%. The consumption sum ratio of critically ill patients in H3 jwsydey@163.com medical institutions and inpatient patients with cancer pain and other patients in H5 medical institutions calculated by DDD method was significantly higher than that by OME method. There were differences in the order of cost burden of different types of patients calculated by two methods. CONCLUSIONS DDD method can accurately reflect the dosage of opioid drugs and facilitate the monitoring and management of the dosage； OME method can more reflect the analgesic effect and compare the cost burden of patients.

Anti-seizure medications (ASMs) are the main therapy for epilepsy.There are many kinds of ASMs with complex mechanism of action, so it is difficult for pharmacists to examine prescriptions.This paper put forward some suggestions on the indications, dosage forms/routes of administration, appropriateness of usage and dosage, combined medication and drug interaction, long-term prescription review, individual differences in pathophysiology of children, and drug selection when complicated with common epilepsy, for the reference of doctors and pharmacists.

OBJECTIVE: To explore clinical effects of repairing skin and soft tissue defect of finger with free posterior interosseous artery perforator flap. METHODS: Totally 8 patients with finger skin and soft tissue defect repaired with free posterior interosseous artery perforator flap were treated from May 2021 to November 2022, including 7 males and 1 female aged from 24 to 54 years old, and soft tissue defect area ranged from 3.0 cm×1.5 cm to 5.0 cm×3.0 cm. The time from injury to flap repair ranged from 3 to 83 h. The free posterior interosseous artery perforator flap was applied to repair finger defect, the area of the flap ranged from 3.5 cm×2.0 cm to 5.2 cm×3.5 cm, the donor area of flap was sutured directly. The survival, appearance, texture and donor complications of the flap were observed after operation, and Dargan functional standard was used to evaluate clinical effect of finger function. RESULTS: All flap of 8 patients were survived, and followed up from 3 to 12 months. There was no obvious swelling, soft texture, obvious pigmentation, linear intaglio in donor area only, and without obvious complications were found. Among them, 3 patients'skin flaps were repaired for the defect of palm of the fingers, and sensory recovery was good, two-point discrimination ranged from 5 to 9 mm. According to Dargan functional evaluation, 3 patients excellent, and 5 good. CONCLUSION Free posterior interosseous artery perforation branch flap could be used to repair the defect of finger. The thickness of flap is moderate, operation is convenient, appearance and texture of the operative flap are good, and the donor site is small without obvious complications, and obtain satisfactory clinical effect.
Male ; Humans ; Female ; Young Adult ; Adult ; Middle Aged ; Perforator Flap ; Fingers ; Upper Extremity ; Ulnar Artery ; Skin

OBJECTIVE: To evaluate the prospective association between cumulative resting heart rate (cumRHR) and rapid renal function decline (RRFD) in a cohort of individuals aged 60 and older. METHODS: In the Tianjin Chronic Kidney Disease Cohort Study, the individuals who underwent three consecutive physical examinations between 2014 and 2017, with estimated glomerular filtration rate (eGFR) greater than 60 mL/min per 1.73 m² and aged 60 years or older were enrolled. A total of 27,564 patients were prospectively followed up from January 1, 2017 to December 31, 2020. The 3-year cumRHR was calculated. The primary outcome was RRFD, defined as an annualized decline in eGFR of 5 mL/min per 1.73 m² or greater. Logistic and restricted spline regression models and subgroup analysis were used to investigate the association of cumRHR with RRFD after adjusting for all confounders. RESULTS: During a median follow-up of 3.2 years, a total of 4,347 (15.77%) subjects developed RRFD. In fully-adjusted models, compared with the lowest quartile of cumRHR, the odds ratio (OR) for the highest was 1.44 (1.28-1.61), P < 0.001. Furthermore, each 1-standard deviation (27.97 beats/min per year) increment in cumRHR was associated with a 17% (P < 0.001) increased risk of RRFD, with a linear positive correlation (P for non-linear = 0.803). Participants with a 3-year cumRHR ≥ 207 (beats/min) * year (equivalent to ≥ 69 beats/min per year in 3 years) were found to be at a higher risk of RRFD. CONCLUSIONS The cumRHR is significantly associated with a higher risk of RRFD among older adults. These results might provide an effective goal for managing and delaying the decline of renal function in the older adults.

