Nuclear medicine molecular imaging has the characteristics of non-invasiveness,high sensitivity,spatiotemporal dynamic visualization,qualitative and quantitative analysis,and by virtue of the advantages of fusion imaging technology,it combines the features of functional metabolism and anatomical structure.Nuclear medicine molecular imaging evaluation is integrated throughout the management of radioactive iodine-refractory differentiated thyroid cancer(RAIR-DTC),including defining RAIR,exploring the lesions,guiding treatment decisions,evaluating efficacy,and assessing prognosis.131I-whole body scan(131I-WBS)is critical for determining RAIR-DTC.Diagnostic 131I-WBS can be used to explore postoperative residual thyroid and suspected iodine-avid metastases before 131I treatment,which is helpful for subsequent 131I treatment decisions.Post-treatment 131I-WBS can further clarify the iodine uptake characteristics of lesions and explore lesions not shown by diagnostic WBS,providing a reference for clarifying the clinical stage of patients and formulating follow-up management plans.The iodine uptake ability of lesions shown by post-treatment 131I-WBS can also predict the therapeutic efficacy of 131I treatment.131I-WBS combined with biochemical changes and other imaging examinations can also be used to evaluate the therapeutic efficacy of 131I treatment.18F-FDG positron emission tomography and computed tomography(PET/CT)is mainly used for high-risk DTC patients with persistently elevated serum thyroglobulin(Tg)or Tg antibody(TgAb)levels and negative 131I-WBS,and can explore and locate lesions.Combining 18F-FDG PET/CT with 131I-WBS provides a thorough evaluation of the overall tumor burden.The uptake of 18F-FDG by DTC metastases indicates poor 131I treatment response and poor prognosis for patients,and is a predictor of rapid disease progression and an increased risk of tumor-specific death.After local or systemic treatment of RAIR-DTC lesions,the early metabolic response to treatment can predict the clinical benefit of patients,allowing for timely adjustment of treatment strategies.In addition,various new radionuclide imaging techniques targeting angiogenesis(such as RGD peptides and prostate specific membrane antigen),fibroblast activation protein and somatostatin receptor can be used as supplementary means when 18F-FDG PET/CT is negative to detect RAIR-DTC lesions.They can also screen patients who qualify for targeted radionuclide therapy based on the uptake ability of imaging agents.These novel theranostics provide new options for progressive RAIR-DTC patients after multiline treatment.

Nuclear medicine molecular imaging has the characteristics of non-invasiveness,high sensitivity,spatiotemporal dynamic visualization,qualitative and quantitative analysis,and by virtue of the advantages of fusion imaging technology,it combines the features of functional metabolism and anatomical structure.Nuclear medicine molecular imaging evaluation is integrated throughout the management of radioactive iodine-refractory differentiated thyroid cancer(RAIR-DTC),including defining RAIR,exploring the lesions,guiding treatment decisions,evaluating efficacy,and assessing prognosis.131I-whole body scan(131I-WBS)is critical for determining RAIR-DTC.Diagnostic 131I-WBS can be used to explore postoperative residual thyroid and suspected iodine-avid metastases before 131I treatment,which is helpful for subsequent 131I treatment decisions.Post-treatment 131I-WBS can further clarify the iodine uptake characteristics of lesions and explore lesions not shown by diagnostic WBS,providing a reference for clarifying the clinical stage of patients and formulating follow-up management plans.The iodine uptake ability of lesions shown by post-treatment 131I-WBS can also predict the therapeutic efficacy of 131I treatment.131I-WBS combined with biochemical changes and other imaging examinations can also be used to evaluate the therapeutic efficacy of 131I treatment.18F-FDG positron emission tomography and computed tomography(PET/CT)is mainly used for high-risk DTC patients with persistently elevated serum thyroglobulin(Tg)or Tg antibody(TgAb)levels and negative 131I-WBS,and can explore and locate lesions.Combining 18F-FDG PET/CT with 131I-WBS provides a thorough evaluation of the overall tumor burden.The uptake of 18F-FDG by DTC metastases indicates poor 131I treatment response and poor prognosis for patients,and is a predictor of rapid disease progression and an increased risk of tumor-specific death.After local or systemic treatment of RAIR-DTC lesions,the early metabolic response to treatment can predict the clinical benefit of patients,allowing for timely adjustment of treatment strategies.In addition,various new radionuclide imaging techniques targeting angiogenesis(such as RGD peptides and prostate specific membrane antigen),fibroblast activation protein and somatostatin receptor can be used as supplementary means when 18F-FDG PET/CT is negative to detect RAIR-DTC lesions.They can also screen patients who qualify for targeted radionuclide therapy based on the uptake ability of imaging agents.These novel theranostics provide new options for progressive RAIR-DTC patients after multiline treatment.

