Purpose To investigate the immunohistochemical HER2 expression in a large group of patients with urothelial carcinoma and to compare the results with the pathologic features and survival rate.Methods A total of 519 urothelial carcinoma specimens were collected from two centers.HER2 expression was measured by EnVision immuno-histochemistry.HER2 expression was compared with clinicopathological parameters,and further analyzed in relation to patient prognosis.Results The median age of the 519 patients was 66 years with a male to female ratio of 1.93∶1.Among them,160 cases were radical specimens,and 359 were transurethral resection specimens.The overall HER2 positivity rate was 61.7％(320/519),of which 148 cases(28.5％)were HER2 1+,238(45.9％)were HER2 2+,and 82(15.8％)were HER2 3+.In addition,51 cases(9.8％)were HER2-negative.HER2-positive ex-pression was associated with age,tumor location,histological grade,histological type,surgical approach,lymphovas-cular invasion,and neural invasion(all P＜0.05),but there was no significant correlation with gender,pT stage,muscular invasion,or lymph node metastasis.Univariate and multivariate logistic regression analysis showed that age≥ 66 years,higher tumor grade,and lymphovascular invasion were risk factors for positive HER2 expression,and high histological grade and lymphovascular invasion were independent risk factors affecting HER2 expression after controlling for confounders.Survival analysis showed no significant difference in recurrence-free survival between patients with HER2-positive and HER2-negative non-muscle-invasive urothelial carcinoma(P=0.274).Conclusion High histologic grade,tumor lymphovascular invasion,and neural invasion were associated with positive HER2 expression in patients with urothelial carcinoma,and higher histologic grade and lymphovascular invasion are important factors affect-ing HER2 expression.However,HER2-positive expression may not affect the prognosis of patients with non-muscle-invasive bladder urothelial carcinoma.

Purpose To investigate the clinicopathological features,diagnosis,differential diagnosis,immuno-phenotype,and prognosis of ovarian mature cystic teratoma(MCT)with an associated mucinous tumor(MT).Meth-ods Clinicopathological and follow-up data from 14 cases of MCT with MT were retrospectively analyzed and supple-mented with a literature review.Results 14 patients' ages ranged from 21-70 years,with a median age of 33 years.Tumors were located in the left ovary(4 cases),right ovary(9 cases),or bilaterally(1 case).The tumors,cystic or cyst-solid,measured 6.0-24.0 cm in maximum diameter(mean:11.7±5.7 cm).Histologically,the MT compo-nents were classified as mucinous cystadenoma(MCA)in 9 cases,borderline mucinous cystadenoma(MBT)in 4 ca-ses,and mucinous adenocarcinoma(MAC)in 1 case.Microscopically,MCT elements from multiple germ layers were identified in 13 cases,with one case showing only mature thyroid tissue.The mucinous epithelium in MCA showed no significant atypia.Mucinous epithelial proliferation accounted＞10％in MBT.MAC demonstrated moderate-to-severe atypia and invasive growth.Immunohistochemically,the MT epithelium was frequently positive for CK7(6/7),CK20(4/5),CDX2(5/6),Villin(4/4),SATB2(3/3),MUC2(2/3),MUC5AC(2/2),MUC6(1/1),and PAX-8(2/7),while negative for ER(6/6),PR(5/5),and WT-1(5/5).The Ki-67 proliferation index was low(＜5％)in 6 cases and high(50％)in one case.During a follow-up of 9-110 months,patients with MCT associated with MCA or MBT were alive without recurrence.The patient with MCT and MAC experienced recurrence 34 months after surgery.Conclusion Ovarian MCT with MT is rare and lacks specific clinical manifestations.Pathological examina-tion combined with immunophenotyping is essential for accurate diagnosis and classification.

