Objective To study the association of serum L-kynurenine changes with nutritional status and vascular stiffness in maintenance hemodialysis (MHD) patients. Methods Twenty gender- and age-matched healthy volunteers (healthy group) and 40 MHD patients,including 20 cases with α-keto aicd(α-keto acid group)and 20 cases without α-keto aicd(non-α-keto acid group)were enrolled in the study.Serum L-kynurenine was measured by high performance liquid chromatography.C-reactive protein (CRP)and interleukin 6 (IL-6)were detected.Subjective global assessment(SGA)and malnutrition inflammation score(MIS)were applied to evaluate the nutritional status.Pulse wave velocity(PWV)was used to evaluate arterial stiffness for both groups of MHD patients. Results Serum L-kynurenine was significantly higher in MHD patients than that in healthy subjects[(3.20±1.12)μmol/L vs (1.74±0.27)μmol/L,P<0.01],while such difference was not found between α-keto aicd group and non-α-keto-aicd group [(3.20±0.88)μmol/L vs (3.29±1.34)μmol/L,P>0.05].IL-6 was significantly higher in MHD patients as compared to healthy subjects[(6.45±3.78)ng/L vs(1.38±1.59)ng/L,P<0.01],while such difference was found between α-keto aicd group and non-α-keto aicd group[(3.37±0.82)ng/L vs (9.62±2.48)ng/L,P<0.051.There was no difference of CRP concentration between two MHD groups.As compared to non-α-keto acid group,higher SGA score(26.00±1.75 vs 22.67±2.61,P=0.001),lower MIS score(5.82±2.27 vs 10.00±2.62,P=0.002),lower left side PWV[(21.11±8.21)m/s vs(24.57±5.45)m/s,P=0.244]and lower right side PWV[(19.27±3.22)m/s vs (24.19±5.41)m/s,P=0.015]were observed in α-keto aicd group.Pearson analysis showed positive correlation between serum L-kynurenine and IL-6(r=0.352,P=0.011)and negative correlation between L-kynurenine and pre-dialysis Scr(r=-0.412,P=0.019). Conclusions Inflammation is common in MHD patients.Tryptophan degeneration product L-kynurenine may indicate inflammation status.α-keto acid improves nutritional status,anemia and arterial stiffness maybe through the alleviation of inflammation in MHD patients.

Objective To investigate the clinical and pathological features of Uurich congenital muscular dystrophy (UCMD). Methods The clinical aspects of 3 patients with UCMD, 2 with Duchenne muscular dystrophy (DMD) and 1 with congenital muscular dystrophy 1A (MDC1A) were analyzed. And the muscle specimens from these patients were studied using immunohistochemistry and immunofluorescence staining. Results UCMD was clinically characterized by neonatal hypotonia with proximal contracturos and distal hyperlaxity at birth or early infancy. Histochemical staining revealed muscle frber hypoplasia andinterstitium proliferation. Immunohistochemistry staining with anti-collagen Ⅵ antibody revealed complete(1/3) or partial (2/3) deficiency of collagen Ⅵ in the sarcolemma and interstitial matrix. Partial deficiency was better demonstrated by immunofluorescence staining. Conclusions The proximal contractures and distal hyperlaxity is the clinical hallmark of UCMD. Collagen Ⅵ immunolabelling can confirm the diagnosis of UCMD.

The pathogenesis of diabetic retinopathy (DR) is complex.Antisense non-coding RNA (ANRIL) in the INK4 locus in long-chain non-coding RNA (lncRNA) is closely related to cell proliferation,differentiation,and individual development.It plays an important role in the dysplasia of retinal vascular endothelial cells and is a new field in the study of the pathogenesis of DR.According to the researches at present,ANRIL may plays its role in the occurrence and development of DR through the signal pathway of nuclear factor-κB and ROS/polyadenylation diphosphate ribose polymerase,and interact with p300,miR-200b,and EZH2 to regulating the expression and function of VEGF.Specific blocking ANRIL and its related pathwaysmay become a new target in the treatment of DR.

