Objective:To assess the application effects of an energy-restricted diet combined with high-protein, high-dietary-fiber meal replacement powder and probiotics in overweight/obese adults.Methods:It was a randomized controlled trial. A consecutive sample of 150 overweight/obese adults who underwent physical examinations at the Health Care Center of the First Hospital of Hebei Medical University between November 2021 and March 2022. The participants were randomly assigned into the combined group, the high-protein group, and the common group (50 participants per group) using a random number table method. All three groups of subjects received weight loss health education, energy-restricted diet, and interventions with meal replacement powder and probiotics (or probiotic placebo). The combined group was given high-protein and high-dietary fiber meal replacement powder and probiotics. The high-protein group was given high-protein meal replacement powder and probiotic placebo. The common group was given ordinary meal replacement powder and probiotic placebo. The meal replacement powder was packaged in 35 g per bag, with main components of varying amounts of protein, fat, carbohydrates, vitamins, and trace elements. Both the probiotic powder and the probiotic placebo came in 2 g sachets. The primary components of probiotic powder were various Bifidobacterium, Lactobacillus and excipients, while the main component of probiotic placebo was excipients. The meal replacement powder and the probiotic powder or probiotic placebo were taken twice a day for a total of 12 weeks, one sachet of each time, followed by a 4-week follow-up. The body weight, body mass index, body fat mass, abdominal circumference and hip circumference were measured before the trial (week 0) and at the end of weeks 2, 4, 8, 12, and 16. The change rates of each indicator were calculated. Biochemical indicators, trace elements, and 25-hydroxyvitamin D levels were measured at the end of week 0, 4, 8, and 12. A product evaluation questionnaire was conducted at the end of week 12. A total of 19 cases dropped out due to various reasons. Finally, 46 cases in the combined group, 42 cases in the high-protein group, and 43 cases in the common group were included in the analysis. Paired-samples t test, Kruskal-Wallis H test, one-way analysis of variance, and Mann-Whitney U test were used to compare the differences in weight-loss and maintenance effects, safety and patient acceptance among the three intervention groups, and to analyze the application effect of the energy-restricted diet combined with high-protein and high-dietary fiber meal replacement powder plus probiotics in overweight/obese adults. Results:Among the 131 overweight/obese adults included in the analysis, there were 57 males and 74 females, with a mean age of (37.30±8.33) years. By the end of the week 12, the body mass index [26.87(25.77, 30.38) vs 29.61(27.96, 33.09) kg/m2; 27.10(24.70, 31.37) vs 29.40(27.20, 34.17) kg/m2; 27.98(26.43, 30.12) vs 29.88(28.22, 31.93) kg/m2] and body fat masses [22.15(17.70, 30.15) vs 30.75(25.63, 35.40) kg; 23.35(19.12, 28.70) vs 29.45(26.20, 37.05) kg; 26.80(24.10, 31.60) vs 30.00(26.00, 34.70) kg] in the combined group, the high-protein group and the common group were all lower than those at baseline (week 0) (all P<0.05). At the end of the week 12, the change rates of body fat mass and body mass index in the combined group were both higher than those in the high-protein group and the common group [(25.98%±9.58%) vs (23.88%±11.15%) and (9.35%±11.00%), 9.29%(7.23%, 11.58%) vs 7.96% (5.51%, 10.92%) and 5.77% (2.68%, 10.03%)] (all P<0.05). At the end of the week 12, the body fat mass in the combined group and the high-protein group were both lower than that in the common group [22.15(17.70, 30.15), 23.35(19.12, 28.70) vs 26.80(24.10, 31.60) kg] (both P<0.05). At the end of the week 12, the decreased values of uric acid and high-sensitivity C-reactive protein in the combined group were both higher than those in the high-protein group and the common group [17.15(13.02, 23.45) vs 1.50(0.22, 28.60) and 4.20(0.15, 19.95) μmol/L, 0.43(0.24, 0.60) vs 0.21(0.06, 0.43) and 0.28(-0.04, 0.88) mg/L](both P<0.05). No serious adverse events were observed during the intervention period and at the end of the intervention. In the product evaluation questionnaire, the combined group scored higher than the high-protein group and the common group on items such as usage frequency, taste, satiety, willingness to continue use, willingness to recommend to others, and willingness to purchase [4(3, 4) vs 3(3, 4) and 3(2, 4) points, 4(3, 4) vs 3(3, 4) and 3(2, 4) points, 4(3, 4) vs 3(3, 4) and 3(3, 3) points, 4(3, 4) vs 3(3, 4) and 3(3, 4) points, 4(3, 4) vs 3(3, 4) and 3(3, 3) points, 3(3, 4) vs 3(3, 4) and 3(2, 3) points] (all P<0.05). Conclusion:An energy-restricted diet combined with high-protein, high-dietary-fiber meal replacement powder and probiotics demonstrates superior weight-loss and weight-maintenance effects in overweight/obese adults, with high safety and great user acceptability.

