[Objective] To explore the clinical features of IgG4-related urinary diseases so as to provide reference for the diagnosis and treatment of such diseases. [Methods] The clinical data of 4 cases of IgG4-related urinary system diseases diagnosed and treated in Xijing Hospital of Air Force Medical University during Aug.2019 and Dec.2023 were retrospectively collected.Here, we report on the diagnosis and treatment of these patients, analysing their symptoms, serology, imaging and pathology as well as their treatment and outcomes. [Results] The patients included 2 male and 2 female.The lesions were involved with the retroperitoneum and urinary system.Three patients had symptoms of lumbar pain.The imaging manifestations were complex, including retroperitoneal mass involving urinary system organs in 2 cases, tabdense shadow of the right kidney in 1 case, and simple cystic mass of kidney in 1 case.Serum IgG4 value was not detected before surgery.All patients underwent radical surgical treatment.Postoperative pathology showed fibrous tissue hyperplasia with a large number of plasma cells, lymphocytes, a few neutrophil infiltrates, and lymphoid follicles and obliterated vasculitis in some specimens.The number of IgG4⁺ plasma cells was more than 10 in all tissues under high power microscope.After surgery, 3 patients had symptoms improved, and serum IgG4 value was within the normal range; 1 patient (patem 3) had elevated IgG4 value during follow-up, received subsequent hormone therapy, and the serum IgG 4 level remained stable. [Conclusion] The symptoms of IgG4-related diseases involving the urinary system are non-specific, and the imaging findings are various, easily confused with other diseases.Early detection of serum IgG4 and biopsy pathology can help clinicians make correct diagnosis in the early stage.

BACKGROUND: The primary limitation to kidney transplantation is organ shortage. Recent progress in gene editing and immunosuppressive regimens has made xenotransplantation with porcine organs a possibility. However, evidence in pig-to-human xenotransplantation remains scarce, and antibody-mediated rejection (AMR) is a major obstacle to clinical applications of xenotransplantation. METHODS: We conducted a kidney xenotransplantation in a brain-dead human recipient using a porcine kidney with five gene edits (5GE) on March 25, 2024 at Xijing Hospital, China. Clinical-grade immunosuppressive regimens were employed, and the observation period lasted 22 days. We collected and analyzed the xenograft function, ultrasound findings, sequential protocol biopsies, and immune surveillance of the recipient during the observation. RESULTS: The combination of 5GE in the porcine kidney and clinical-grade immunosuppressive regimens prevented hyperacute rejection. The xenograft kidney underwent delayed graft function in the first week, but urine output increased later and the single xenograft kidney maintained electrolyte and pH homeostasis from postoperative day (POD) 12 to 19. We observed AMR at 24 h post-transplantation, due to the presence of pre-existing anti-porcine antibodies and cytotoxicity before transplantation; this AMR persisted throughout the observation period. Plasma exchange and intravenous immunoglobulin treatment mitigated the AMR. We observed activation of latent porcine cytomegalovirus toward the end of the study, which might have contributed to coagulation disorder in the recipient. CONCLUSIONS 5GE and clinical-grade immunosuppressive regimens were sufficient to prevent hyperacute rejection during pig-to-human kidney xenotransplantation. Pre-existing anti-porcine antibodies predisposed the xenograft to AMR. Plasma exchange and intravenous immunoglobulin were safe and effective in the treatment of AMR after kidney xenotransplantation.
Transplantation, Heterologous/methods* ; Kidney Transplantation/methods* ; Heterografts/pathology* ; Immunoglobulins, Intravenous/administration & dosage* ; Graft Survival/immunology* ; Humans ; Animals ; Sus scrofa ; Graft Rejection/prevention & control* ; Kidney/pathology* ; Gene Editing ; Species Specificity ; Immunosuppression Therapy/methods* ; Plasma Exchange ; Brain Death ; Biopsy ; Male ; Aged