Objective:To discuss the medication law in prescriptions of Professor Shao Nianfang in the treatment of kidney deficiency and bone marrow loss in senile dementia based on data mining.Methods:Medical cases of kidney deficiency and bone marrow loss in senile dementia in the Geriatric Hospital of Shandong University of Traditional Chinese Medicine from 1st Jan. 2014 to 31st Oct, 2019 were collected. Through hospital electronic medical records system prescription statistics, using ancient and modern medical case cloud platform (V1.2.4), medication frequency, property ans taste, efficacy analysis, correlation rule analysis, clustering analysis and complex network analysis were performed.Results:Totally 110 cases were included in medical cases, involving 238 kinds of Chinese materia medica. The top 10 Chinese materia medica with use frequency were Poria, Acori Tatarinowii Rhizoma, Corni Fructus, Dioscoreae Rhizoma, Rehmanniae Radix Praeparata, Alpiniae Oxyphyllae Fructus, Rehmanniae Radix, Astragali Radix, Chuanxiong Rhizoma, Atractylodis Macrocephalae Rhizoma; the properties were mainly mild, warm slight cold, and cold; the tastes were mainly sweet, bitter, pungent, and light; the meridians were mainly spleen, liver, lung and kidney meridians; the efficacy was clearing dampness and promoting diuresis, clearing heat and promoting blood circulation, calming mind, clearing heat and detoxification, reducing dampness and promote appetizing, tonifying spleen; the association analysis found 15 groups of drug combinations used more than 25 times, they were: Corni Fructus and Poria, Corni Fructus and Dioscoreae Rhizoma, Dioscoreae Rhizoma and Corni Fructus, Rehmanniae Radix Praeparata and Corni Fructus, Dioscoreae Rhizoma and Poria, Astragali Radix and Poria, Alismatis Rhizoma and Poria, Moutan Cortex and Poria, Rehmanniae Radix Praeparata and Poria, Rehmanniae Radix and Poria, Polygalae Radix and Acori Tatarinowii Rhizoma, Moutan Cortex and Corni Fructus, Moutan Cortex and Dioscoreae Rhizoma, Alismatis Rhizoma and Corni Fructus, Alismatis Rhizoma and Dioscoreae Rhizoma; clustering analysis identified four groups of new prescriptions, the first group: Poria, Rehmanniae Radix, Rehmanniae Radix Praeparata, Alismatis Rhizoma, Moutan Cortex, Corni Fructus, Dioscoreae Rhizoma; the second group: Acori Tatarinowii Rhizoma, Cistanches Herba, Morindae Officinalis Radix; the third group: Alpiniae Oxyphyllae Fructus, Chuanxiong Rhizoma, Glycyrrhizae Radix et Rhizoma Praeparata Cum Melle; the fourth group: Atractylodis Macrocephalae Rhizoma, Codonopsis Radix, Astragali Radix, Angelicae Sinensis Radix; the results of complex network analysis showed that the core prescription was modified Liuwei Dihuang Pills. Conclusion:This study found that in view of kidney deficiency and bone marrow loss in senile dementia, Professor Shao pays attention to strengthening the healthy qi, and focuses on tonifying deficiency, taking into account the methods of clearing dampness, clearing heat, detoxification, removing blood stasis and restoring consciousness. The four new prescriptions found in the study can provide a reference for modified medication for syndrome differentiation.

Objective:To explore the diagnostic value of chest CT imaging in differential diagnosis between common-type COVID-19 and mycoplasma pneumonia (MP).Methods:From the January to February 2020, the clinical and imaging data of COVID-19 patients (diagnosed in the Affiliated Hospital of Jining Medical University, the Fourth People's Hospital of Jining and the Second People's Hospital of Jining) and MP patients (diagnosed in the Affiliated Hospital of Jining Medical University) were retrospectively collected and analyzed. Forty-three patients with common-type COVID-19 (28 males, 15 females, 43±14 years old) and 50 patients with MP (19 males, 31 females, 37±14 years old) were enrolled as COVID-19 group and MP group, respectively. The clinical manifestations, laboratory results and chest CT findings of these two groups were analyzed and compared.Results:(1) Clinical manifestations: there were more patients with muscle ache and asthenia in COVID-19 group than in MP group (χ 2=5.110, 4.834, P<0.05). No significant difference was found in fever and cough between two groups (χ 2=0.378, 0.097, P>0.05). (2) Laboratory examination: the procalcitonin level of cases in COVID-19 group was significantly lower than that in MP group (χ 2=12.263, P=0.001). No significant difference was found in leukocyte count, lymphocyte count, C-reactive protein level and erythrocyte sedimentation rate ( Z=-1.117, χ 2=2.410, 0.787, 0.800, all P>0.05) between two groups. (3) Chest CT findings bilateral lung involvement was found more in COVID-19 group than in MP group (χ 2=30.012, P<0.001); while the one lobe of ipilateral lung involvement was less in COVID-19 group than in MP group (χ 2=19.927, P<0.001); there was no significant difference in multiple lobes of ipilateral lung involvment between the two groups (χ 2=1.366, P>0.05). Ground glass, paving stone sign and air bronchus sign were found significantly more in COVID-19 group than in MP group (χ 2=30.171, 19.119, 9.790, all P<0.05); while the pulmonary consolidation, central lobular nodule and centripetal thickening of bronchus wall were found significantly less in COVID-19 group than in MP group (χ 2=25.450, 33.532, 48.553, all P<0.001). Conclusions:The clinical manifestations and laboratory examination have limited value in the differential diagnosis of common-type COVID-19 and MP, while chest CT imaging might be more valuable in the early differential diagnosis of these two diseases.

