177Lu-prostate specific membrane antigen(PSMA)radio-ligand therapy has been approved abroad for advanced prostate cancer and has been in several clinical trials in China.Based on domestic clinical practice and experimental data and referred to international experience and viewpoints,the expert group forms a consensus on the clinical application of 177Lu-PSMA radio-ligand therapy in prostate cancer to guide clinical practice.

Purpose To explore the application value of clinical-ultrasound parameter model in secondary hyperparathyroidism(SHPT).Materials and Methods A total of 86 patients(134 lesions)with renal insufficiency who underwent maintenance hemodialysis in the First Affiliated Hospital of Shihezi University from October 2020 to August 2022 were included and divided into group 1 according to the level of parathyroid hormone(iPTH)(iPTH＜300 pg/ml),group 2(iPTH 300-800 pg/ml)and group 3(iPTH≥800 pg/ml),all patients underwent gray-scale parathyroid ultrasound and acoustic palpation tissue quantitative imaging examinations.The characteristics of glandular gray-scale ultrasound and virtual touch tissue imaging quantification parameters between different groups,combined with relevant clinical indicators,established a clinical-ultrasound parameter model,used multiple linear regression to analyze the correlation between the model and iPTH,explored the independent risk factors of iPTH,and evaluated this model to evaluate SHPT the value of.Results There were significant differences in dialysis age,phosphorus,alkaline phosphatase,serum creatinine,corrected calcium and phosphorus product,lesion size,number,echo,shear wave velocity(SWV)max,SWVcen,and SWVmean among the three groups(F/x2/H=6.396-53.524,all P＜0.05).Dialysis age,phosphorus,alkaline phosphatase,and SWVratio were independent influencing factors of iPTH level(β=0.514,0.422,0.226,-0.368,all P＜0.005).The area under the curve,sensitivity,specificity and accuracy of the model for diagnosing SHPT and predicting surgical treatment with iPTH levels of 300 pg/ml and 800 pg/ml were 0.967,95.00％,100.00％,97.73％and 0.824,77.42％,71.43％and 90.00％,respectively.Conclusion Dialysis age,phosphorus,alkaline phosphatase and SWVratio are independent influencing factors of iPTH level,and the clinical-ultrasound parameter model is of great value in accurately assessing the severity of SHPT.

Objective To evaluate the application value of low-dose CT (LDCT) in physical examination for coal miners with different exposure time.Methods The consecutive three-year imaging data of 972 coal miners with over 20-year exposure were retrospectively reviewed.All miners were divided into 3 groups according to different exposure time,including 317 cases with less than 10 years,299 cases with 10-20 years and 356 cases with more than 20 years.All subjects underwent LDCT examination every year during three consecutive years.Results Baseline LDCT:As the exposure time was prolonged (with less than 10 years,10-20 years and more than 20 years),the number of coal miners has increased with non-calcified pulmonary nodules,interstitial pulmonary lesions,clinically cured or stable stage of pulmonary tuberculosis,pulmonary calcification and pulmonary fibrous stripes,but without statistically significant difference.The detection rates of lung bullae,aorta and coronary artery sclerosis were also increased mildly,with the prolonged exposure time.There was no significant correlation between exposure time and detection rates of bronchiectasis,pulmonary inflammatory lesions,lymph node enlargement or calcification,pleural lesions.The exposure time of 6 cases of malignant nodules and 2 cases of active tuberculosis was more than 10 years.During a two-year follow-up using LDCT scan,there were no significant changes in most of intrapulmonary,pleural and mediastinal lesions.Neither were in pulmonary nodules less than or equal to 4 mm.Three pulmonary nodules with 4-8 mm diameters were enlarged.Most of the inflammatory lesions have changed in size.Conclusion The LDCT scan has a certain value for chest physical examination of the coal miners with different exposure time.It is very necessary to screen the high-risk population of coal miners with exposure time of more than 10 years using LDCT.LDCT reexamination has significant value for pulmonary nodules and inflammatory lesions with diameter of more than 4 mm.Most of intrapulmonary,pleural and mediastinal lesions have no obvious change in the short term,and make an annual reexamination unnecessary,neither does a negative baseline LDCT.

