Objective To compare the dose distribution between three-dimensional conformal radiotherapy(3D-CRT) and intensity-modulated radiotherapy (IMRT) in treating locally advanced pancreatic cancer,and report the efficacy of IMRT combined with regional chemotherapy using gemcitabine (GEM).Methods Ten patients with locally advanced pancreatic cancer were enrolled in this study.3D-CRT and IMRT plans were designed for each patient.The dose distributions of target volume and normal tissues were analyzed using the dose volume histogram (DVH).Twenty-five locally advanced pancreatic cancers patients who were treated by IMRT combined with regional chemotherapy using gemcitabine (combined group) were retrospective analyzed,as well as 25 hospitalized patients of the same period who were treated by regional chemotherapy using gemcitabine alone (chemotherapy alone group).The therapeutic efficacy and adverse events were compared between two groups.Results IMRT plans decrease the mean dose and volume of duodenum,liver,stomach,both kidney and small bowel that received highdose irradiation.The 1-,2-year survival rate of the combined group and chemotherapy alone group was 60％,28％ and 36％,12％.The median survival time of two groups was 15 and 10 months,respectively (x2 =4.16,P ＜0.05).The total response rate of the combined group and the chemotherapy alone group was 64％ and 32％,respectively (x2 =5.13,P ＜ 0.05).The upper gastrointestinal side-effect rate of the combined group was higher than that of the chemotherapy alone group(Z =-2.354,P ＜ 0.05).There was no statistic significance in hematologic toxicity,liver and renal functional damage between the two groups.Conclusions Compared with 3D-CRT plan,IMRT plan could reduce the dose of organ at risks.IMRT combined with regional chemotherapy using gemcitabine could significantly improve the survival rate of patients with locally advanced pancreatic cancer with mild adverse events.

Objective To explore the correlation between apparent diffusion coefficient(ADC)and neonatal behavioral neurological assessment(NBNA) of newborns with hypoxic ischemic encephalopathy (HIE),and to evaluate ADC in the early diagnosis of HIE from the imaging perspective. Method One hundred and nine neonates aged 0—7 days with HIE underwent conventional MRI and DWI. According to HIE grading standards, there were 43 neonates in the mild group, 38 in the moderate group, 28 in the severe group, and meanwhile 24 normal neonates with the same ages were selected as the control group. All cases were assessed with NBNA, and ADC values of bilateral frontal white matter, parietal white matter, periventricular white matter, posterior limb of the internal capsule(PLIC), ventral lateral nucleus of thalamus, lenticular nucleus, splenium of the corpus callosum, brainstem were measured. ADC values of different groups were compared by analysis of variance, and the correlations between ADC values of all ROIs and NBNA were analyzed by Pearson correlation. Results Except lenticular nucleus and the brainstem, ADC values of frontal white matter, parietal white matter, periventricular white matter and PLIC, ventral lateral nucleus of thalamus, splenium of the corpus callosum were decreased in the mild, moderate, severe group. In the mild, moderate, and severe group, the ADC values of frontal deep white matter were(1.82± 0.33)× 10-3,(1.77 ± 0.34)× 10-3 and(1.62 ± 0.31)× 10-3 mm2/s,while they were(1.81 ± 0.34)× 10-3,(1.79 ± 0.27)× 10-3 and(1.72 ± 0.31)× 10-3 mm2/s for the parietal deep white matter,(1.27 ± 0.15)× 10-3,(1.23 ± 0.12)× 10-3 and(1.15 ± 0.17)× 10-3 mm2/s for the periventricular white matter,(1.08 ± 0.09)× 10-3,(0.97 ± 0.07)×10-3 and(0.84±0.06)×10-3 mm2/s for the PLIC,(1.13±0.07)×10-3 ,(1.08±0.13)×10-3 and(1.00± 0.13)× 10-3 mm2/s for the ventral lateral nucleus of thalamus,(1.27 ± 0.22)× 10-3,(1.18 ± 0.16)× 10-3 and (1.00 ± 0.23)× 10-3 mm2/s for the splenium of the corpus callosum. There were statistically significant differences between the 3 groups (F=61.27,16.27, 23.26, 72.70, 26.73, 66.09,all P<0.05). In the mild, modreate and severe group, NBNA were(36.8 ± 1.4) in the mild group,(33.5 ± 1.6) in the moderate,and (29.3 ± 2.6) in the severe group. There was positive correlation between ADC values of frontal white matter, parietal white matter, periventricular white matter and PLIC, ventral lateral nucleus of thalamus, splenium of the corpus callosum and NBNA scores(r=0.60,0.49,0.54,0.67,0.56,0.65,all P<0.05). Conclusions There are correlations between ADC values of the related ROIs of HIE and NBNA scores. Combining two aspects might diagnose the brain injury of HIE more accurately and objectively.