Objective To compare the clinical efficacy of using edaravone dexmedetomidine at different times after intravenous thrombolysis in elderly patients with acute ischemic stroke(AIS).Methods A prospective study was conducted on 180 elderly AIS patients undergoing intravenous thrombolysis with recombinant tissue-type plasminogen activator in our department from April 2022 to December 2023.The patients were randomly divided into immediate group,12 h group and 24 h group,receiving an edaravone dexmedetomidine injection immediately and at 12 and 24 h after thrombolysis,respectively.During the study period,2 cases were excluded from both the immediate group and the 24 h group.NIHSS and MMSE were used to assess neurological function and cognitive function.The levels of TNF-α,IL-6 and hs-CRP were detected.The occurrence of complications after thrombolytic therapy was recorded in the three groups.Results The NIHSS scores of the three groups were significantly lower at 7 d after thrombolysis and 3 months after discharge than those before thrombolysis(P＜0.05).The scores of the immediate group were obviously lower than those of the 12 h and 24 h groups 7 d after thrombolysis,and 3 months after discharge,and the scores of the 12 h group were significantly lower than that of the 24 h group at 3 months after discharge(P＜0.05).The MMSE scores were significantly higher in the three groups at 7 d after thrombolysis and 3 months after discharge than before thrombolysis(P＜0.05).The MMSE scores of the immediate group were significantly higher than those of the 12 h and 24 h groups at 7 d after thrombolysis,and 3 months after discharge(P＜0.05),and the MMSE scores of the 12 h group were significantly higher at 7 d after thrombolysis,and 3 months after discharge than those of the 24 h group(P＜0.05).At 7 d after thrombolysis,the levels of TNF-α,IL-6,and hs-CRP were significantly decreased in the three groups than before thrombolysis(P＜0.05),and the levels were notably lower in the immediate group than the 12 h and 24 h groups,and in the 12 h group than the 24 h group(P＜0.05).The incidence of complications was significantly lower in the immediate group than the 12 and 24 h groups(P＜0.05).At 3 months after discharge,good prognosis was observed in 22 cases(37.93％)from the immediate group,11 cases(18.33％)from the 12 h group,and 10 cases(17.24％)from the 24 h group,and the rate of good prognosis was significantly higher the immediate group than the other two groups(x2 three groups=8.558,x2 immediate group vs.12h group=4.623,x2 immediate group vs.24h group=6.214,P＜0.05).Conclusion Immediately using edaravone dexmedetomidine as adjuvant therapy for AIS after thrombolysis is more effective than using in 12 and 24 h after thrombolysis,which can significantly attenuate inflammatory reactions,better restore neurological and cognitive functions,reduce the occurrence of complications,and improve their short-term prognosis.

Purpose To investigate the immunohistochemical HER2 expression in a large group of patients with urothelial carcinoma and to compare the results with the pathologic features and survival rate.Methods A total of 519 urothelial carcinoma specimens were collected from two centers.HER2 expression was measured by EnVision immuno-histochemistry.HER2 expression was compared with clinicopathological parameters,and further analyzed in relation to patient prognosis.Results The median age of the 519 patients was 66 years with a male to female ratio of 1.93∶1.Among them,160 cases were radical specimens,and 359 were transurethral resection specimens.The overall HER2 positivity rate was 61.7％(320/519),of which 148 cases(28.5％)were HER2 1+,238(45.9％)were HER2 2+,and 82(15.8％)were HER2 3+.In addition,51 cases(9.8％)were HER2-negative.HER2-positive ex-pression was associated with age,tumor location,histological grade,histological type,surgical approach,lymphovas-cular invasion,and neural invasion(all P＜0.05),but there was no significant correlation with gender,pT stage,muscular invasion,or lymph node metastasis.Univariate and multivariate logistic regression analysis showed that age≥ 66 years,higher tumor grade,and lymphovascular invasion were risk factors for positive HER2 expression,and high histological grade and lymphovascular invasion were independent risk factors affecting HER2 expression after controlling for confounders.Survival analysis showed no significant difference in recurrence-free survival between patients with HER2-positive and HER2-negative non-muscle-invasive urothelial carcinoma(P=0.274).Conclusion High histologic grade,tumor lymphovascular invasion,and neural invasion were associated with positive HER2 expression in patients with urothelial carcinoma,and higher histologic grade and lymphovascular invasion are important factors affect-ing HER2 expression.However,HER2-positive expression may not affect the prognosis of patients with non-muscle-invasive bladder urothelial carcinoma.