Objective To evaluate the efficacy and safety of combining ureteroscopic holmium laser lithotripsy with microchannel percutaneous nephrolithotomy(mPCNL)in the treatment of upper urinary tract calculus.Methods From September 2020 to September 2023,300 patients diagnosed with upper urinary tract calculus were randomly divided into control group 1,control group 2,and the combined group by random number table method,100 patients in each.Control group 1 received treatment via ureteroscopic holmium laser lithotripsy,control group 2 underwent mPCNL,while the combined group was treated with a combination of ureteroscopic holmium laser lithotripsy and mPCNL.The perioperative indicators,serum inflammatory factor levels,pain scores,and incidence of complications were compared among the three groups.Results The stone clearance rate of the combined group was higher than that of control group 1 and control group 2,the surgical time was longer than that of control group 1 and control group 2,and the hospitalization time was shorter than that of control group 1 and control group 2,but the intraoperative bleeding volume of control group 1 was less than that of combined group and control group 2,the differences were statistically significant(P<0.05).Compared with before surgery,the levels of tumor necrosis factor-α(TNF-α)in three groups was increased 1 h after surgery;Compared with 1 h after surgery,the levels of TNF-α in three groups were decreased at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).The procalcitonin(PCT)levels of the three groups at 1 and 12 h after the operation were significantly higher than those before the operation.The PCT level at 24 h after the operation was significantly lower than that at 12 h after the operation,but significantly higher than that before the operation and 1 h after the operation in three groups,the differences were statistically significant(P<0.05).At 1,12,and 24 h after surgery,the visual analogue scale(VAS)scores of the three groups decreased sequentially,and the control group 1 was lower than that of combined group and control group 1,the difference was statistically significant(P<0.05).The total incidence of complications was no statistically obviously different among the three groups(P>0.05).Conclusion The ureteroscopic holmium laser lithotripsy combined with mPCNL for upper urinary tract calculus has a high stone clearance rate,fast postoperative recovery,and does not increase the incidence of complications.

Objective To explore the clinicopathological characteristics and prognosis of multiple-molecular classifier endometrioid adenocarcinomas with DNA polymerase epsilon catalytic subunit(POLE)mutations.Methods In this study,we involved 261 patients with endometrioid adenocarcinoma admitted to the Shengjing Hospital of China Medical University.We detected the expression of the POLE gene and that of p53 protein and mismatch repair(MMR)proteins using gene sequencing and immunohistochemistry,respectively.We analyzed the correlation between different molecular classifications and clinicopathological characteristics using x2 or Fisher test,and Kaplan-Meier survival curves to analyze patients' prognosis.Results We identified nine multiple-molecular classifier cases of endome-trioid adenocarcinoma with POLE mutations,including six POLE mutated+p53 abnormal(POLE mut+p53abn)and three POLE mutated+MMR-deficient(POLE mut+dMMR)cases.Patients with POLE mut+p53abn exhibited significant differences from those with p53abn in terms of the pathological characteristics of tumor-infiltrating lymphocytes and the presence of tumors with peritumoral lymphocyte infiltra-tion(P＜0.05),while no statistically significant difference was present compared to patients with POLE mut(P＞0.05).Kaplan-Meier sur-vival curve analysis revealed that the progression-free survival rates of patients with POLE mut+p53abn and POLE mut+dMMR(100.0％)were higher than those of patients with p53abn(50.0％)and dMMR(8.8％,P＜0.05).Conclusion The clinicopathological characteris-tics of patients with POLE mut+p53abn are similar to those with POLE mut.Both patients with POLE mut+p53abn and POLE mut+dMMR display a good prognosis.

