ObjectiveTo define the difference of urine analysis result,α1-microglobulin (α1-MG) and β2-microglobulin ( β2-MG) between those patients suffering from calcium oxalate stone,non-calcium oxalate stone and non-urolithiasis controls at the same time period.MethodsData from 100 patients admitted to the Department of Urology,First Affiliated Hospital of Anhui Medical University from July,2010 to September,2010 were reviewed.66 patients (45 men,21 women) suffered from urolithiasis,and 34 patients (22 men,12 women) were non-urolithiasis.Patients' ages in urolithiasis group varied from 13 to 78 years and the male to female ratio was 2.1∶1.0.The patients in non-urolithiasis controlgroup aged from 12 to 80 years and the male to female ratio was 1.8∶1.0.Blood and urine were taken from the patient the next morning after admission.The biochemistry from blood and 24 h urine were measured by automatic biochemistry analyzer.The α 1-MG and β2-MG content were measured by radioimmunoassay.The stone compositions were analyzed by infrared spectroscopy.ResultsThere was difference in the levels of serum creatinine and blood urea nitrogen among three groups ( P ＜ 0.05).In controls,those with calcium oxalate stone had higher level of urinary α1-MG and β2-MG,but there were no differences in the urinary electrolyte levels.Group of non-calcium oxalate stones urinary uric acid levels were higher than calcium oxalate and control groups,the difference was statistically significant.ConclusionsIn the formation of uric acid stones,uric acid increased as independent risk factors.α1-MG,β2-MG may promote the formation of calcium oxalate stones.

Objective:To investigate the relationship between the age-adjusted Charlson comorbidity index(aCCI)and the risk of in-hospital death for people aged ≥ 90 years with community-acquired pneumonia(CAP), and to construct a novel scoring model for predicting in-hospital mortality.Methods:Basic personal and medical data about sex, age, hospitalization days, hospitalization expenses, in-hospital outcomes and discharge/admitting diagnosis of CAP patients aged ≥ 90 years hospitalized in Peking University Third Hospital between 2010 and 2019 were collected retrospectively.Multivariate Logistic regression analysis was conducted to examine the association between aCCI or other complications and in-hospital death.The receiver operating characteristic curve(ROC)was used to assess the value of aCCI and a new scoring model in predicting in-hospital death of CAP in people aged ≥ 90 years.Results:A total of 274 CAP patients aged ≥ 90 years were included in this study, of whom 85 died in hospital.Multivariate Logistic regression analysis showed that malnutrition( OR=2.21, 95% CI: 1.05-4.67, P<0.05), respiratory failure( OR=18.91, 95% CI: 9.34-38.25, P<0.001)and aCCI( OR=1.51, 95% CI: 1.23-1.85, P<0.001)were prognostic factors for in-hospital death in CAP patients aged ≥ 90 years.Based on the above results, a novel scoring model, MRC(malnutrition, respiratory failure, aCCI)was established.The area under the ROC curve of the aCCI score for predicting the risk of in-hospital death in CAP patients aged ≥ 90 years was 0.743(95% CI: 0.684-0.802). The area under the ROC curve of the MRC score was 0.891(95% CI: 0.848-0.933), indicating a higher predictive value than that of the aCCI score alone( Z=6.337, P<0.001). Conclusions:The MRC score model can be used to evaluate and predict the risk of in-hospital death in long-living CAP patients.

Objective To review the methodological quality of evidence-based guidelines on prevention and repair of perineal injury at vaginal delivery,and analyze the characteristics of guidelines to provide references for evidence-based decision-making.Methods We systematically searched websites of professional organizations,websites of clinical practice guidelines and databases for guidelines on prevention and repair of perineal injury,and used AGREE Ⅱ to evaluate the chosen guidelines.Results We identified totally 7 relevant evidence-based guidelines in this field.The average standardized scores of guidelines in 6 domains of AGREE Ⅱ were 90.21％(scope and purpose),68.25％ (stakeholder involvement),69.94％ (rigor of development),89.41％ (clarity of presentations),70.63％ (applicability),and 68.25％(independence),respectively.The overall standardized score for 7 guidelines was 75.65％,and the total score was 5.67 (7 points).For overall quality,4 of them were grade A and 3 of them were grade B.Conclusion The overall quality of included guidelines were high,but stakeholder involvement,rigor of development and independence in some guidelines needs to be improved.There was no Chinese evidence-based gui-deline in this field,and high-quality foreign guidelines could be used as evidence in combination with local conditions.