Objective To evaluate the effect of irregular follow-up during normalized prevention and control of novel coronavirus pneumonia (COVID-19) epidemic on BK virus (BKV) reactivation and clinical prognosis of kidney transplant recipients. Methods Clinical data of 363 kidney transplant recipients were retrospectively analyzed, and they were divided into the pre-epidemic follow-up group and during-epidemic follow-up group according to the follow-up time. All patients were followed up for 1 year. The follow-up interval was compared between two groups. The infection of BKV and the correlation between the infection process of BKV and renal graft function were analyzed in two groups. Results A total of 1 790 preson-times were followed up before COVID-19 epidemic and 2 680 during COVID-19 epidemic. Compared with the during-epidemic follow-up group, the follow-up intervals within 3, 3-6 and 7-12 months after kidney transplantation were shorter in the pre-epidemic follow-up group, and the differences were statistically significant (all P<0.05). Within 1 year after kidney transplantation, 35 cases（32%） were diagnosed with BKV viruria, 3 cases（3%） of BKV viremia and 1 case（1%） of BKV-associated nephropathy (BKVAN) in the pre-epidemic follow-up group, and 53（25%）, 3（1%） and 1（1%） in the during-epidemic follow-up group, with no statistical significance (all P>0.05). In the pre-epidemic follow-up group, the time for the initial diagnosis of BKV viruria was longer and the viral load of the first urinary BKV reactivation was smaller than those in the during-epidemic follow-up group, with statistical significance (both P<0.05). The load of the first urinary BKV reactivation was positively correlated with the peak load of urinary BKV, and the differences between the baseline and serum creatinine levels at 1 and 3 months after BKV reactivation (all P<0.05). Conclusions Irregular follow-up after kidney transplantation may lead to early BKV reactivation and higher detection value of the first viral load of urinary BKV, delay diagnosis and interventions, and lead to poor prognosis. It is urgent to establish a remote follow-up system to meet the follow-up requirements of kidney transplant recipients when public health incidents occur.

Objective To investigate the feasibility and clinical experience of kidney transplantation from donors with Marfan syndrome (MFS). Methods Clinical data of 2 recipients undergoing kidney transplantation from the same MFS patient were retrospectively analyzed and literature review of 2 cases was conducted. Characteristics and clinical diagnosis and treatment of kidney transplantation from MFS patients were summarized. Results The Remuzzi scores of the left and right donor kidneys of the MFS patient during time-zero biopsy were 1 and 2. No significant difference was observed in the renal arteriole wall compared with other donors of brain death and cardiac death. Two recipients who received kidney transplantation from the MFS patient suffered from postoperative delayed graft function. After short-term hemodialysis, the graft function of the recipients received the left and right kidney began to gradually recover at postoperative 10 d and 20 d. After discharge, serum creatinine level of the recipient received the left kidney was ranged from 80 to 90 μmol/L, whereas that of the recipient received the right kidney kept declining, and the lowest serum creatinine level was 232 μmol/L before the submission date (at postoperative 43 d). Through literature review, two cases successfully undergoing kidney transplantation from the same MFS donor were reported. Both two recipients experienced delayed graft function, and then renal function was restored to normal. Until the publication date, 1 recipient has survived for 6 years, and the other recipient died of de novo cerebrovascular disease at postoperative 2 years. Conclusions MFS patients may serve as an acceptable source of kidney donors. However, the willingness and general conditions of the recipients should be carefully evaluated before kidney transplantation. Intraoperatively, potential risk of tear of renal arterial media should be properly treated. Extensive attention should be paid to the incidence of postoperative complications.