Objective To explore the clinicopathological characteristics and prognosis of multiple-molecular classifier endometrioid adenocarcinomas with DNA polymerase epsilon catalytic subunit(POLE)mutations.Methods In this study,we involved 261 patients with endometrioid adenocarcinoma admitted to the Shengjing Hospital of China Medical University.We detected the expression of the POLE gene and that of p53 protein and mismatch repair(MMR)proteins using gene sequencing and immunohistochemistry,respectively.We analyzed the correlation between different molecular classifications and clinicopathological characteristics using x2 or Fisher test,and Kaplan-Meier survival curves to analyze patients' prognosis.Results We identified nine multiple-molecular classifier cases of endome-trioid adenocarcinoma with POLE mutations,including six POLE mutated+p53 abnormal(POLE mut+p53abn)and three POLE mutated+MMR-deficient(POLE mut+dMMR)cases.Patients with POLE mut+p53abn exhibited significant differences from those with p53abn in terms of the pathological characteristics of tumor-infiltrating lymphocytes and the presence of tumors with peritumoral lymphocyte infiltra-tion(P＜0.05),while no statistically significant difference was present compared to patients with POLE mut(P＞0.05).Kaplan-Meier sur-vival curve analysis revealed that the progression-free survival rates of patients with POLE mut+p53abn and POLE mut+dMMR(100.0％)were higher than those of patients with p53abn(50.0％)and dMMR(8.8％,P＜0.05).Conclusion The clinicopathological characteris-tics of patients with POLE mut+p53abn are similar to those with POLE mut.Both patients with POLE mut+p53abn and POLE mut+dMMR display a good prognosis.

Objective To evaluate the efficacy and safety of combining ureteroscopic holmium laser lithotripsy with microchannel percutaneous nephrolithotomy(mPCNL)in the treatment of upper urinary tract calculus.Methods From September 2020 to September 2023,300 patients diagnosed with upper urinary tract calculus were randomly divided into control group 1,control group 2,and the combined group by random number table method,100 patients in each.Control group 1 received treatment via ureteroscopic holmium laser lithotripsy,control group 2 underwent mPCNL,while the combined group was treated with a combination of ureteroscopic holmium laser lithotripsy and mPCNL.The perioperative indicators,serum inflammatory factor levels,pain scores,and incidence of complications were compared among the three groups.Results The stone clearance rate of the combined group was higher than that of control group 1 and control group 2,the surgical time was longer than that of control group 1 and control group 2,and the hospitalization time was shorter than that of control group 1 and control group 2,but the intraoperative bleeding volume of control group 1 was less than that of combined group and control group 2,the differences were statistically significant(P<0.05).Compared with before surgery,the levels of tumor necrosis factor-α(TNF-α)in three groups was increased 1 h after surgery;Compared with 1 h after surgery,the levels of TNF-α in three groups were decreased at 12 and 24 h after surgery,the differences were statistically significant(P<0.05).The procalcitonin(PCT)levels of the three groups at 1 and 12 h after the operation were significantly higher than those before the operation.The PCT level at 24 h after the operation was significantly lower than that at 12 h after the operation,but significantly higher than that before the operation and 1 h after the operation in three groups,the differences were statistically significant(P<0.05).At 1,12,and 24 h after surgery,the visual analogue scale(VAS)scores of the three groups decreased sequentially,and the control group 1 was lower than that of combined group and control group 1,the difference was statistically significant(P<0.05).The total incidence of complications was no statistically obviously different among the three groups(P>0.05).Conclusion The ureteroscopic holmium laser lithotripsy combined with mPCNL for upper urinary tract calculus has a high stone clearance rate,fast postoperative recovery,and does not increase the incidence of complications.