Objective To evaluate the role of programmed cell death ligand-1 (PD-L1) in a mouse model of bone cancer pain.Methods Ninety-six male C3H/HeN mice (20-25 g,4-6 weeks old),which inoculated with osteolytic NCTC 2472 cells,were used to build the model of bone cancer pain.Part one:sixtyfour male C3H/HeJ mice were randomly divided into sham group (group Sham,n =32) and tumor group (group Tumor,n=32).Part two:Twenty-four male C3H/HeJ mice which were inoculated with osteolytic NCTC 2472 cells were randomly divided into group T (tumor,n=8),group PD-L1 (intrathecal injection with PLX3397,1 μg/5μl,n=8) and group NS (intrathecal injection with normal saline,n=8).Also,there were eight male C3H/HeJ mice in group S which were intra-femur inoculated with α-MEM.The pain behaviors of Sham group and Tumor group were observed and the expression of PD-L1 was detected before inoculation and on 4,7,10,14 and 21 days after inoculation,including paw withdrawal mechanical threshold (PWMT) and the number of spontaneous flinches (NSF).On 14 d after inoculation,the mice of group PD-L1 and group NS were intrathecal injected with drugs respectively.Pain behaviors were observed before injection and 2,4,6,24h after injection.Results Compared with group Sham,PWMT was significantly decreased and NSF was increased on 7～ 21 d after inoculation in group Tumor (P＜0.05).Compared with baseline and group S (baseline (0.38±0.06),group Sham (0.35±0.08),(0.38±0.08),(0.36±0.07)),the expression of PDL1 was up-regulated on 10-21 d after inoculation in group Tumor ((0.77±0.06),(1.21±0.04),(1.18±0.06)) (P＜0.05).Compared with group NS,PWMT was significantly increased (group NS (0.25t0.12),(0.25±0.12),(0.31±0.12),group PD-L1 (1.43±0.49),(1.35±0.44),(0.95±0.26)),and NSF was decreased on 2-6 h after injection in group PD-L1 (group NS(11.74± 1.31),(13.78±0.0.91),(13.63±1.06),group P D-L1 (4.90± 0.82),(4.15± 0.71),(7.65±0.56)) (P＜0.05).Conclusion Expression of PD-L1 in spinal cord was up-regulated in the mouse model of bone cancer pain.Intrathecal injection of recombinant PD-L1 has an analgesic effect on mice with bone cancer.

We retrospectively analyzed a child with early-onset globoid cell leukodystrophy(Krabbe's disease)caused by complex heterozygous variations in the GALC gene.The girl was admitted to the hospital at the age of 4 month with main complaints of"No obvious cause of milk refusal,poor mental state,drowsiness,convulsions,fever."Brain MRI showed abnormal symmetric signals changes in bilateral cerebellar hemispheres,bilateral internal capsule hind limbs and bilateral ventricles,thin corpus callosum,myelination process lags behind the level of children of the same age.High-throughput sequencing analysis identified compound heterozygous mutations in GALC gene(NM 000153.4):c.[908+1G>A];[194G>A and the two heterozygous mutations were correspondingly inherited from his father and mother,respectively.The application of high-throughput sequencing technology can diagnose Krabbe disease efficiently and accurately,which assists in clinical identification and diagnosis.

Objective:To explore the feasibility of mismatch of amide proton transfer weighted (APTw) imaging with diffusion weighted imaging (DWI) in evaluating ischemic penumbra (IP) in patients with wake-up stroke.Methods:A prospective study was performed; 96 patients with wake-up stroke and unilateral middle cerebral artery territory infarction admitted to Emergency Stroke Department, Affiliated Hospital of Jining Medical University from September 2020 to January 2023 were chosen. All patients underwent routine MRI, DWI, APTw imaging and 3D arterial spin labeling (3D-ASL) before treatment and 90 d after treatment. IP presence was defined as changes of abnormal signal on T2-fluid-attenuated inversion recovery (FLAIR) 90 d after treatment greater than 20% of high signal range on DWI before treatment, and it was used as the gold standard to compare the efficacy in evaluating whether the patients had IP based on mismatch of 3D-ASLwith DWI and mismatch of APTw imaging with DWI before treatment. The infarct core (IC) region, mismatch region of APTw imaging with DWI, mismatch region of 3D-ASL with APTw imaging were delineated on the fusion images in patients with IP based on mismatch of 3D-ASLwith DWI and mismatch of APTw with DWI, and the differences of APTw values in different regions were compared.Results:According to the 90-d follow-up results, 50 patients had IP and 46 patients did not have IP. Specificity, accuracy and sensitivity evaluating whether the patients had IP based on mismatch of 3D-ASL with DWI were 86.9%, 93.7% and 100.0%, respectively; specificity, accuracy and sensitivity evaluating whether the patients had IP based on mismatch of APTw imaging with DWI were 100.0%, 95.8% and 92.0%, respectively. The APTw max, APTw min and APTw ave values of the IC region were significantly lower than those of mismatch region of APTw with DWI, and the APTw max-min values of mismatch region of APTw imaging with DWI were significantly higher than those of mismatch region of 3D-ASL with APTw imaging ( P<0.05). Conclusion:APTw imaging can reflect the acidosis status of different brain regions in patients with wake-up stroke; specificity and accuracy evaluating whether the patients have IP based on mismatch of APTw imaging with DWI are higher than those based on mismatch of 3D-ASL with DWI.

After the specific binding of programmed death-1 (PD-1) to programmed death ligand 1 (PD-L1) , the PD-1/PD-L1 complex can exert a co-suppressive/co-stimulatory immunoregulatory effect, which can inhibit the activation and proliferation of T cells and their cytokine secretion, and play a key role in tumor immunity, autoimmunity and immune tolerance. This review summarizes structures and regulatory mechanisms of the PD-1/PD-L1 signaling pathway, aimming to facilitate the understanding of immune pathogenesis of idiopathic inflammatory myopathies complicated by malignant tumors, and to seek potential therapeutic targets and diagnostic strategies.