Objective:To investigate the predictive value of early thyroid function changes on the efficacy of patients with Graves′ disease (GD) after 131I therapy. Methods:Data of patients with GD (59 males, 214 females; age (37.4±11.4) years) who underwent single therapy of 131I in Tianjin Medical University General Hospital from November 2017 to January 2019 were retrospectively analyzed. Symptoms, signs and laboratory tests (serum free triiodothyronine (FT 3) and serum free thyroxine (FT 4)) of patients were observed to assess the efficacy of 131I treatment. Efficacy was divided into complete remission (CR), partial remission (PR), non-remission (NR) or relapse. The changes of thyroid function (ΔFT 3=FT 3 before treatment-FT 3 after treatment)/FT 3 before treatment×100%; ΔFT 4=FT 4 before treatment-FT 4 after treatment)/FT 4 before treatment×100%) 1 month after 131I therapy in each efficacy group and differences among them were compared by using independent-sample t test, χ2 test, one-way analysis of variance and the least significant difference t test. ROC curves were drawn to analyze the predictive values of early thyroid function changes on the efficacy of 131I treatment for GD. Logistic regression analyses were performed to identify the influencing factors for the efficacy of 131I therapy. Results:CR rate and total effective rate of 273 GD patients after single therapy of 131I were 67.03%(183/273) and 92.67%(253/273), respectively. After 1 month, CR rate of euthyroidism group ( n=95) was significantly higher than that of hyperthyroidism group ( n=178; 81.05%(77/95) vs 59.55%(106/178); χ2=4.60, P=0.032). ΔFT 3 and ΔFT 4 at the first month were statistically significant and decreased sequentially in the CR group ( n=183), PR group ( n=70), NR or relapse groups ( n=20; F values: 15.40, 12.54, both P<0.001). ROC curve analysis showed that patients with ΔFT 3≥73.64% and (or) ΔFT 4≥59.03% had a higher probability of achieving CR, with sensitivities of 84.3% and 86.7%, and specificities of 62.6% and 62.6%, respectively. Logistic regression analysis showed that 24 h radioactive iodine uptake (odds ratio ( OR)=1.095, 95% CI: 1.031-1.139), dose of 131I given per gram of thyroid tissue ( OR=1.562, 95% CI: 1.321-1.694), ΔFT 3 ( OR=1.354, 95% CI: 1.295-1.482), ΔFT 4 ( OR=1.498, 95% CI: 1.384-1.608) were factors affecting the outcome of patients with GD treated with 131I treatment (all P<0.05). Conclusion:Effects of 131I treatment can be predicted based on the change of the thyroid function at the first month after 131I treatment in patients with GD.