Objective To explore the relationship between the relevant factors and prostate cancer among Hui and Han populations.Methods The study involved 267 prostate cancer patients as cases ( 214 cases from Han population and 53 cases from Hui population ) and 534 prostatic hyperplasia patients as controls ( 428 cases from Han population and 106 cases from Hui population ) . All the patients were collected from the General Hospital of Ningxia Medical University during January of 2007 to September of 2013.The level of fasting blood glucose ( FBG) , total cholesterol ( TC) , triglyceride ( TG) , total prostate specific antigen (T-PSA), free prostate specific antigen (F-PSA) and free/total prostate specific antigen(F/T-PSA) were collected from the clinical medical records of the patients.Data were analyzed by the conditional logistic regression method, and attributable risk proportion ( ARP ) was calculated.Results In Hui population, the risk of prostate cancer for drinkers was 20.48 times higher than the non-drinkers (35.8%(19/53) to 5.7%(6/106), OR=20.48, 95%CI: 4.95-84.66) .The high level of F-PSA significantly increased the risk of prostate cancer for Hui group ( 83.0%( 44/53 ) to 55.7%( 59/106 ) , OR=4.27, 95%CI:1.18-15.43).In contrast, the high TG level decreased the risk of prostate cancer for Hui group (18.9%(10/53) to 20.8%(22/106), OR=0.24, 95%CI:0.07-0.83).In Han population, the risk of prostate cancer for smokers was 1.89 times higher than the non-smokers (55.1%(118/214) to 39.7%(170/428), OR=1.89,95%CI:1.28-2.78).Either high level of T-PSA or F-PSA increased the risk of prostate cancer for Han group (86.4%(185/214) to 53.7%(230/428),OR=2.34,95%CI:1.22-4.52;85.5%(183/214) to 56.1%(240/428), OR=2.43, 95%CI:1.29-4.59).However, the high TG level or high ratio of F/T-PSA decreased the risk of prostate cancer ( 15.4%( 33/214 ) to 18.7%( 80/428), OR=0.59, 95%CI:0.36-0.98;53.3%(114/214) to 73.4%(314/428), OR=0.53, 95%CI:0.36-0.78).The APRs of drinking and high level of F-PSA in Han populations were 66.6%,62.4%in Hui populations ,and the APRs of smoking and high level of T-PSA, high level of F-PSA were 33.8%,71.3%, 67.3% in Han populations.Conclusion Both drinking and high level of F-PSA might be the risky factors of prostate cancer while the high TG level might be protective factor for Hui group. However, for Han population, smoking, high T-PSA level, and high F-PSA level might be risky factors for prostate cancer while the high TG level and high ratio of F/T-PSA might be protective factors.In summary, the clinical relevant factors of prostate cancer may play different roles between Hui and Han populations in Ningxia region.

Objective To explore the relationship between the relevant factors and prostate cancer among Hui and Han populations.Methods The study involved 267 prostate cancer patients as cases ( 214 cases from Han population and 53 cases from Hui population ) and 534 prostatic hyperplasia patients as controls ( 428 cases from Han population and 106 cases from Hui population ) . All the patients were collected from the General Hospital of Ningxia Medical University during January of 2007 to September of 2013.The level of fasting blood glucose ( FBG) , total cholesterol ( TC) , triglyceride ( TG) , total prostate specific antigen (T-PSA), free prostate specific antigen (F-PSA) and free/total prostate specific antigen(F/T-PSA) were collected from the clinical medical records of the patients.Data were analyzed by the conditional logistic regression method, and attributable risk proportion ( ARP ) was calculated.Results In Hui population, the risk of prostate cancer for drinkers was 20.48 times higher than the non-drinkers (35.8%(19/53) to 5.7%(6/106), OR=20.48, 95%CI: 4.95-84.66) .The high level of F-PSA significantly increased the risk of prostate cancer for Hui group ( 83.0%( 44/53 ) to 55.7%( 59/106 ) , OR=4.27, 95%CI:1.18-15.43).In contrast, the high TG level decreased the risk of prostate cancer for Hui group (18.9%(10/53) to 20.8%(22/106), OR=0.24, 95%CI:0.07-0.83).In Han population, the risk of prostate cancer for smokers was 1.89 times higher than the non-smokers (55.1%(118/214) to 39.7%(170/428), OR=1.89,95%CI:1.28-2.78).Either high level of T-PSA or F-PSA increased the risk of prostate cancer for Han group (86.4%(185/214) to 53.7%(230/428),OR=2.34,95%CI:1.22-4.52;85.5%(183/214) to 56.1%(240/428), OR=2.43, 95%CI:1.29-4.59).However, the high TG level or high ratio of F/T-PSA decreased the risk of prostate cancer ( 15.4%( 33/214 ) to 18.7%( 80/428), OR=0.59, 95%CI:0.36-0.98;53.3%(114/214) to 73.4%(314/428), OR=0.53, 95%CI:0.36-0.78).The APRs of drinking and high level of F-PSA in Han populations were 66.6%,62.4%in Hui populations ,and the APRs of smoking and high level of T-PSA, high level of F-PSA were 33.8%,71.3%, 67.3% in Han populations.Conclusion Both drinking and high level of F-PSA might be the risky factors of prostate cancer while the high TG level might be protective factor for Hui group. However, for Han population, smoking, high T-PSA level, and high F-PSA level might be risky factors for prostate cancer while the high TG level and high ratio of F/T-PSA might be protective factors.In summary, the clinical relevant factors of prostate cancer may play different roles between Hui and Han populations in Ningxia region.