Objective:To assess the application effects of an energy-restricted diet combined with high-protein, high-dietary-fiber meal replacement powder and probiotics in overweight/obese adults.Methods:It was a randomized controlled trial. A consecutive sample of 150 overweight/obese adults who underwent physical examinations at the Health Care Center of the First Hospital of Hebei Medical University between November 2021 and March 2022. The participants were randomly assigned into the combined group, the high-protein group, and the common group (50 participants per group) using a random number table method. All three groups of subjects received weight loss health education, energy-restricted diet, and interventions with meal replacement powder and probiotics (or probiotic placebo). The combined group was given high-protein and high-dietary fiber meal replacement powder and probiotics. The high-protein group was given high-protein meal replacement powder and probiotic placebo. The common group was given ordinary meal replacement powder and probiotic placebo. The meal replacement powder was packaged in 35 g per bag, with main components of varying amounts of protein, fat, carbohydrates, vitamins, and trace elements. Both the probiotic powder and the probiotic placebo came in 2 g sachets. The primary components of probiotic powder were various Bifidobacterium, Lactobacillus and excipients, while the main component of probiotic placebo was excipients. The meal replacement powder and the probiotic powder or probiotic placebo were taken twice a day for a total of 12 weeks, one sachet of each time, followed by a 4-week follow-up. The body weight, body mass index, body fat mass, abdominal circumference and hip circumference were measured before the trial (week 0) and at the end of weeks 2, 4, 8, 12, and 16. The change rates of each indicator were calculated. Biochemical indicators, trace elements, and 25-hydroxyvitamin D levels were measured at the end of week 0, 4, 8, and 12. A product evaluation questionnaire was conducted at the end of week 12. A total of 19 cases dropped out due to various reasons. Finally, 46 cases in the combined group, 42 cases in the high-protein group, and 43 cases in the common group were included in the analysis. Paired-samples t test, Kruskal-Wallis H test, one-way analysis of variance, and Mann-Whitney U test were used to compare the differences in weight-loss and maintenance effects, safety and patient acceptance among the three intervention groups, and to analyze the application effect of the energy-restricted diet combined with high-protein and high-dietary fiber meal replacement powder plus probiotics in overweight/obese adults. Results:Among the 131 overweight/obese adults included in the analysis, there were 57 males and 74 females, with a mean age of (37.30±8.33) years. By the end of the week 12, the body mass index [26.87(25.77, 30.38) vs 29.61(27.96, 33.09) kg/m2; 27.10(24.70, 31.37) vs 29.40(27.20, 34.17) kg/m2; 27.98(26.43, 30.12) vs 29.88(28.22, 31.93) kg/m2] and body fat masses [22.15(17.70, 30.15) vs 30.75(25.63, 35.40) kg; 23.35(19.12, 28.70) vs 29.45(26.20, 37.05) kg; 26.80(24.10, 31.60) vs 30.00(26.00, 34.70) kg] in the combined group, the high-protein group and the common group were all lower than those at baseline (week 0) (all P<0.05). At the end of the week 12, the change rates of body fat mass and body mass index in the combined group were both higher than those in the high-protein group and the common group [(25.98%±9.58%) vs (23.88%±11.15%) and (9.35%±11.00%), 9.29%(7.23%, 11.58%) vs 7.96% (5.51%, 10.92%) and 5.77% (2.68%, 10.03%)] (all P<0.05). At the end of the week 12, the body fat mass in the combined group and the high-protein group were both lower than that in the common group [22.15(17.70, 30.15), 23.35(19.12, 28.70) vs 26.80(24.10, 31.60) kg] (both P<0.05). At the end of the week 12, the decreased values of uric acid and high-sensitivity C-reactive protein in the combined group were both higher than those in the high-protein group and the common group [17.15(13.02, 23.45) vs 1.50(0.22, 28.60) and 4.20(0.15, 19.95) μmol/L, 0.43(0.24, 0.60) vs 0.21(0.06, 0.43) and 0.28(-0.04, 0.88) mg/L](both P<0.05). No serious adverse events were observed during the intervention period and at the end of the intervention. In the product evaluation questionnaire, the combined group scored higher than the high-protein group and the common group on items such as usage frequency, taste, satiety, willingness to continue use, willingness to recommend to others, and willingness to purchase [4(3, 4) vs 3(3, 4) and 3(2, 4) points, 4(3, 4) vs 3(3, 4) and 3(2, 4) points, 4(3, 4) vs 3(3, 4) and 3(3, 3) points, 4(3, 4) vs 3(3, 4) and 3(3, 4) points, 4(3, 4) vs 3(3, 4) and 3(3, 3) points, 3(3, 4) vs 3(3, 4) and 3(2, 3) points] (all P<0.05). Conclusion:An energy-restricted diet combined with high-protein, high-dietary-fiber meal replacement powder and probiotics demonstrates superior weight-loss and weight-maintenance effects in overweight/obese adults, with high safety and great user acceptability.