Objective To investigate the critical value of TSH-stimulated Tg(sTg) in the diagnosis of metastasis from DTC, and to evaluate the diagnostic value of the ratio of sTg to suppressed Tg (sTg/suppressed Tg).Methods A total of 330 post-operative DTC patients(87 males, 243 females, age range: 12-70 years)who underwent thyroid remnant ablation from August 2008 to December 2014 were retrospectively reviewed.Their serum TgAb levels were normal.The patients were divided into non-metastasis group(147 cases)and metastasis group(183 cases) according to results of ultrasonography, CT and WBS.The difference of sTg between the two groups were compared by Mann-Whitney rank sum test.ROC curve was used to analyze the relationship between sTg, sTg/suppressed Tg ratio and metastasis, the cutoff value was calculated.Results The sTg was significantly different between the non-metastasis group and metastasis group: 1.0 (0.1, 2.0) μg/L vs 36.5 (3.9, 126.7) μg/L;u=-6.642, P<0.05.The AUC for ROC curve in metastasis group was 0.85, and the cutoff value was 2.05 μg/L, with the sensitivity 85.2%, specificity 67.3%, and accuracy 82.3%.While sTg<2.05 μg/L, the AUC of sTg/suppressed Tg ratio was 0.941, and the cutoff value was 4.3, with the sensitivity 93.3%, specificity 88.2%, and accuracy 92.3%.Conclusions The sTg has a specific value for the diagnosis of metastasis from DTC after operation and the cutoff value is 2.05 μg/L in this set of patients.The ratio of sTg/suppressed Tg could be used to correct the sTg and to improve the diagnostic sensitivity.

Objective To investigate the clinical effect of titanium plate fixation for posterior one-door-open laminoplasty in the treatment of elderly patients with multi segmental cervical spondylotic myelopathy,to analyze the advantages and disadvantages of open cervical spine fixation under fixed mode.Methods Thirty-eight cases with multi segmental cervical spondylotic myelopathy treated in China Meitan General Hospital with titanium plate fixation and posterior cervical laminoplasty from January 2011 to January 2014 were selected as the research object,a retrospective analysis was made on the clinical data of the patients.Group A with 20 cases was fixed with open-door segment C3~C6;18 cases in group B were treated with open door fixation of segmental C3~C7.X-ray,CT,MR were examined in preoperative time,JOA score was performed at 7d and 6 months after surgery.Door opening angle of CT cross section,the anteroposterior diameter(APD)of the spinal canal and shaft fusion were measured.MR spinal cord signal changes and the degree of compression,cervical spine activity, postoperative pain,the initial pain degree,VAS score and remission time differences were evaluated and analyzed.Results The incision healed in group A and B after the operation,the incidence rate of axial symptoms was 30%(6/20)in group A and 38.9%(7/18)in group B,the difference was statistically significant(P= 0.043); postoperative JOA scores were(12.2 ± 2.3)% points and(12.8 ± 1.7)points respectively in group A and B,the improvement rate of nerve function were(49.31 ± 14.5)% and(47.93 ±18.6)%,respectively in group A and B,the change rate of cervical spine were(-2.37±1.88)% and(-2.65 ±1.23)%,respectively in group A and B,the difference was not statistically significant(P>0.05).Initial VAS scores were(3.2±1.3)points and(4.1±1.7)points respectively in group A and B,the pain time were(55.2±28.5)d and(24.9± 19.2)d respectively,and complete remission time were(93.2± 47.3)d and(152.5 ± 59.3)d respectively,the differences between the two groups were statistically significant(P=0.028,P=0.031) .There were no change in opening angle,the anteroposterior diameter of spinal canal and spinal canal expansion rate at 7 days after surgery,but the door had bony fusion,without lamina closure phenomenon,and the seveity of spinal cord compression was improved at 6 months after surgery, compared with the preoperative time.Conclusion To obtain the ideal clinical treatment effect on titanium plate fixation of open-door laminoplasty in the treatment of multilevel cervical myelopathy in the elderly patients,the characteristics of the patient's own disease and selective fixation section should be taken into consideration.