Objective To investigate the predictive value of serum ferritin(SF)and glycated haemoglobin(HbA1c)in the occurrence of adverse perinatal outcomes in pregnant women with gestational diabetes melli-tus(GDM).Methods A total of 97 pregnant women with GDM who underwent antenatal examination and gave birth in Qionglai Maternal and Child Health Hospital from March 2021 to February 2023 were selected as observation group,and another 116 healthy pregnant women who came to the hospital for prenatal examina-tion were concurrently selected as control group.The fasting blood glucose(FBG),SF and HbA1c were com-pared between two groups,and the clinical characteristics,SF and HbA1c levels were compared among women with different perinatal outcomes.Then the influencing factors of adverse perinatal outcomes in GDM preg-nant women were identified,and the value of serum SF and HbA1c in predicting adverse perinatal outcomes in GDM pregnant women was determined.Results FBG,triglycerides(TG),total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C),SF,and HbA1c were elevated in observation group compared to control group,and the differences were statistically significant(P＜0.05).FBG,TG,TC,SF,and HbA1c were higher in poor perinatal outcome group than in good perinatal outcome group,and the differences were statistically significant(P＜0.05).Multivariate Logistic regression analysis denoted that FBG,TG,TC,SF and HbA1c were independent influencing factors for adverse perinatal outcomes(P＜0.05).Receiver operating character-istic(ROC)curve analysis indicated that the area under the curve of single detection and combined detection of SF and HbA1c in predicting the adverse perinatal outcomes in GDM were 0.741(95％CI:0.638-0.844),0.685(95％CI:0.570-0.800)and 0.874(95％CI:0.797-0.951),respectively.Conclusion SF and HbA1c are abnormally elevated in pregnant women with GDM,and SF combined with HbA1c has certain predictive value for perinatal outcomes of pregnant women with GDM.

Objective:To explore the risk factors related to acute rejection (AR) after pediatric kidney transplantation (KT).Methods:Retrospective analysis was performed for 189 pediatric KT recipients from September 2011 to August 2022.They were divided into two groups of AR (n=33) and non-AR (n=156).Univariate and multivariate Logistic regression analyses were performed for identifying potential risk factors of AR.And the effects of AR on graft function and survival were also examined.Results:During follow-ups, a total of 33(17.5%) patients developed AR with a 1-year cumulative incidence of AR of 16.9%(32/189).Univariate analysis revealed that median time on dialysis was longer in AR group than that in non-AR group (19 vs. 11 months, P=0.034).Median age of donors (12 vs. 24 months, P=0.033), median weight of donors (9.5 vs. 12 kg, P=0.025) and median donor/recipient body weight ratio (0.36 vs. 0.50, P=0.005) were lower in AR group than those in non-AR group.And the proportion of subtherapeutic tacrolimus (TAC) trough level was higher in AR group than that in non-AR group (45.5% vs. 21.2%, P=0.004).Multivariate regression analysis indicated that subtherapeutic TAC trough level was an independent risk factor for AR ( OR=2.977, 95% CI: 1.314-6.743, P=0.009).At the last follow-up, serum creatinine and eGFR were (78.4±24.3) vs. (74.6±24.7) μmol/L and (85.3±26.3) vs. (89.5±24.2) ml·min -1·1.73 m -2 in AR and non-AR groups respectively.There were no significant differences.1/5-year patient survival rate was both 97% in AR group and both 99.4% in non-AR group; 1/5-year graft survival rate both 90.9% in AR group and was 98.1% and 97.4% in non-AR group.No significant inter-group differences existed in patient and graft survival. Conclusions:Although an occurrence of early AR does not negatively impact graft outcomes, the incidence of AR remains high after pediatric KT.Therefore prompt diagnosis and treatment of AR should be strengthened.