Objective To investigate the incidence and risk factors of recurrence of renal calculi after intracavitary lithotripsy. Methods The clinical data of 190 patients with renal stones who underwent endoluminal lithotripsy in our hospital were retrospectively collected. Based on the results of CT, B-ultrasound, or X-ray examination of the urinary system during the 2-year follow-up period, therecurrence of renal calculi was analyzed. Univariate and multivariate Logistic regression were used to analyze the risk factors of stone recurrence. Results of 190 patients, 49 patients experienced stone recurrence within 2 years after surgery, with a recurrence rate of 25.79%. Univariate Logistic regression analysis showed that body mass index(BMI), diabetes, smoking, older age and hypertension were protective factors for stone recurrence. Multivariate Logistic regression analysis showed that diabetes and smoking were risk factors for stone recurrence, while age and hypertension were protective factors for stone recurrence. Conclusion The recurrence of renal stone after intracavitary lithotripsy is common. Diabetes and smoking are risk factors for the recurrence of renal stone, while older age and hypertension are protective factors.

Objective:To investigate the role of IL-21/IL-21R-mediated CD4 + T cells in Chlamydia muridarum ( Cm) respiratory infection. Methods:C57BL/6 mice (WT mice) and IL-21R -/- mice were used to establish the models of Cm respiratory infection through intranasal inhalation of Cm. Flow cytometry was used to detect the proportion, number, activity and function of CD4 + T cells in lung and spleen tissues at 0, 3, 7 and 14 d after Cm respiratory tract infection. IFN-γ and IL-4 levels in spleen cell culture supernatants were detected by ELISA. Na?ve WT mice were transferred with CD4 + T cells in the spleen tissues of IL-21R -/- mice or WT mice on 7 d after infection and given Cm intranasally 2 h later. Then the mice were weighed daily and sacrificed on 14 d after infection. The bacterial load and pathological changes in lung were analyzed. Flow cytometry was performed to detect the proportions and numbers of neutrophils (CD45 + CD11b + Gr-1 high) and alveolar macrophages (CD45 + F4/80 + CD11c high)as well as the proportions of Th1 (IFN-γ + CD4 + ) and Th2 (IL-4 + CD4 + ) cells. ELISA was also performed to measure IFN-γ and IL-4 levels in spleen cell culture supernatants. Results:Compared with WT mice, IL-21R -/- mice showed elevated numbers and enhanced activation of CD4 + T cells, increased proportion of Th1 cells and decreased proportion of Th2 cells in spleen and lung tissues after Cm respiratory infection. Besides, IFN-γ levels increased, while IL-4 levels decreased in spleen cell culture supernatants of IL-21R -/- mice. After Cm infection, the na?ve WT transferred with CD4 + T cells from IL-21R -/- mice showed less body weight loss, reduced bacterial load and alleviated pathological changes in lung tissues, increased proportion of Th1 cells in lung tissue and higher IFN-γ level in spleen cell culture supernatants. Conclusions:IL-21/IL-21R-mediated CD4 + T cells could aggravate Cm respiratory infection by suppressing Th1 cell immune responses.