Objective:To investigate the clinical effect and indications of the three kinds of pedicled perforator flaps in repairing soft tissue defects around the elbow joint.Methods:The clinical data of patients with soft tissue defects around the elbow joint, admitted to the Department of Center for Orthopaedic Repair and Reconstruction of Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences (Xinhua Hospital Chongming Branch) from December 2013 to November 2022 were retrospectively analyzed. The distal based medial antebrachial neurocutaneous flap in the middle and distal part of the upper arm, the perforator pedicled propeller flap of inferior cubital artery or the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery in the proximal forearm were respectively designed according to the location, appearance, size of the recipient site and the perforating point of the perforating vessel in the donor site to repair soft tissue defects around the elbow joint. The donor site was directly closed or covered by free skin grafting cut from the hidden area of the affected limb. The donor and recipient sites were followed up and observed to evaluate the curative effect from the following three aspects. (1) The self-evaluation of the curative effect was divided into three grades: satisfactory, general and unsatisfactory. (2) Elbow joint function evaluation: according to Mayo’s elbow joint function scoring standard which was divided into four grades: excellent, good, general and poor. (3) Comprehensive evaluation: the evaluation criteria for wound repair around the ankle joint of the lower extremity were used for scoring: 16 to 21 points as excellent, 11 to 15 points as good, 6 to 10 points as general, 0 to 5 points as poor, and the excellent and good ratio was calculated at the same time, that is, the sum of the number of excellent and good cases/the total number of cases×100%.Results:A total of 51 patients were enrolled, including 31 males and 20 females. The age ranged from 16 to 87 years old, with a mean of 56.1 years old. About the defect location, there were 20 cases in the anterior side of the elbow joint, 18 cases in the posterior side of the elbow joint, 8 cases in the medial side of the elbow joint, and 5 cases in the lateral side of the elbow joint. The defect sizes after debridement were from 3.5 cm×2.5 cm to 16.0 cm× 6.0 cm. Among the 51 patients, 21 cases were repaired by the distal based medial antebrachial neurocutaneous flap, 19 cases were repaired by the perforator pedicled propeller flap of inferior cubital artery, and the other 11 cases were repaired by the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery. The sizes of the flaps were from 4.5 cm × 3.5 cm to 18.0 cm × 8.0 cm. Forty-six of the 51 patients got primary healing, and the other five had necrosis of different degrees at the distal edge of the flap (≤1.5 cm×1.0 cm), including 2 cases of the distal based medial antebrachial neurocutaneous flap, 2 cases of the perforator pedicled propeller flap of inferior cubital artery and 1 case of the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery who were healed after dressing change. The patients were followed up for 3 to 60 months after the operation, with a mean of 12 months, the flaps in the recipient sites survived well, at the same time, the color and elasticity of the flaps were close to normal, and the two-point discrimination was 4-9 mm without bloated appearance. The elbow joint of the affected limb was stable and with good movement. No obvious deformity was observed, and the functional recovery was excellent. The incision of the donor site healed well and the scar was easily accepted. Self-evaluation: 39 patients were satisfied and 12 were general. Elbow joint function evaluation: excellent in 15 cases and good in 36 cases. Comprehensive evaluation: excellent in 17 cases, good in 30 cases, general in 4 cases, that meant the excellent and good ratio reached to 92%(47/51).Conclusion:The three kinds of pedicled perforator flaps have constant perforating vessels, abundant blood supply and simple operation. They can be used to repair soft tissue defects around the elbow joint while good clinical result can be obtained. The distal based medial antebrachial neurocutaneous flap is focused on the anterior and ulnar sides of the elbow joint, the perforator pedicled propeller flap of inferior cubital artery is focused on the elbow fossa, and the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery is focused on the posterior and radial sides of the elbow joint.

