Objective:To establish a lung cancer model of patient-derived tumor xenografts (PDTX) and to explore the relation-ship between primary cisplatin resistance and ERCC1 and IGFBP5 expression levels. Methods:Lung cancer tissues from 84 patients who underwent surgery were collected and implanted into nude mice. Patient characteristics for the first generation xenografts that were and were not engrafted were compared. Passage 3 xenografts were treated with cisplatin. The expression levels of ERCC1 and IGFBP5 in cisplatin-resistant and cisplatin-sensitive groups were detected using immunohistochemistry assay. Results:The model success rates were 32.14%(27/84) in first-generation xenografts, 88.89%(24/27) in second-generation xenografts, and 95.83%(23/24) in third-gener-ation xenografts. The tumorigenicity of first-generation xenografts was correlated with size, differentiation, clinical stage, and histologi-cal type. PDTX tumors maintain the histological type of parental tumors through serial passage in nude mice. ERCC1 expression level was significantly higher in the cisplatin-resistant group than in the cisplatin-sensitive group, whereas the IGFBP5 expression level was lower in the cisplatin-resistant group than in the cisplatin-sensitive group. Conclusion:Lung cancer PDTX models were successfully es-tablished, and histological characteristics of the primary cancers were retained. Therefore, the models may serve a function in preclini-cal research of lung tumor biology and for exploring the drug resistance mechanism of tumors. The cisplatin resistance of primary lung cancer may be correlated with the expression level of ERCC1 and IGFBP5 in lung carcinoma.

Adverse reactions commonly associated with apalutamide include hot flashes, fatigue, joint pain, rash, hypertension, and anemia. Apalutamide-induced agranulocytosis is relatively rare. In this paper, we reported a case with metastatic hormone-sensitive prostate cancer who developed agranulocytosis after taking apalutamide for one month. The patient’s neutrophil count returned to normal with appropriate supportive therapy, and no significant decrease in neutrophil count was observed during 10 months of follow-up after discharge.

Ligamentum flavum cysts in the spinal canal are rare space-occupying lesions.They usually occur in the middle-aged and people over 50 years old, without obvious sex or regional differences, and mostly involve the cervical, thoracic and lumbar vertebrae, especially the lumbar vertebrae(L4/5 and L5/S1). There are no characteristic manifestations for ligamentum flavum cysts.They can cause neurological symptoms due to compression of nerve roots or the dural sac.For example, patients with lumbar ligamentum flavum cysts may complain of symptoms of lumbar disc herniation-related sciatica, which can easily lead to misdiagnosis.Surgical excision of the cyst is the most effective method.Recently, one patient with this disease was admitted to our department.After surgical fenestration, the ligamentum flavum cyst in the lumbar canal was resected and its diagnosis was eventually confirmed histologically.After 17 months of follow-up, the patient recovered well.

Objective To discuss the Etiological Distribution of COPD patients and explore the potential influencing factors of COPD infection. Methods From January 2018 to January 2021, 134 patients with concurrent pulmonary infection and 131 patients without any infection were selected from all 295 patients with COPD treated in our hospital. A total of 265 patients (30 patients with accidental pulmonary infection and other organ system infection, which did not meet the inclusion and exclusion criteria of this study, were excluded). The study collected the basic information of subjects and the information of potential factors affecting pulmonary infection. SPSS statistical software package was used to analyze the research data. Firstly, the etiology of patients with COPD infection (134 cases) was further analyzed to explore the distribution characteristics of etiology. At the same time, the related conditions of COPD patients with infection (134 cases) and patients without any infection (131 cases) were compared and analyzed to explore the related factors affecting COPD patients with pulmonary infection. Results A total of 149 bacterial strains were detected in this study. Gram-negative bacteria accounted for a higher proportion of lung infection (97/149 , 65.10%), gram-positive bacteria 50 strains (50/149 , 33.56%), and other (fungi, etc.) 2 strains (2/149 , 1.34%). Gram-negative bacteria included acinetobacter baumannii (53/149 , 35.57%), Klebsiella pneumoniae (25/149 , 16.78%), Pseudomonas aeruginosa (16/149 , 10.74%) and Escherichia coli (3/149 , 2.01%). Gram-positive bacteria included staphylococcus aureus (24/149,16.11%), Staphylococcus superficial (13/149 , 8.72%), Staphylococcus haemolyticus (9/149 , 6.04%), and streptococcus pneumoniae (4/149,2.68%). Compared with chronic obstructive pulmonary disease (134 cases) and without any infection (131 cases), it was suggested that the proportion of patients aged >60 years, smoking history, type 2 diabetes mellitus, mechanical ventilation and antibiotics use time was >15 days (P<0.05). Further univariate and multivariate Logistics regression models were used to analyze the risk factors of increased pulmonary infection. Finally, multivariate analysis showed that age >60 years, smoking history, type 2 diabetes mellitus, and >15 OR duration of antimicrobial use were all risk factors, and all of them had P<0.05. Conclusion Gram negative bacteria are the main pathogens of lung infection in COPD patients. The risk of lung infection is higher in patients with high age, smoking history, type 2 diabetes and long time use of antibiotics, which is worthy of clinical attention.