Objective:To explore the application of high-throughput second-generation gene sequencing technology based upon metagenomics in the diagnosis of pulmonary infection after organ transplantation.Methods:From June 2016 to January 2020, clinical records were retrospectively reviewed for 34 renal and liver transplant recipients hospitalized for pulmonary infection. From June 2016 to December 2018, they were assigned as group A (n=20) of traditional pathogen detections. From January 2019 to January 2020, 14 cases in group B were sequenced by high-throughput second-generation technology. The detection rate, sensitivity and specificity, the return time of detection results, the average length of stay and the mortality of 28 days between two groups were analyzed.Results:No significant inter-group difference existed in clinical data (age, gender, antibody induction method, immunosuppressant use, etc.). As compared with group A, the positive detection rate of etiology and the the sensitivity were higher in group B and the differences in specificity were statistically insignificant. The return time of test results in group B was significantly shorter than that in group A. And the difference was statistically significant. The average hospitalization stay and 28-day mortality of group B were lower than those of group A. And the differences were statistically significant.Conclusions:High-throughput second-generation gene sequencing technology can improve the detection rate of pulmonary infection after organ transplantation. Providing a " precise and accurate" direction for disease treatment, it is a useful supplement to traditional diagnostic methods.

Objective:To retrospectively summarize the clinical experiences of managing renal artery stenosis after donor kidney transplantation in children.Methods:From January 2018 to October 2021, 114 pediatric kidney transplants(donor/recipient aged <18 years)were performed.According to the findings of color Doppler ultrasonography, they were divided into two groups of normal( n=80)and rapid flow( n=34). Rapid flow group were assigned into symptomatic( n=13)and asymptomatic( n=21)sub-groups based upon clinical features of hypertension and renal instability. Results:Among them, there were 65 males and 49 females.A significant inter-gender difference existed in the proportion of higher arterial flow rate of transplanted kidney(38.5% and 18.4%, P=0.02). No significant difference existed in age or body weight of transplant recipients among all groups( P>0.05). The mean age(10.4 months)and body weight(9 kg)of donors were significantly lower in symptomatic group than those in normal group(65.3 months, 21 kg)and asymptomatic group(64.4 months, 21.2 kg). The mean velocity of symptomatic group was significantly higher than that of asymptomatic group(363.5 vs 228.8 cm/s)( P<0.001). In symptomatic group, 6 cases received medications and their clinical manifestations were completely relieved.Among 7 patients invasively treated, one percutaneous transluminal angioplasty(PTA)was offer once( n=2), twice( n=2)and triple( n=1)with clinical relief and stable renal function.One case of bleeding at puncture site during PTA had treatment failure with a gradual loss of graft function.One ineffective case of PTA was subsequently placed with an endovascular stent.However, repeated stent dilation failed due to restenosis.After surgical exploration, vascular stent removal and transplantation of renal artery clipping, clinical symptoms were relieved. Conclusions:Male recipient, low body weight or young donor may be risk factors for transplant renal artery stenosis(TRAS)during pediatric donor renal transplantation.A higher flow rate of transplanted renal artery on ultrasonography could not confirm the diagnosis of TRAS.Greater arterial flow and associated clinical manifestations often hint at a strong possibility of TRAS, requiring drug or invasive treatment interventions.If PTA efficacy is not satisfactory, multiple treatments should be performed.Nevertheless, stenting should be avoided as far as possible to prevent in-stent restenosis.