Objective To investigate the critical value of TSH-stimulated Tg(sTg) in the diagnosis of metastasis from DTC,and to evaluate the diagnostic value of the ratio of sTg to suppressed Tg (sTg/suppressed Tg).Methods A total of 330 post-operative DTC patients(87 males,243 females,age range:12-70 years)who underwent thyroid remnant ablation from August 2008 to December 2014 were retrospectively reviewed.Their serum TgAb levels were normal.The patients were divided into non-metastasis group (147 cases) and metastasis group(183 cases) according to results of ultrasonography,CT and WBS.The difference of sTg between the two groups were compared by Mann-Whitney rank sum test.ROC curve was used to analyze the relationship between sTg,sTg/suppressed Tg ratio and metastasis,the cutoff value was calculated.Results The sTg was significantly different between the non-metastasis group and metastasis group:1.0 (0.1,2.0) μg/L vs 36.5 (3.9,126.7) μg/L;u=-6.642,P＜0.05.The AUC for ROC curve in metastasis group was 0.85,and the cutoff value was 2.05 μg/L,with the sensitivity 85.2％,specificity 67.3％,and accuracy 82.3％.While sTg＜2.05 μg/L,the AUC of sTg/suppressed Tg ratio was 0.941,and the cutoff value was 4.3,with the sensitivity 93.3％,specificity 88.2％,and accuracy 92.3％.Conclusions The sTg has a specific value for the diagnosis of metastasis from DTC after operation and the cutoff value is 2.05 μg/L in this set of patients.The ratio of sTg/suppressed Tg could be used to correct the sTg and to improve the diagnostic sensitivity.

Objective: To investigate the clinical significance of low-dose CT (LDCT) in coal mine workers with relatively long working years. Methods: A total of 907 coal mine workers with ≥20 working years were enrolled, among whom there were 863 male and 44 female workers with a mean age of 49.5 years. Digital radiography (DR) was performed for these workers in 2013, and LDCT was performed for three consecutive years from 2014 to 2016. Results: A total of 32 workers were found to have lung nodules by DR in 2013, while in 2014, 269 workers were found to have non-calcified lung nodules by LDCT, and there was a significant difference in the number of workers with lung nodules (χ²=233.73, P<0.005) . There was also a significant difference in the detection rate of nodules between the workers with different working years of dust exposure (χ²=6.648, P=0.00) . The male workers had a significantly higher detection rate of nodules than the female workers (χ²=5.690, P=0.017) . There was no significant difference in the number of nodules between workers with different types of work (χ²=16.985, P=0.05) . There were 443 lung nodules in total, among which 71.56% were solid nodules and 55.75% had a size of ≤4mm; malignant nodules were confirmed by surgery in 6 (0.66%) of the 907 workers after baseline LDCT. LDCT reexamination in 2015 and 2016 found new nodules in 8 workers and enlarged nodules in 3 workers, and there was no significant change in the number of nodules with a size of ≤4 mm. Conclusions It is necessary to perform high-risk population screening for coal mine workers by LDCT. The follow-up strategies for nodules with a size of ≤4mm are the same as those for negative results; annual reexamination is recommended for nodules with a size of >4-8 mm, and clinical treatment should be considered for nodules with a size of >8 mm.