Purpose To investigate the clinicopathological features,diagnosis,differential diagnosis,immuno-phenotype,and prognosis of ovarian mature cystic teratoma(MCT)with an associated mucinous tumor(MT).Meth-ods Clinicopathological and follow-up data from 14 cases of MCT with MT were retrospectively analyzed and supple-mented with a literature review.Results 14 patients' ages ranged from 21-70 years,with a median age of 33 years.Tumors were located in the left ovary(4 cases),right ovary(9 cases),or bilaterally(1 case).The tumors,cystic or cyst-solid,measured 6.0-24.0 cm in maximum diameter(mean:11.7±5.7 cm).Histologically,the MT compo-nents were classified as mucinous cystadenoma(MCA)in 9 cases,borderline mucinous cystadenoma(MBT)in 4 ca-ses,and mucinous adenocarcinoma(MAC)in 1 case.Microscopically,MCT elements from multiple germ layers were identified in 13 cases,with one case showing only mature thyroid tissue.The mucinous epithelium in MCA showed no significant atypia.Mucinous epithelial proliferation accounted＞10％in MBT.MAC demonstrated moderate-to-severe atypia and invasive growth.Immunohistochemically,the MT epithelium was frequently positive for CK7(6/7),CK20(4/5),CDX2(5/6),Villin(4/4),SATB2(3/3),MUC2(2/3),MUC5AC(2/2),MUC6(1/1),and PAX-8(2/7),while negative for ER(6/6),PR(5/5),and WT-1(5/5).The Ki-67 proliferation index was low(＜5％)in 6 cases and high(50％)in one case.During a follow-up of 9-110 months,patients with MCT associated with MCA or MBT were alive without recurrence.The patient with MCT and MAC experienced recurrence 34 months after surgery.Conclusion Ovarian MCT with MT is rare and lacks specific clinical manifestations.Pathological examina-tion combined with immunophenotyping is essential for accurate diagnosis and classification.

Objective To compare the clinical efficacy of using edaravone dexmedetomidine at different times after intravenous thrombolysis in elderly patients with acute ischemic stroke(AIS).Methods A prospective study was conducted on 180 elderly AIS patients undergoing intravenous thrombolysis with recombinant tissue-type plasminogen activator in our department from April 2022 to December 2023.The patients were randomly divided into immediate group,12 h group and 24 h group,receiving an edaravone dexmedetomidine injection immediately and at 12 and 24 h after thrombolysis,respectively.During the study period,2 cases were excluded from both the immediate group and the 24 h group.NIHSS and MMSE were used to assess neurological function and cognitive function.The levels of TNF-α,IL-6 and hs-CRP were detected.The occurrence of complications after thrombolytic therapy was recorded in the three groups.Results The NIHSS scores of the three groups were significantly lower at 7 d after thrombolysis and 3 months after discharge than those before thrombolysis(P＜0.05).The scores of the immediate group were obviously lower than those of the 12 h and 24 h groups 7 d after thrombolysis,and 3 months after discharge,and the scores of the 12 h group were significantly lower than that of the 24 h group at 3 months after discharge(P＜0.05).The MMSE scores were significantly higher in the three groups at 7 d after thrombolysis and 3 months after discharge than before thrombolysis(P＜0.05).The MMSE scores of the immediate group were significantly higher than those of the 12 h and 24 h groups at 7 d after thrombolysis,and 3 months after discharge(P＜0.05),and the MMSE scores of the 12 h group were significantly higher at 7 d after thrombolysis,and 3 months after discharge than those of the 24 h group(P＜0.05).At 7 d after thrombolysis,the levels of TNF-α,IL-6,and hs-CRP were significantly decreased in the three groups than before thrombolysis(P＜0.05),and the levels were notably lower in the immediate group than the 12 h and 24 h groups,and in the 12 h group than the 24 h group(P＜0.05).The incidence of complications was significantly lower in the immediate group than the 12 and 24 h groups(P＜0.05).At 3 months after discharge,good prognosis was observed in 22 cases(37.93％)from the immediate group,11 cases(18.33％)from the 12 h group,and 10 cases(17.24％)from the 24 h group,and the rate of good prognosis was significantly higher the immediate group than the other two groups(x2 three groups=8.558,x2 immediate group vs.12h group=4.623,x2 immediate group vs.24h group=6.214,P＜0.05).Conclusion Immediately using edaravone dexmedetomidine as adjuvant therapy for AIS after thrombolysis is more effective than using in 12 and 24 h after thrombolysis,which can significantly attenuate inflammatory reactions,better restore neurological and cognitive functions,reduce the occurrence of complications,and improve their short-term prognosis.