Objective:To evaluate the efficacy of individualized removal therapeutic regimen for donor-specific antibodies (DSA) and examine its related influencing factors.Method:From January 2016 to January 2021, 34 recipients of kidney transplant (KT) underwent regular DSA testing and the results were positive. DSA removal therapy based upon rituximab (RTX) plus intravenous immune globulin (IVIG) was offered. Correlation between DSA negative conversion rate and DSA types, time from start of treatment to transplantation, HLA loci targeted by DSA and DSA mean fluorescent intensity (MFI) were analyzed retrospectively. Changes of immunedominant DSA (iDSA) and serum creatinine in individuals with de novo DSA (dnDSA) before and after treatment were also examined.Results:At Month 3 post-treatment, antibodies turned negative in 17/34(50.0%) patients and DSA became negative in 19/34(55.9%) at the last follow-up. Then we identified 78 DSA from all patients. No significant difference existed in negative conversion rate of pfDSA and dnDSA at Month 3 post-treatment [62.9%(39/62) vs 37.5%(6/16)] and at the last follow-up [4.2%(46/62) vs 56.3%(9/16)]( P=0.067, 0.219). For pfDSA, negative conversion rate of pfDSA with different MFIs after 3-month treatment varied significantly [negative conversion rate of weak positive DSA was 78.6%(33/42) and positive and above DSA 30%(6/20), P<0.001]. It was an independent related factor of whether or not pfDSA could turn negative (48.6%, 95% CI: 22.3%-66.8%, P=0.001). At the last follow-up, negative conversion rate of pfDSA differed markedly at different timepoints from start of treatment to transplantation [treated within 30 days post-operation was 79.2%(42/53) and over 30 days post-operation was 44.4%(4/9), P=0.042] and among different DSA MFI [88.1%(37/42) of weakly positive DSA and 45%(9/20) of positive and above DSA, P<0.001] and they were independent related factors for negative conversion of pfDSA (34.8%, 95% CI: 3.2%-61.8%, P=0.008; 43.1%, 95% CI: 18.5%-63.4%, P=0.001). Mean decline rate in iDSA was 66.67% at Month 3 post-treatment and 77.90% at the last follow-up. The difference was statistically significant ( P=0.035). Serum level of creatinine of 9 patients with dnDSA was (110.2±26.9) μmol/L pre-treatment, (178.8±90.5) μmol/L during treatment, (153.9±72.8) μmol/L at Month 3 post-treatment and (213.6±185.8) μmol/L at the last follow-up. Serum creatinine rose during treatment ( t=-2.794, P=0.023), declined at Month 3 post-treatment ( t=3.430, P=0.009) and spiked again at the last follow-up ( P=0.028). Conclusion:After DSA removal therapy based upon RTX plus IVIG, negative conversion rate of pfDSA is correlated with its MFI and time from start of treatment to transplantation. There is no significant rebound in DSA MFI and graft function of dnDSA patients improves immediately after treatment.

Objective:To compare short-term clinical efficacy between femoral neck system (FNS) and cannulated compression screws (CCS) in the treatment of femoral neck fractures in young adults.Methods:Retrospectively analyzed were the data of 94 patients with femoral neck fracture who had been admitted to Department of Orthopedics and Traumatology, The First Affiliated Hospital to University of Science and Technology of China, Department of Orthopaedics, The First Affiliated Hospital to Anhui Medical University and Department of Orthopaedics, The Second Affiliated Hospital to Anhui Medical University from October 2019 to October 2020. They were divided into 2 groups according to their modes of internal fixation: a FNS group ( n=47) and a CCS group ( n=47). In the FNS group there were 30 males and 17 females with a mean age of (47.8±9.8) years; in the CCS group there were 26 males and 21 females with a mean age of (43.7±13.1) years. The 2 groups were compared in terms of operation time, incision length, intraoperative blood loss, fracture healing time, weight-bearing time, Harris hip score and complications. Results:There was no significant difference in preoperative general data or follow-up duration between the 2 groups, showing comparability between groups ( P>0.05). In the FNS group, operation time [(47.7±9.4) min] was significantly shorter than that in the CCS group [(66.1±3.8) min], postoperative partial and full weight-bearing time [2.0 (2.0, 3.0) weeks, (6.4±2.1) weeks] significantly earlier than that in the CCS group [8.0 (3.0, 9.0), (10.1±3.4) weeks], fracture healing time [3.0(3.0, 4.0) months] significantly shorter than that in the CCS group [3.0(3.0, 4.0) months], Harris hip score at the last follow-up [95.0 (93.0, 95.0) points] significantly higher than that in the CCS group [90.0 (88.0, 95.0) points], incidence of lateral thigh irritation [0% (0/47)] significantly lower than that in the CCS group [31.9% (15/47)], and neck shortening length (4.3±3.9 mm) significantly shorter than that in the CCS group (6.9±4.5 mm) (all P<0.05). There was no significant difference in the rate of avascular necrosis of the femoral head or rate of internal fixation failure between the 2 groups ( P>0.05). Conclusion:In the treatment of femoral neck fractures in young adults, compared with CCS fixation, FNS fixation can shorten operation time and fracture healing time, allow patients to ambulate early after surgery, which is beneficial to maintenance of femoral neck length and to functional recovery of the hip.