Objective:To investigate the feasibility and reliability of the frozen section during targeted prostate biopsy.Methods:The clinical and pathological information of patients who received cognitive fusion transperineal targeted plus systematic biopsy and frozen section of 1-2 core targeted biopsy were consecutively collected and retrospectively studied. The median age was 70 (ranging 64-78) years, with the median prostate-specific antigen (PSA) level of 11.00 (ranging 6.63-16.52) ng/ml and the median prostate volume of 35.72 (ranging 22.59-47.71) ml. All patients received bi-parametric magnetic resonance imaging (bp-MRI) and have Prostate Imaging Reporting and Data System (PI-RADS) 3 or higher lesions diagnosed on bp-MRI. The suspected lesions would be taken by targeted biopsy of which one or two cores would be sent to prepare for the frozen sections. Then a cognitive fusion targeted and systematic biopsy covering the above targeted zones would be routinely administered under a transperineal approach as a standard protocol. The total time used for diagnosis of the frozen sections, the pathological diagnosis and the International Society of Urological Pathology (ISUP) grade groups (GG) would be recorded. The sensitivity, the positive predictive value, and the accuracy on grade groups would be analyzed, using the pathological diagnosis based on standard sections from the same targeted lesion.Results:A total of 29 patients were included in this study. Accordingly, 29 suspected lesions were identified on bp-MRI. A total of 20 lesions were finally diagnosed of PCa on frozen section, with the detection rate of 69.0%. Of those, 9(45.0%) cases were ISUP GG 1 diseases, 5(25.0%) cases were GG 2 diseases, 1(5.0%) case was GG 3 disease, and 5(25.0%) cases were GG 4-5 diseases. A total of 22 lesions were diagnosed with PCa on standard sections of cores from the same targeted lesions, with the detection rate of 75.9%. Of those, 6(27.3%) cases were GG 1 disease, 11(50.0%) cases were GG 2 diseases, 1(4.5) case was GG 3 disease, and 4(18.2%) cases were GG 4-5 diseases. The sensitivity and the positive predictive value of frozen section were 90.9% and 100%, respectively. No false positive diagnosis was made by frozen section. Compared to diagnosis from frozen sections, the GG diagnosed from final standard sections were found to upgrade and downgrade in 2 and 2 cases, respectively. The accuracy rate on GG of frozen sections was 80%. The time used for the diagnosis of frozen sections was (11±2) minutes. The histology quality control of four specimens was dissatisfactory. Two were due to tissue loss and deformation during sampling, and the other two were due to cytoclasis during low-temperature transferring.Conclusion:It is feasible and reliable to make a pathological diagnosis from frozen section of prostate targeted biopsy.