Objective:To investigate the alterations of resting-state functional connectivity (RSFC) in ventral tegmental area (VTA) and substantia nigra (SN) among male smokers, and its correlation with clinical characteristics of smoking.Methods:The resting-state functional magnetic resonance data of 131 subjects recruited from January 2014 to December 2018 were analyzed retrospectively, including 76 smokers (smoking group) and 55 non-smokers (control group). VTA/SN was selected as regions of interest (ROI), and then calculated RSFC between VTA/SN and the whole brain.Based on SPM12 software, independent sample t-test was conducted to compare the differences in RSFC between smoking group and control group.Based on SPSS 22.0 software, Pearson correlation analysis was used to investigate the relationships between the RSFC of brain regions with significant differences and Fagerstr?m test for nicotine dependence (FTND) score, pack-year of smokers. Results:Compared with control group, the results showed decreased RSFC between VTA and the brain regions related default mode network (DMN)(including posterior cingulate cortex, right anterior cuneiform lobe, bilateral superior temporal gyrus, right middle temporal gyrus and right inferior parietal lobule), and regions of limbic system(including right marginal lobe and right angular gyrus), right calcarine (MNI: x, y, z=24, -55, -14) and left insula(MNI: x, y, z=-35, -11, 9) in smoking group(GRF corrected, voxel level P<0.005, cluster level P<0.05). Taking SN as the seed, there was no significant difference between smoking group and control group ( P>0.05). RSFC of VTA-left superior temporal gyrus was positively correlated with pack-year( r=0.243, P=0.034) and FTND ( r=0.282, P=0.014). VTA-left insula RSFC was positively correlated with FTND ( r=0.316, P=0.006). Conclusion:The RSFC in the mesolimbic system and the VTA-DMN circuit exist abnormal changes in smokers.To some extent, it may explain the reward deficits and dysfunction of emotion regulation in smokers, which may provide clues for further understanding the mechanism of tobacco addiction.

Objective:To explore the practical value of general anesthesia with non-intubated spontaneous breathing in uniportal thoracoscopic surgery in elderly patients.Methods:Clinical data of 86 elderly patients undergone uniportal thoracoscopy surgery during hospitalization at our hospital between March 2020 and December 2021 were retrospectively reviewed and analyzed.Based on the anesthesia intubation method, they were divided into a non-intubated spontaneous breathing video-assisted thoracic surgery group(NI-VATS group)and a one-lung ventilation video-assisted thoracic surgery group(OLV-VATS group), with 43 cases in each group.Data were compared on the inflammatory indexes, preparation time for anesthesia, time to awakening after anesthesia, intraoperative lung collapse score, mediastinal flutter score, time to postoperative feeding, digestive tract complications, sore throat, postoperative pulmonary atelectasis, and hospitalization time.Results:Compared with the OLV-VATS group, the NI-VATS group had a shorter anesthesia preparation time [(19.8±2.6)min vs.(32.3±4.5)min, t=-15.77, P<0.001]and a shorter time to awakening [(6.8±2.1)min vs.(11.9±2.9)min, t=-9.485, P<0.001], slightly poorer operating field during surgery, an unfavorable lung collapse score [(2.5±0.7) vs.(1.8±0.7) t=4.704, P<0.001], worse mediastinal flutter [(2.1±0.6) vs.(1.3±0.5), t=6.514, P<0.001]. Lower procalcitonin(PCT)[(0.189±0.130)μg/L vs.(0.264±0.123)μg/L, t=-2.744, P=0.007), a shorter time to postoperative feeding [(3.4±1.0)h vs.(5.5±1.0)h, t=-9.55, P<0.001], and lower rates of digestive tract reactions(4.7% vs.20.9%, χ2=5.108, P=0.024)and throat pain(4.7% vs.23.3%, χ2=6.198, P=0.013), and a shorter length of hospital stay [(3.8±0.3)d vs.(4.9±0.8)d, t=-7.266, P<0.001]. Conclusions:For the elderly patients undergoing uniportal thoracoscopic surgery, non-intubated spontaneous breathing may somewhat obstruct the operating field, but it can shorten the time of anesthesia and the time to awakening, does not increase complications from anesthesia and surgery, favors rapid postoperative recovery for patients and therefore should be promoted.

Objective:To explore the value of machine learning models based on MRI predict the brain age of smokers and healthy controls, and further to explore the relationship between smoking and brain aging.Methods:This was a retrospective study. Dataset 1 consisted of 95 male smokers [20-50 (34±7) years old] and 49 healthy controls [20-50 (33±7) years old] recruited from August 2014 to October 2017 in First Affiliated Hospital of Zhengzhou University. Dataset 2 contained 114 healthy male volunteers [20-50 (34±11) years old] from the Southwestern University Adult Imaging Database from 2010 to 2015. All subjects underwent high-resolution 3D T 1WI scan. Gaussian process regression (GPR) model and support vector machine model were constructed to predict brain age based on structural MR images of healthy controls in dataset 1 and dataset 2. After the performance of the model was verified by the cross-validation method, the mean absolute error (MAE) between the predicted brain age and the actual age and the correlation ( r-value) between the actual age and the predicted brain age were calculated, and the best model was finally selected. The best models were applied to smokers and healthy controls to predict brain age. Finally, a general linear model was used to compare the differences in brain-predicted age difference (PAD) between smokers and healthy controls with age, taking years of education and total intracranial volume as covariates. Result:The performance of GPR model (MAE=5.334, r=0.747) in predicting brain age was better than support vector machine model (MAE=6.040, r=0.679). The GPR model predicted that PAD value of smokers in dataset 1 (2.19±6.64) was higher than that of healthy controls in dataset 1 (-0.80±8.94), and the difference was statistically significant ( F=8.52, P=0.004). Conclusion:GPR model based MRI has better performance in predicting brain age in smokers and healthy controls, and smokers show increased PAD values, further indicating that smoking accelerates brain aging.