Objective:To explore the predictive value of pre-biopsy serum inflammatory markers on positive prostate biopsy results, establish a nomogram model based on pre-biopsy inflammatory markers combined with other parameters, and evaluate its predictive ability for prostate biopsy results.Methods:The clinical data of 601 patients undergoing transperineal prostate biopsy who were admitted to the Second Hospital of Tianjin Medical University from August 2019 to August 2021 were retrospectively analyzed. The median age was 68(35, 89)years, and the median tPSA was 9.56(4.01, 19.95)ng/ml. The median fPSA was 1.36(0.88, 2.02)ng/ml, the median PSAD was 0.16(0.11, 0.26)ng/ml 2, and the median platelet-to-lymphocyte ratio(PLR)was 129.90(98.95, 169.89). PI-RADS v2.1 score<3 points in 189 cases(31.45%), 3 points in 174 cases(28.95%), 4 points in 190 cases(31.61%), and 5 points in 48 cases(7.99%). A simple randomization method was used to obtain 421 cases(70.00%)in the modeling group and 180 cases(30%)in the validation group.There was no significant difference in the clinical data between the two groups ( P>0.05). Univariate and multivariate logistic regression analysis were performed in the modeling group to screen independent influencing factors for the prediction of positive prostate biopsy results. A nomogram model was established and internal verification was conducted. External validation of the model was performed in the validation group. Receiver operating characteristic(ROC)curve was used to verify model discrimination, Hosmer-Lemeshow goodness-of-fit test was used to verify model calibration, and decision curve analysis (DCA) was used to evaluate the net benefit and clinical utility of the predictive model. Results:The results of univariate analysis showed that the age( OR=1.060, P<0.01), histological inflammation( OR=0.312, P<0.01), the number of biopsy needles( OR=0.949, P=0.009), f/tPSA( OR=0.954, P=0.003), PV( OR=0.973, P<0.01), PSAD( OR=29.260, P<0.01), PI-RADS v2.1 score(3-point OR=3.766, P=0.001; 4-point OR=11.800, P<0.01; 5-point OR=57.033, P<0.01), lymphocyte count( OR=1.535, P=0.013), NLR( OR=0.848, P=0.044), PLR( OR=0.994, P=0.005)and SII( OR=0.999, P=0.009)were statistically different between the prostate patients and non-prostate cancer patients in the modeling group; Multivariate analysis showed that age( OR=1.094, P<0.001), fPSA( OR=0.605, P=0.002), histological inflammation ( OR=0.241, P<0.001), PSAD ( OR=7.57, P=0.013), PLR ( OR=0.994, P=0.005) and PI-RADS v2.1 Score(3-point OR=2.737, P=0.016; 4-point OR=8.621, P<0.001; 5-point OR=47.65, P<0.001) was an independent influencing factor for prostate cancer at initial biopsy; a nomogram model based on age, fPSA, PSAD, PLR and PI-RADS v2.1 scores was established. The AUC of the modeling group was 0.849(95% CI 0.810-0.888), and the sensitivity was 80.9%, and the specificity was 76.1%; the AUC of the validation group was 0.862(95% CI 0.809-0.915), and the sensitivity was 91.9%, and the specificity was 67.8%, suggesting that the diagnostic prediction model had a good discrimination. The calibration curve showed that the prediction model was well calibrated ( χ2=6.137, P=0.632). The decision curve analysis (DCA) of the modeling and validation groups indicated a larger net benefit of the predictive model. Conclusions:The nomogram model established in this study based on age, fPSA, PSAD, PLR and PI-RADS v2.1 score showed good predictive efficacy for prostate biopsy in patients with PSA between 4-20 ng/ml.

Prostate cancer in patients with dwarfism is rarely reported. One case was reported in this article. The patient was admitted to the hospital due to the PSA elevation for more than 4 years. Due to the dwarf disease, the patient could not accommodate the transrectal ultrasound probe, and was highly suspected of prostate cancer.The prostate needle biopsy was not performed. Combined with the medical history, PSA level, preoperative MRI and PSMA-PET/CT examination, the patient was clinically diagnosed with localized prostate cancer, and radical surgical treatment was performed.