Objective:Based on multi-parametric prostate magnetic resonance imaging (mpMRI) and related clinical indicators, a nomogram model for patients with PI-RADS ≥3 and PSA 4-20ng/ml was developed and validated, and the predictive value of the model in diagnosing clinically significant prostate cancer was evaluated.Methods:The clinical and pathological data of 865 patients who underwent ultrasound-guided transperineal prostate biopsy for the first time at the Department of Urology, Second Hospital of Tianjin Medical University from January 2020 to August 2023, with PI-RADS scores ≥3 and PSA levels between 4-20 ng/ml were retrospectively analyzed. These 865 patients were included in Cohort A, and from them, 437 patients with PHI were selected in Cohort B. In Cohort A, the median age was 68(64, 73); the median f/tPSA was 14.36 (10.63, 19.74); the median PSAD was 0.17(0.11, 0.25); 375 cases (43.35%) with PV≤50 ml and 490 cases (56.65%) with PV>50 ml; PSA fluctuation <-50% 84 cases (9.71%), -50%--20% in 206 cases (23.82%), and >-20% in 575 cases (66.47%); PI-RADS v2.1 3 scores 546 cases (63.12%), 4 in 230 cases (23.59%), and 5 in 89 cases (10.29%); localization of suspicious lesions on mpMRI in the peripheral zone in 619 cases (71.56%), transitional zone in 181 cases (20.92%), others in 42 cases (4.86%), and both peripheral and transitional zones in 23 cases (2.66%). In Cohort B, the median PSAD was 0.17 (0.12, 0.25); the median D-dimer was 310.00 (230.00, 411.48); the median PHI was 49.75 (35.90, 73.27); with 198 cases (45.31%) with PV≤50 ml and 239 cases (54.69%) with PV>50 ml; PSA fluctuation<-50% was in 40 cases (9.15%), -50%--20% in 107 cases (24.49%), and>-20% in 290 cases (66.39%); PI-RADS v2.1 scores 3 was in 289 cases (66.13%), 4 in 103 cases (23.57%), and 5 in 45 cases (10.30%).Patients in cohorts A and B were randomly assigned to the training set and validation set using R language with " 123" as the random number seed, at a ratio of 7∶3.There was no statistically significant difference between the clinical data of the training and validation sets for both groups ( P>0.05).Univariate and multivariate logistic regression analyses were used to identify independent risk factors for CsPCa, and a nomogram model was constructed using R. The diagnostic performance of the prediction model was evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis(DCA).External validation of the model was conducted in the validation set. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy, and missed diagnosis rate analyses were performed on nomogram models A and B, as well as PSAD and PHI, under different thresholds. Results:Cohort A training set has 608 cases, and the validation set has 257 cases.The results of multivariate backward regression analysis in the training set show that age( OR=1.06, P=0.001), f/tPSA( OR=0.96, P=0.008), prostate volume (PV)>50ml( OR=0.36, P<0.01), prostate-specific antigen density(PSAD)( OR=145.19, P<0.01), PSA fluctuation(-50%--20%: OR=1.97, P=0.234; >-20%: OR=6.81, P<0.01), PI-RADS v2.1 score(4: OR=10.65, P<0.01; 5: OR=21.20, P<0.01), and localization of suspicious lesions on mpMRI(TZ: OR=0.57, P=0.074; Others: OR=0.26, P=0.022) were all risk factors for CsPCa. Nomogram A was developed based on these risk factors and had an area under the ROC curve (AUC) of 0.905 (95% CI 0.881-0.928) for the training set and 0.893 (95% CI 0.854-0.931) for the validation set. Cohort B training set developed based on age( OR=1.05, P=0.053), PV>50ml( OR=0.18, P<0.01), PSAD( OR=54.14, P=0.021), PSA fluctuation(-50%--20%: OR=4.78, P=0.100; >-20%: OR=20.37, P=0.001), PHI( OR=1.02, P=0.002), D-Dimer( OR=1.00, P=0.031), and PI-RADS scores(4: OR=11.35, P<0.01; 5: OR=57.61, P<0.01) as risk factors for CsPCa. Nomogram B had an AUC of 0.933(95% CI 0.906-0.959) for the training set and 0.908 (95% CI 0.859-0.958) for the validation set.The two nomogram models mentioned above both have excellent discrimination, and the calibration curves also indicated that the calibration of the two models were good.Moreover, both nomogram A and nomogram B demonstrate good clinical net benefits in the DCA curves of the training and validation sets, especially when applying nomogram B to predict CsPCa, with an accuracy rate of up to 85.82%. Conclusions:The two nomogram models developed in study, based on mpMRI and related clinical indicators, both have excellent predictive value for the diagnosis of clinically significant prostate cancer prior to prostate biopsy in patients with PI-RADS≥3 and PSA 4-20ng/ml.

[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.