Objective:To investigate the microstructural abnormalities of the white matter in first-episode medication-free patients with schizophrenia (FESZ) based on inter-voxel diffusivity metric local diffusion homogeneity (LDH) and traditional intra-voxel diffusivity metric.Methods:A total of 56 FESZ patients admitted to our hospital from January 2020 to December 2021 were selected as research subjects, and 64 healthy volunteers recruited during the same period were selected as healthy controls. All subjects accepted magnetic resonance diffusion tensor imaging, and the LDH, anisotropy fraction (FA), mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were obtained by FSL and PANDA software. Tract-based spatial statistics (TBSS) method was employed to analyze and compare the differences in the diffusivity metrics of white matter fibers between the two groups. For white matter fiber tracts with significant inter-group differences, receiver operating characteristic(ROC) curve was used to evaluate the diagnostic value of each diffusivity metric in FESZ, and Spearman partial correlation was used to analyze the relation between each diffusivity metric and positive and negative symptom scale (PANSS) scores.Results:As compared with that in the heathy control group, LDH in partial voxel clusters in bilateral anterior thalamic radiation of the FESZ group was statistically increased ( P<0.05, FWE correction). As compared with that in the heathy control group, the mean LDH in the tracts of interest (TOI) of the right inferior longitudinal fasciculus and the right uncinate fasciculus in the FESZ group was significantly increased ( P<0.05, FDR correction). In the above 4 fasciculi, ROC analysis showed that LDH had diagnostic efficacy ( P<0.05), and the diagnostic efficacy of LDH was the highest when the fasciculi structures were combined (AUC=0.733, P<0.001). LDH in white matter fiber tracts with significant inter-group differences had no statistical correlation with PANSS scores ( P>0.05). No voxel clusters or TOIs enjoyed statistical differences between groups were noted in the FA, MD, AD and RD parameter maps ( P>0.05). Conclusion:The inter-voxel diffusivity metric LDH can detect the compensatory changes of white matter microstructure in FESZ patients that could not be detected by traditional intra-voxel diffusivity metric.

Objective:To evaluate the precision of quantitative CT (QCT) in measuring fat content of goose liver and to explore the influence of tube voltage on liver fat measurement.Methods:From January to March 2017, 22 Landes geese were selected to establish fatty liver models with overfeeding. The QCT was performed under 2 different tube voltages, 80 and 120 kV. In addition to the voltage, the other scanning parameters were the same. Three ROI were placed in the centre part of the left lobe, upper and lower half of the right lobe on the 3D reconstructed images. The volume percentage of goose liver fat (Fat% QCT) was calculated according to the formula provided by Mindways. Immediately after the QCT examinations, each goose was dissected, and the whole liver was removed. Then samples were taken in the corresponding areas of the ROI by QCT. The fat (triglyceride) content of the samples was measured by the biochemical extraction method. The Spearman correlation tests were used to determine the correlation between the QCT measurements of 80 kV and 120 kV groups and the results of biochemical extraction method. The Wilcoxon signed-rank test was performed to compare Fat% QCT between 80 kV and 120 kV groups. Bland-Altman plots were used to assess agreement between the two groups′ measurements. Results:The Fat% QCT of both 80 kV and 120 kV group positively correlated highly with biochemical extraction ( r s=0.936, P<0.001, r s=0.927, P<0.001) respectively. No statistically significant difference of Fat% QCT was detected between 80 kV and 120 kV group ( Z=-0.141, P=0.888). Bland-Altman analysis showed a small difference of Fat% QCT between the 80 kV and 120 kV group, in which mean values were 0.20%. Conclusions:Using biochemical extracted triglyceride as the reference, under the conditions of low-dose 80 kV and standard 120 kV tube voltages, QCT measurement of fat content is accurate and reliable in goose liver.