Objective:To investigate the clinical effect and indications of the three kinds of pedicled perforator flaps in repairing soft tissue defects around the elbow joint.Methods:The clinical data of patients with soft tissue defects around the elbow joint, admitted to the Department of Center for Orthopaedic Repair and Reconstruction of Chongming Hospital Affiliated to Shanghai University of Medicine & Health Sciences (Xinhua Hospital Chongming Branch) from December 2013 to November 2022 were retrospectively analyzed. The distal based medial antebrachial neurocutaneous flap in the middle and distal part of the upper arm, the perforator pedicled propeller flap of inferior cubital artery or the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery in the proximal forearm were respectively designed according to the location, appearance, size of the recipient site and the perforating point of the perforating vessel in the donor site to repair soft tissue defects around the elbow joint. The donor site was directly closed or covered by free skin grafting cut from the hidden area of the affected limb. The donor and recipient sites were followed up and observed to evaluate the curative effect from the following three aspects. (1) The self-evaluation of the curative effect was divided into three grades: satisfactory, general and unsatisfactory. (2) Elbow joint function evaluation: according to Mayo’s elbow joint function scoring standard which was divided into four grades: excellent, good, general and poor. (3) Comprehensive evaluation: the evaluation criteria for wound repair around the ankle joint of the lower extremity were used for scoring: 16 to 21 points as excellent, 11 to 15 points as good, 6 to 10 points as general, 0 to 5 points as poor, and the excellent and good ratio was calculated at the same time, that is, the sum of the number of excellent and good cases/the total number of cases×100%.Results:A total of 51 patients were enrolled, including 31 males and 20 females. The age ranged from 16 to 87 years old, with a mean of 56.1 years old. About the defect location, there were 20 cases in the anterior side of the elbow joint, 18 cases in the posterior side of the elbow joint, 8 cases in the medial side of the elbow joint, and 5 cases in the lateral side of the elbow joint. The defect sizes after debridement were from 3.5 cm×2.5 cm to 16.0 cm× 6.0 cm. Among the 51 patients, 21 cases were repaired by the distal based medial antebrachial neurocutaneous flap, 19 cases were repaired by the perforator pedicled propeller flap of inferior cubital artery, and the other 11 cases were repaired by the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery. The sizes of the flaps were from 4.5 cm × 3.5 cm to 18.0 cm × 8.0 cm. Forty-six of the 51 patients got primary healing, and the other five had necrosis of different degrees at the distal edge of the flap (≤1.5 cm×1.0 cm), including 2 cases of the distal based medial antebrachial neurocutaneous flap, 2 cases of the perforator pedicled propeller flap of inferior cubital artery and 1 case of the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery who were healed after dressing change. The patients were followed up for 3 to 60 months after the operation, with a mean of 12 months, the flaps in the recipient sites survived well, at the same time, the color and elasticity of the flaps were close to normal, and the two-point discrimination was 4-9 mm without bloated appearance. The elbow joint of the affected limb was stable and with good movement. No obvious deformity was observed, and the functional recovery was excellent. The incision of the donor site healed well and the scar was easily accepted. Self-evaluation: 39 patients were satisfied and 12 were general. Elbow joint function evaluation: excellent in 15 cases and good in 36 cases. Comprehensive evaluation: excellent in 17 cases, good in 30 cases, general in 4 cases, that meant the excellent and good ratio reached to 92%(47/51).Conclusion:The three kinds of pedicled perforator flaps have constant perforating vessels, abundant blood supply and simple operation. They can be used to repair soft tissue defects around the elbow joint while good clinical result can be obtained. The distal based medial antebrachial neurocutaneous flap is focused on the anterior and ulnar sides of the elbow joint, the perforator pedicled propeller flap of inferior cubital artery is focused on the elbow fossa, and the V-Y advancement flap based on the perforator of proximal forearm posterior interosseous artery is focused on the posterior and radial sides of the elbow joint.