Objective:To investigate the practicality and safety of performing a radical prostatectomy(RP)shortly after the diagnosis of prostate cancer using a combination of prostate targeted biopsy and intraoperative frozen section.Methods:Prospective enrollment was conducted for patients suspected of having prostate cancer based on abnormal prostate specific antigen(PSA)levels.The inclusion criteria for the study were as follows: patients aged 80 years or younger with an ECOG score of 1 or lower.Prior to biopsy, patients underwent both prostate magnetic resonance imaging(MRI)and prostate specific membrane antigen positron emission tomography/computed tomography(PSMA PET/CT)to determine the likelihood of prostate cancer with clinical stages within T 2-3aN 0M 0.In order to be included in the study, patients must agree to receive RP after their prostate cancer diagnosis has been confirmed by biopsy.All enrolled patients underwent a targeted prostate biopsy, consisting of 1-2 cores.These specimens were then examined through frozen section analysis.For patients diagnosed with prostate cancer through intraoperative frozen section pathology, RP was immediately performed.In this study, transperineal prostate targeted+ systematic biopsy was utilized for patients with undiagnosed prostate cancer.Additionally, routine pathological examination of specimens was conducted.The study analyzed the baseline data, surgical conditions, pathological results, and follow-up information of patients in a descriptive manner. Results:Seven patients, ranging in age from 54 to 77 years with a mean age of 66.7 years, were enrolled in the study.Their mean PSA level was 12.668 μg/L, ranging from 4.359 to 22.195 μg/L.Of these patients, 4 had a PI-RADS score of 4 and 3 had a score of 5.The maximum diameter of the index lesion was 1.3 cm, ranging from 0.5 to 2.2 cm.PSMA PET/CT scores were 4 in 1 case and 5 in 6 cases.The index lesions detected by PSMA PET/CT were consistent with those detected by MRI, and the maximum standardized uptake value(SUVmax)was 15.7, ranging from 5.3 to 39.4.Prostate cancer was diagnosed through targeted biopsy and intraoperative frozen section pathology.Four cases had a Gleason score of 3+ 3=6, while one case had a Gleason score of 3+ 4=7, another had a score of 4+ 3=7, and the last had a score of 4+ 4=8.All patients underwent RP treatment immediately after the prostate cancer diagnosis.Only one patient had slight adhesion at the apex of the prostate, while the other six patients were evaluated by surgeons as having no obvious adhesion at the apex.All surgeries were completed successfully, with a mean operation time of 149.7(ranging from 108 to 255)minutes.After RP, whole mount pathology results indicated that all cases were prostate adenocarcinoma, with a Gleason score of 3+ 4=7 in four cases and 4+ 3=7 in three cases.The pathological stages were pT2 in three cases and pT3a in four cases, with five cases having negative surgical margins and two cases with positive surgical margins.During the study, all patients were monitored for a period of 5.4 months(ranging from 3 to 7 months)and no complications of Clavien Dino≥Ⅰ were observed.PSA levels were measured at 6 weeks and 3 months after surgery, with readings of 0.020 μg/L(ranging from 0 to 0.079 μg/L)and 0.016 μg/L(ranging from 0 to 0.087 μg/L), respectively.No hormonal therapy or radiotherapy was administered during this time.Four patients were able to recover from urinary continence.Conclusions:Based on a combination of MRI and PSMA PET/CT, it is both safe and feasible to promptly perform RP following the diagnosis of prostate cancer through targeted biopsy for index lesions, along with intraoperative frozen section.

Objective:To evaluate the safety and feasibility of applying injectable cross-linked sodium hyaluronate isolation gel in radical hypofractionated radiation therapy for prostate cancer.Methods:In this prospective study, patients at Beijing Hospital who were pathologically diagnosed with clinical stage T 1-2N 0M 0 prostatic acinar adenocarcinoma by puncture and underwent radical radiation therapy were included. All patients received ultrasound-guided cross-linked sodium hyaluronate isolation gel injection and image-guided intensity-modulated radiation therapy (IG-IMRT). The prescription dose was moderately hypofractionated, with a prescription dose of 60 Gy in 20 fractions for 5 times a week, once daily, which was delivered to 95% of the planning target volume (PTV) of prostate and seminal vesicle. Analyze the prostate rectal spacing (PRS) at the baseline, on the day of injection, during the radiotherapy, 1 month and 3 months after radiotherapy, changes in rectal volume before and after injection, and incidence of rectum-related side effects. The changes in all indexes before and after injection were analyzed by using t-test. Results:A total of 13 patients were enrolled from March 2022 to February 2023. The isolation gel maintained morphologic stability without significant spatial changes during radiotherapy, and the mid-prostate had the best effect, with PRS up to 1 cm. At 3 months after radiotherapy, the isolation gel was seen to decreased in volume with a certain absorptive capacity. The irradiated volume of rectum was decreased significantly in all patients after gel injection, and the mean volumes of rectal V 60 Gy , V 50 Gy , V 30 Gy , and V 20 Gy before and after injection were 1.923% vs. 0.280%, 10.255% vs. 3.172%, 29.602% vs. 18.800%, and 49.452% vs. 40.259% (all P<0.005). The average values (range) of rectal V 60 Gy , V 50 Gy , V 30 Gy , V 20 Gy decreases were 84.9%( 29% - 100%), 69.6%(27%-100%), 36.3%(0%-75%), and 17.8%(0%-50%), respectively. No grade 3-4 side effects occurred in all patients, and there were no common grade 1-2 rectal side effects such as diarrhea, rectal bleeding, proctitis and anal pain, etc. Only one patient developed grade 1 constipation during radiotherapy. Conclusion:Injection of Chinese made cross-linked sodium hyaluronate isolation gel can significantly reduce the irradiated volume of rectum and the incidence of rectal toxicities in prostate cancer patients undergoing radical radiotherapy.