Objective:To explore the application value in cerebral blood perfusion status of dynamic susceptibility contrast enhanced perfusion weighted imaging (DSC-PWI) in ischemic cerebrovascular disease (ICVD).Methods:Retrospective analysis of 31 cases ICVD head magnetic resonance imaging (MRI), diffusion weighted imaging (DWI), magnetic resonance angiography (MRA) and DSC-PWI image in clinical diagnosis, and selectively analyze parameters including relative cerebral blood flow (rCBF), relative cerebral blood volume (rCBV), mean transit time (MTT) and time to peak (TTP) for generalize its characteristics.Results:31 cases of ICVD, 16 cases hypoperfusion, rCBF decreased significantly, rCBV decreased, MTT and TTP prolonged, include 7 cases of large vessel disease and 5 cases of small vessel disease. The collateral circulation formed 9 cases, including 3 cases with good compensation, rCBF normal, rCBV normal, MTT and TTP prolonged, 6 cases with bad compensation, rCBF decreased, rCBV normal or increased, MTT and TTP prolonged. The blood reperfusion in 3 cases, rCBF normal or slightly increased, rCBV increased, MTT shortened or normal, and TTP shortened. The excessive perfusion in 3 cases, rCBF significantly increased and rCBV significantly increased, with MTT and TTP shortened.Conclusions:DSC-PWI can reliably reflect the perfusion state and collateral circulation compensation of ICVD, so as to guide the selection of clinical treatment program and significantly improve the prognosis of patients.

Objective:To investigate the abnormal dynamic characteristics of brain functional connectivity in patients with neuropsychiatric systemic lupus erythematosus (NPSLE) and its correlation with clinical indicators by using dynamic functional connectivity (dFC) analysis based on independent component analysis (ICA).Methods:The clinical and imaging data of female NPSLE patients diagnosed in the First Affiliated Hospital of Zhengzhou University from July 2018 to September 2019 were prospectively collected. The levels of complement C3, C4, CH50, glucocorticoid prednisone dosage, systemic lupus erythematosus disease activity index (SLEDAI) score and Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology (ACR) damage index (SDI) score were recorded. Age and sex matched healthy controls (HC) were enrolled at the same time. All subjects underwent resting state functional MRI (rs-fMRI). The spatial group independent component analysis was performed on MRI data using GIFT software, and 29 independent components (IC) were selected as internal connectivity network; five functional connectivity states and three dFC indexes (fraction time, mean dwell time, number of transitions) were obtained by using sliding time window technology. Two independent sample t test was used to calculate the difference of functional connectivity in different states. Mann-Whitney U test was used to calculate the difference of dFC indexes between groups. Spearman correlation analysis was used to calculate the correlation between dFC index and clinical data in NPSLE group. Results:A total of 45 NPSLE patients and 35 HC patients were enrolled. There was no significant difference in age and education level between the two groups ( t=-0.327, -0.460, P>0.05). Compared with HC group, NPSLE group had higher fraction time and longer mean dwell time ( Z=-2.496, -2.462, P<0.05); in state3 strong connection, compared with HC group, functional connectivity (FC) between posterior cerebellar lobe (IC39) and basal ganglia (IC10) was enhanced ( t=-5.201, P<0.05); FC was found decreased between posterior cerebellar lobe (IC39) and temporal lobe (IC5), temporal lobe (IC7), superior parietal lobe (IC65) ( t=4.212, 5.572, 4.415, P<0.05), as well as between paracentral lobular region (IC12) and posterior cingulate gyrus (IC15) ( t=3.893, P<0.05) in NPSLE group. The SDI score of NPSLE patients was negatively correlated with the fraction time and mean dwell time of state1 and state3 strong connection state ( P<0.05), and the SLEDAI score was negatively correlated with the fraction time and mean dwell time of state1 and state2 ( P<0.05). The SDI and SLEDAI scores were positively correlated with the fraction time and mean dwell time of state4 weak connection state, respectively ( P<0.05). The levels of serum complement C3, C4 and CH50 in NPSLE patients were positively correlated with the number of transitions ( r=0.428, 0.354, 0.385, P<0.05), and the dosage of prednisone was negatively correlated with the number of transitions ( r=-0.466, P<0.05). The validation analysis results showed the experimental results could be effectively repeated. Conclusion:The dFC analysis method based on ICA can effectively identify the alterations of brain functional connectivity on a shorter time scale, which may provide a new perspective for further exploration of the neuroimaging mechanism of cognitive impairment in NPSLE.

From December 2019, Coronavirus disease 2019 (COVID-19) pneumonia (formerly known as the 2019 novel Coronavirus [2019-nCoV]) broke out in Wuhan, China. In this study, we present serial CT findings in a 40-year-old female patient with COVID-19 pneumonia who presented with the symptoms of fever, chest tightness, and fatigue. She was diagnosed with COVID-19 infection confirmed by real-time reverse-transcriptase-polymerase chain reaction. CT showed rapidly progressing peripheral consolidations and ground-glass opacities in both lungs. After treatment, the lesions were shown to be almost absorbed leaving the fibrous lesions.