ObjectiveTo investigate the Alzheimer-associated neurofilament protein （AD7c-NTP） in urine of middle-aged and elderly people and its correlation between common metabolites. MethodsA total of 1 150 middle-aged and elderly people who did their physical exmanination in the health examination center of the Sichuan Science City Hospital and the Third Hopital of Mianyang were recruited from March 2017 to March 2020. The level of urine AD7c-NTP were measured by enzyme-linked immunosorbent assay （ELISA）， and common metabolites in blood were measured by biochemical analyzer. Based on urine AD7c-NTP level ≤1.5 ng/mL， the objects was divided into normal group （n=956） and elevated group （n=194）. Thier demographic data and blood biochemical indicators were collected. ResultsThe urine AD7c-NTP level in middle-aged and elderly people was 0.60（0.30~1.20） ng/mL. The urine AD7c-NTP level was higher in women than that in men ［1.04（0.40~1.30） ng/mL vs. 0.84（0.30~1.00） ng/mL， Z=4.202， P˂0.01］. And the urine AD7c-NTP level was lower in the normal group than that in the elevated group ［0.50（0.30~0.90） ng/mL vs. 2.10（1.70~2.10） ng/mL， Z=22.035， P˂0.01］. The results of the univariate comparison showed that， the differences between the two groups in age （Z=6.545）， fasting glucose （Z=3.506）， blood uric acid （Z=2.574）， urea nitrogen （Z=2.891）， creatinine （Z=2.243）， total bilirubin （Z=3.936）， glutathione （Z=0.969）， total cholesterol （t=3.956） and low density lipoprotein （Z=-5.678） were were statistically significant （P˂0.05 or 0.01）. Spearman correlation analysis showed that， the urine AD7c-NTP level was positively correlated with age and the levels of urea nitrogen， glucose， total cholesterol and low density lipoprotein （r=0.177， 0.178， 0.171， 0.109， 0.149， P˂0.01）， and negatively correlated with the level of total bilirubin （r=-0.172， P˂0.01）. Conclusionthe urine AD7c-NTP level in middle-aged and elderly females was signifitcantly higher than in middle-aged and elderly males.The urine AD7c-NTP level of middle-aged and elderly people was positively correlated with age， urea nitrogen， glucose， total cholesterol and low density lipoprotein， and negatively correlated with total bilirubin.

Objective:To evaluate the prognostic value of sepsis-induced coagulopathy (SIC) in patients with sepsis.Methods:From January 2019 to December 2021, patients with sepsis admitted to the Intensive Care Unit of our hospital were retrospectively classified into the SIC group and non-SIC group according to SIC diagnostic criteria. The baseline clinical data, severity score, total length of hospital stay, length of ICU stay and 28-day survival were compared between the two groups. Kaplan-Meier was used to compare the 28-day survival of patients with sepsis between the two groups. Cox proportional hazard regression model was employed to analyze the risk factors of prognosis in patients with sepsis.Results:Totally 274 patients with sepsis were included in the analysis, including 139 patients in the SIC group and 135 patients in the non-SIC group. The two groups were compared in the perspectives of the Platelet count (PLT), prothrombin time (PT) , procalcitonin (PCT), D dimer, hematocrit, red blood cell distribution width, hemoglobin, acute kidney injury (AKI), the use of continuous renal replacement treatment (CRRT), the use of vasoactive drugs, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHEⅡ) score were compared between the two groups and the difference were statistically different (all P<0.05). Kaplan-Meier analysis showed that the 28-day mortality rate in the SIC group was significantly higher than that in the non-SIC group (32.4% vs. 14.1%, P<0.05). COX proportional hazard model showed that SIC score ( HR= 2.17, 95% CI: 1.15-3.91, P<0.05), APACHEⅡ score ( HR= 1.13, 95% CI: 1.09-1.17, P<0.05) and the use of vasoactive drugs ( HR=3.66, 95% CI: 1.53-8.75, P<0.05) were independent influencing factors for 28-day death in patients with sepsis. Conclusions:Patients with sepsis and SIC have more severe disease and increased mortality risk. SIC score exhibits good clinical value in predicting the prognosis of patients with sepsis.