Objective:To investigate the predictive value of a radiomics model based on biparametric magnetic resonance imaging(bpMRI)for biochemical recurrence(BCR)after radical prostatectomy(RP)in elderly prostate cancer patients(≥60 years old).Methods:A retrospective analysis was conducted on data from 175 patients treated at Beijing Hospital from August 2017 to December 2021.Based on pathological results, image segmentation was performed on preoperative bpMRI T2, diffusion weighted imaging(DWI), and apparent diffusion coefficient(ADC)sequences.Pyradiomics was utilized to extract radiomic features, and Cox regression, Spearman correlation coefficient, and LASSO regression were employed for feature dimensionality reduction, leading to the construction of radiomic labels.Clinical models and image-clinical combined models were developed using multifactorial Cox regression analysis, and the performance of these models in predicting BCR was evaluated using the concordance index(C-index).Results:The 175 patients were randomly divided into a training set(122 cases)and a test set(53 cases)at a ratio of 7∶3, with 24 cases(19.7%, 24/122)and 11 cases(20.8%, 11/53)experiencing BCR, respectively.A total of 5 775 radiomic features were extracted from the three sequences, and after dimensionality reduction, 5 features were selected to construct the radiomic labels.The radiomics model exhibited C-index values of 0.764(95% CI: 0.655-0.872)and 0.769(95% CI: 0.632-0.906)in the training and test sets, respectively.Multifactorial Cox regression analysis revealed serum prostate-specific antigen(PSA)( HR=1.032, 95% CI: 1.010-1.054), postoperative pathology International Society of Urological Pathology(ISUP)grade grouping( HR=1.682, 95% CI: 1.039-2.722), and positive surgical margins( HR=2.513, 95% CI: 1.094-5.774)as independent predictors of BCR.The clinical model exhibited C-index values of 0.751(95% CI: 0.655-0.846)and 0.753(95% CI: 0.630-0.877)in the training and test sets, respectively.Following combined modeling of clinical factors and radiomic labels, the image-clinical combined model demonstrated the highest C-index values, namely 0.782(95% CI: 0.679-0.874)and 0.801(95% CI: 0.677-0.915)in the training and test sets, respectively. Conclusions:The radiomics model based on bpMRI can predict the occurrence of BCR after RP in elderly prostate cancer patients.Combined modeling of clinical factors and radiomic labels can enhance predictive efficiency.

The clinical data of 160 elderly patients with upper urinary tract stones who underwent flexible ureteroscopic lithotripsy (FURL) in Beijing Hospital from May 2021 to November 2022 were retrospectively analyzed, including 80 patients with ambulatory surgery (study group) and 80 patients with the traditional surgery (control group). The efficacy and safety were compared between two groups. There were no significant differences in the rate of complete stone removal (91.3% (73/80) vs. 90.0% (72/80), P>0.05), operation time (60.0 (41.0, 90.0)min vs.61.0(50.0, 96.5)min, P>0.05), and incidence of postoperative systemic inflammatory response syndrome (SIRS) (8.8% (7/80) vs.12.5% (10/80), P>0.05) between two groups, while the postoperative length of hospital stay (5.0 (5.0, 6.0)h vs. 18.0 (16.2, 30.0)h, P<0.05) was shorter and the medical expenses ((20 696.7±4 645.5)Yuan vs. (31 030.8±6 275.1)Yuan, P<0.05) was less in the study group than those in the control group. The study indicates that the day surgery mode of flexible ureteroscopic lithotripsy has advantages of faster recovery and less cost over the traditional surgery mode for elderly patients.