In recent years,the infection of nontuberculous mycobacterium(NTM)has been increasing rapidly,which captivates widespread attention.The infection rate of NTM in kidney transplant recipients is more significantly elevated due to the impact of immunosuppressive drugs and other factors.However,due to the lack of sufficient research evidence,relevant guidelines for the diagnosis and treatment of NTM after kidney transplantation are still lacking.To further standardize the diagnosis and treatment of NTM disease in kidney transplant recipients,and deepen medical practitioners'understanding and diagnosis and treatment of NTM disease in organ transplantation in China,Branch of Organ Transplantation of Chinese Medical Association organized relevant experts to formulate this guideline by referring to the latest edition of"An official ATS/IDSA statement:diagnosis,treatment,and prevention of nontuberculous mycobacterial diseases","Expert Consensus on the Diagnosis and Treatment of Nontuberculous Mycobacterial Disease",and"Technical Specification for Clinical Diagnosis and Treatment of Nontuberculous Mycobacteria in Organ Transplant Recipients(2019 Edition)",and considering the characteristics of kidney transplant recipients.

Objective:The investigation and research on the application status of Hepatic Venous Pressure Gradient (HVPG) is very important to understand the real situation and future development of this technology in China.Methods:This study comprehensively investigated the basic situation of HVPG technology in China, including hospital distribution, hospital level, annual number of cases, catheters used, average cost, indications and existing problems.Results:According to the survey, there were 70 hospitals in China carrying out HVPG technology in 2021, distributed in 28 provinces (autonomous regions and municipalities directly under the central Government). A total of 4 398 cases of HVPG were performed in all the surveyed hospitals in 2021, of which 2 291 cases (52.1%) were tested by HVPG alone. The average cost of HVPG detection was (5 617.2±2 079.4) yuan. 96.3% of the teams completed HVPG detection with balloon method, and most of the teams used thrombectomy balloon catheter (80.3%).Conclusion:Through this investigation, the status of domestic clinical application of HVPG has been clarified, and it has been confirmed that many domestic medical institutions have mastered this technology, but it still needs to continue to promote and popularize HVPG technology in the future.

At present, male infertility has become a serious social and medical burden in all countries in the world, and reduce people′s happy life index. Base on this, radiologists and clinicians are trying to find some new technologies of the medical image examination methods, including X-rays, B-ultrasound, magnetic resonance imaging, etc, attempt to obtain the exact etiology diagnosis of male infertility in order to get more effective treatments and benefits with more happy families. This article of reviews the application and research progress of the latest imaging techniques in the etiological diagnosis of male infertility in recent years.

Objective:To investigate the effects of iron deficiency in early life on neurobehavioral manifestations in CDH2 genetic mutation rats, in order to explore interaction between iron deficiency and CDH2 gene mutation in autism-like behavior.Methods:The 16 female SD rats with established CDH2 genetic mutations were randomly divided into 8 rats as iron deficiency group and 8 rats as normal diet control group.After mating, rats were fed low-iron diets during pregnancy and lactation or standard diets as control.The offsprings were randomly divided into 27 rats as iron deficiency group and 27 rats as control group.The voice communication ability of offspring was studied through ultrasonic vocalizations.The data and videos of open-field test, three-chamber social interaction test were recorded by animal behavioral video analysis system(Smart3.0). The characteristics of behavior changes were analyzed by statistical methods.Results:Total number of calls in rats aged 10 day in iron deficiency group[(755.67±161.86)times]were significantly lower than that in the control group[(1461.89±166.57)times]( P<0.05). Total calling duration[(41.77±16.17)s]were significantly lower than that in the control group[(86.22±10.07)s]( P<0.05). There is a certain synergistic effect of CDH2 genetic mutation and iron deficiency on the reduction of total calls in rats aged 6 and 8 day( P<0.05). The total distance, distance in zone-periphery, mean speed in zone-total and mean speed in zone-periphery of rats in iron deficiency group were all higher than that in the control group( P<0.05); the numbers of standing and rearing were reduced( P<0.05). In the second stage of the three-chamber test, the rats in the iron deficiency group had shorter communication time with the new stranger 2 and longer interaction time with the old stranger 1 compared with the control, showing a weakening trend of social ability, but the difference was not statistically significant( P>0.05). Conclusion:Autism-like behavioral changes occurred in rats with iron deficiency in early life and CDH2 genetic mutation, and there is a certain degree of synergy.Iron deficiency and CDH2 mutation may increase the risk of autism spectrum disorder.