Objective To analyze the clinicopathological data of patients with papillary thyroid microcarcinoma(PTMC)and papillary thyroid non-microcarcinoma(non-PTMC)who received 131I therapy retrospectively,and compare the therapeutic response of the two groups of patients,so as to guide 131I therapy decisions for PTMC patients.Methods A total of 1 118 patients with papillary thyroid carcinoma(PTC)underwent 131I therapy in the Department of Nuclear Medicine,Tianjin Medical University General Hospital from January 2015 to December 2020 were enrolled.Chi-square test and Mann-Whitney U test were used to compare the differences of clinicopathological features and 131I therapy,therapeutic response between two groups.The incomplete response(IR)rate curves of the two groups were plotted by Kaplan-Meier analysis.Results The proportion of patients with multifocal,involvement of bilateral thyroid lobes in PTMC group were higher than those in non-PTMC group,and the proportion of patients with extra-thyroid extension,T4,N1b,stimulated thyroglobulin(sTg)>10 μg/L,and high risk stratified were lower than those in non-PTMC group(P<0.05).Most patients in PTMC group received remnant ablation for the first time,while more patients in non-PTMC group received adjuvant therapy and therapy for known disease(P<0.05).There was no statistically significant difference in 131I therapeutic response,the rates of excellent response(ER)and IR in two groups,and the differences in curves of IR rate between the two groups were also no statistically significance(P>0.05).Conclusions PTMC has a certain degree of invasiveness.As long as the patients were comprehensively evaluated and the standard 131I therapy was adopted,the treatment outcomes of patients with PTMC and non-PTMC were roughly the same.Therefore,the clinical value of the definition of PTMC is extremely limited in the formulation of 131I therapeutic dose regimens.

In the past few decades, some studies reported that changing the specific surface properties of titanium implants, such as surface morphology, surface chemistry, surface charge and wettability, improved the bone bonding ability of titanium implants. Based on the existing evidence, this review paper analyzes the methods and characteristics of surface chemical modification of the superhydrophilic implants (Thommen INICELL?) that were listed in China in recent years, and clarifies the process of early osseointegration from the viewpoint of histomorphology, and evaluates its clinical application effects.

Objective:To investigate the prognostic factors of differentiated thyroid cancer (DTC) patients with positive thyroglobulin antibody (TgAb) and varying ages after operation and 131I treatment. To explore the value of TgAb level and its change in the prognosis of DTC patients. Methods:Clinical data of 131 TgAb positive DTC patients were retrospectively analyzed. According to age, they were divided into young group(age<55 years, n=95) and elder group (age≥55 years, n=36). According to response, it was divided into excellent response group (110 cases) and non-excellent response group (21 cases). χ2 test and t test were used to compare the clinicopathological features between excellent response group and non-excellent response group. By logistic regression analysis, the independent risk factors affecting the prognosis of patients were analyzed. The receiver operating characteristic curve was used to determine the TgAb value of persistent or recurrent DTC, and the Kaplan-Meier regression curve was used to analyze the time of TgAb becoming negative. P<0.05 was statistically significant. Results:In young patients, the higher serum TgAb level before 131I treatment and the lateral lymph node metastasis were the independent influencing factors of poor prognosis [ OR=0.89(95% CI 0.83-0.95), OR=0.15(95% CI 0.05-0.52); both P<0.05]. In elder group, extraglandular invasion and higher serum TgAb before 131I treatment were associated with poorer prognosis [ OR=0.05(95% CI 0-0.83), OR=0.91(95% CI 0.76-1.13); P<0.05]. The serum TgAb thresholds for predicting DTC persistence/recurrence were 315.5 IU/mL(246.0 IU/mL in the young group and 516.5 IU/mL in the elder group). The mean time TgAb sera turned negative was (26.37±2.22) months [(23.28±2.37) months for young group and (32.64±4.07) months for elder group]. The TgAb decreased >50% in one year of the patients who had a lower probability of disease persistence/recurrence than the group without ( P<0.05). Conclusions:The high level of serum TgAb before 131I treatment and lateral lymph node metastasis were independent factors of poor prognosis in young patients, while in elder patients, extraglandular tumor invasion and the high level of serum TgAb before 131I treatment were independent factors of poor prognosis. The rate of TgAb change one year after treatment may be used as an early marker for predicting the disease status of TgAb positive patients.