Objective To study the role and mechanism of sphingosine-l-phosphate (S1P)/sphingosine-1-phosphate receptor 1 (S1P1) signal pathway during post conditioning of hypertrophic cardiomyocytes.Methods Neonatal rat cardiomyocytes were isolated and cultured,then stimulated by norepinephrine (NE) to induce cardiomyocytes hypertrophy.Using tri-gas incubator to create hypoxia and reoxygenation enviroment to mimic ischemia-reperfusion and postconditioning.Hypertrophic cardiomyoctyes were divided into five groups according to the presence or absence of various drugs and postconditiong and relevant signal pathways changes were detected:(1) IPost group (hypoxia + postconditioning);(2) IPost + S1P group (cells were pretreated with S1P (1 μmol/L) for 2 h before IPost);(3) IPost + W-146 + S1P group (cells in IPost + W-146 + S1P group were pretreated with S1P1 inhibitor W-146 (0.4 μmol/L) for 20 min);(4) IPost + PD98059 + S1P group (cells in IPost + S1P group were pretreated with MAPK antagonist PD98059 (125 μmo[/L) for 20 min);(5) IPost + LY-294002 + S1P group (cells in IPost + S1P group were pretreated with PI3K antagonist LY294002 (0.1 μmol/L) for 20 min).Apoptosis was detected by flow cytometry and protein expression of relevant signal pathways were detected by Western blot.Results (1) Apoptosis rate was significantly increased in hypoxia/reoxygenation (27.90 ± 4.49) ％ group compared with normal control group (7.97 ± 2.18) ％,which could be significantly reduced in IPost group (15.90 ± 1.77) ％ (all P ＜ 0.05).(2) Apoptosis rate and caspase-3 expression were both significantly lower in IPost + S1P and IPost + S1P + LY-294002 groups than in IPost and IPost + S1P + W-146 and IPost + S1P + PD98059 group (all P ＜ 0.05).(3)p-ERK1/2 expression was significantly higher in IPost + S1P and IPost + S1P + LY-294002 group than in IPost and IPost + SIP + W-146 group and IPost + S1P + PD98059 group (all P ＜ 0.05) while p-Akt expression was similar among IPost,IPost + S1P + W-146 and IPost + S1P +PD98059 groups.p-ERK1/2 and p-Akt levels in IPost + S1P + W-146 group and IPost + S1P + PD98059 were similar as in IPost group.Conclusions S1P can play protective role on NE induced cardiomyocytes hypertrophy during post conditioning through downregulating caspase-3 expression and reducing apoptosis rate via targeting S1P1 and activating ERK1/2 signal pathway.

Objective To evaluate the effectiveness and influencing factors of 131I treatment for cervical lymph node metastases of papillary thyroid carcinoma (PTC).Methods Eighty-nine post-operative PTC patients (24 males,65 females,11-72 years) with cervical lymph nodes as the only site of metastasis (negative serum TgAb,1-4 times of 131I treatment) on 131I planar Rx-WBS or SPECT/CT were retrospectively reviewed.Results of 131I Rx-WBS or SPECT/CT,serum Tg levels under both TSH-suppressed and TSH-stimulated conditions were measured and recorded.CR and PR were recognized as effective therapy.x2 test and logistic regression analysis were used to analyze the data.Results The effective rate of 1-4 times of 131I treatment was 57.30％(51/89),73.03％(65/89),80.90％(72/89),83.15％(74/89),respectively (x2=18.792,P＜0.01).Logistic regression analysis suggested that therapeutic effectiveness was related to the size of metastatic lymph nodes and whether metastatic lymph nodes could be visualized on the post-ablative 131I Rx-WBS or SPECT/CT.Conclusions 131I treatment is an effective modality for PTC patients with cervical lymph nodes as the only site of metastasis.The cumulative effective rate increased within a limited times of treatment.The size of metastatic lymph nodes and whether metastatic lymph nodes could be visualized on the first post-ablative 131I Rx-WBS or SPECT/CT are the key factors for the therapeutic effectiveness.

Objective To assess the diagnostic value of human epididymis secretory protein (HE4) versus CA125 for endometrial cancer.Methods Serum HE4 and CA125 levels were measured by enzyme-linked immunosorbent assay (ELISA) and electrochemiluminescence immunoassay (ECLI) in 35 patients with endometrial cancer,48 patients with benign endometrial disorders and 40 healthy controls.The best cutoff value,sensitivity and specificity were calculated with pathological results as golden standard.Receiver operating characteristic curves were plotted,and areaunderthecurve (ROC-AUC) was used to compare diagnostic value of HE4 and CA125.Results The median value in HE4 in endometrial cancer were 51.46 pmol/L,which was significantly higher than in the healthy and benign disorder controls (25.65 pmol/L and 27.92 pmol/L).However,CA125 levels did not show statistically significant difference among the 3 groups.The ROC-AUC of HE4 for discriminating endometrial cancer between healthy controls and benign disorder controls were 0.922 and 0.759,respectively,which showed higher diagnostic value than CA125 (ROC-AUC of 0.590 and 0.457,respectively).HE4 had a specificity/sensitivity of 87.5％ /86.1％ for distinguishing healthy controls from endometrial cancer,and 95.5％ /50％ for differential diagnosis with benign disorders.Conclusions Measurement of HE4 can be used as a tumor marker for diagnosis of endometrial cancer.