Objective:To investigate the clinicopathological characteristics, immunophenotypes, diagnostic criteria and differential diagnosis of atrophic kidney-like lesion (AKLL).Methods:Three cases of AKLL were collected from April 2021 to October 2023 at the Xiangya Hospital of Central South University, Changsha, Zhejiang Provincial People′s Hospital, Hangzhou and Ningbo Clinical Pathology Diagnosis Center, Ningbo, China. The clinical, morphological, and immunohistochemical characteristics were analyzed. Relevant literature was also reviewed. A targeted DNA-based next-generation sequencing (a panel of 150 genes) was performed on one of the three cases.Results:There were 1 female and 2 males, aged 30, 57, and 17 years (mean 34.6 years), respectively. The lesions were all incidentally identified during physical or imaging examination. Radiologically, they were all presented as a unilateral renal parenchymal mass. Grossly, the maximum diameters of the lesions were 1.8, 4.0, and 6.5 cm (mean 4.1 cm), respectively. The tumor cut-surfaces were sponge-like, multilocular cystic, and solid, respectively. At low magnification, the lesions were well-circumscribed, while a thick fibromuscular capsule was noted in cases 1 and 3. Cases 1 and 2 were composed of thin-walled cysts or follicular like structures of varying sizes, with the cyst wall lined by flattened and atrophic, or hobnail cells. The luminal spaces contained dense eosinophilic secretion and associated calcifications, while some cysts contained discohesive cells floating in the eosinophilic material. The tissue between the cysts showed predominantly small atrophic tubular structures. Case 3 was almost entirely composed of atrophic and collapsed tubular structures with focal cyst formation, imparting a solid sheets growth pattern under low magnification. Immunohistochemical staining revealed that the cyst lining cells and the intracystic floating cells were WT1 positive, PAX8 negative and CK7 negative, while the atrophic renal tubules were WT negative, PAX8 positive and CK7 positive. Targeted next-generation sequencing in case 1 showed no significant genetic abnormalities. All 3 patients underwent partial nephrectomy. No evidence of recurrence or metastasis was found with a follow-up of 17 to 36 months.Conclusions:AKLL is a rare and novel benign renal disease. It is easily misdiagnosed as a renal neoplasm grossly and histologically. Careful morphological observation combined with characteristic immunophenotypes can aid in its diagnosis and differential diagnosis.

Objective To assess the prognostic value of serum lysine hydroxylase 3(PLOD3)and cytokeratin 19 fragment(CYFRA21-1)in predicting the efficacy of three-dimensional brachytherapy in patients with pulmonary metastases.Methods A total of 102 patients with lung metastases who underwent three-dimensional brachytherapy at our hospital were selected as the lung metastasis group from August 2021 to August 2023.During the same period,a control group consisting of 60 healthy individuals who underwent physical examinations was selected.The lung metastasis group was further divided into an effective group(n=66)and an ineffective group(n=36)based on therapeutic outcomes.Enzyme-linked immunosorbent assay was employed to measure the levels of serum PLOD3 and CYFRA21-1.Multiple logistic regression analysis was conducted to identify factors influencing the efficacy of three-dimensional brachytherapy in the lung metastasis group.Receiver operating characteristic(ROC)curves were used to assess the predictive value of serum PLOD3 and CYFRA21-1 for treatment efficacy.Results The levels of serum PLOD3 and CYFRA21-1 in the case group were(34.47±6.17)μg/L,(27.85±5.14)μg/L,respectively,which exhibited significantly higher values compared to those observed in the control group(7.26±2.21)μg/L,(9.31±2.46)μg/L(P<0.05).A positive correlation was found between serum PLOD3 and CYFRA21-1 in the Lung metastasis group(r=0.667,P=0.000).Logistic regression analysis revealed that multiple metastatic lesions along with elevated serum levels of PLOD3 and CYFRA21-1 were identified as risk factors for the efficacy of three-dimensional brachytherapy in patients with lung metastases(P<0.05).Furthermore,when combined with three-dimensional brachytherapy,the area under the curve(AUC)for serum PLOD3 and CYFRA21-1 was calcu-lated as 0.868,demonstrating a superior performance compared to individual measurements of either serum PLOD3 alone(AUC=0.815)or CYFRA21-1 alone(P<0.05).Conclusions The levels of serum PLOD3 and CYFRA21-1 are elevated in patients with lung metastases,exhibiting a significant correlation with the efficacy of three-dimensional brachytherapy.The combined utilization of these two biomarkers demonstrates a robust predictive value for treatment efficacy in patients suffering from lung metastases.

Objective:To explore the clinical characteristics, treatment, and prognosis of patients with spondyloarthritis (SpA) and clinically insignificant monoclonal garmmopathy of undetermined significance (MGUS).Methods:A retrospective study was performed to analyze the clinical characteristics of patients simultaneously diagnosed with both SpA and MGUS at the First Affiliated Hospital to Zhengzhou University between January 2020 and December 2024, supplemented by a literature review.Results:Among the 5 patients (2 males, 3 females; age range 33~65 years), 4 presented with peripheral arthritis and 2 with extra-articular manifestations. All patients demonstrated elevated globulin and IgG levels, with 4 being HLA-B27 positive. M-protein typing revealed IgG/κ in 3 cases and IgA/λ in 2. All five patients underwent both X-ray and MRI examinations, with sacroiliitis being detected in 4 cases. Three patients with long disease duration showed poor response to conventional therapy (NSAIDs/DMARDs). Targeted therapies yielded variable outcomes: one patient achieved normalized globulin/IgG levels with etanercept (3-year follow-up without MGUS progression); another showed marked clinical improvement and significant globulin/IgG reduction with JAK inhibitor (tofacitinib, treated for 7 years); while a third demonstrated no symptom relief then switching from TNF-α inhibitor to IL-17 inhibitor.Conclusion:Persistent hyperglobulinemia in SpA patients warrants MGUS screening. Those with SpA-MGUS may require targeted therapies, where JAK inhibitors and monoclonal TNF-α inhibitors appear to be the preferred options, though long-term monitoring for MGUS progression remains essential.

Objective:To investigate the clinical application of ultrasound-guided percutaneous catheter drainage in the management of pediatric pancreatitis, delineate the indications, and assess the efficacy and safety of the procedure.Methods:A retrospective case analysis.Eighteen patients who underwent ultrasound-guided percutaneous drainage at Children′s Hospital of Chongqing Medical University from September 2018 to January 2023 were conducted.The cohort comprised 10 males and 8 females aged 1 year 4 months to 15 years and 9 months.The causes of disease were traumatic pancreatitis (9 cases), acute pancreatitis (8 cases), and recurrent pancreatitis (1 case).The disease duration ranged from 1 day to 5 months.The indications for the procedure included acute peripancreatic fluid collection with infection and peritonitis, pancreatic pseudocyst, progressive increase of acute peripancreatic fluid collection, or compression symptoms.Patients′ clinical data, including drainage site, drainage condition, puncture technique, puncture success rate and puncture complications, were collected and analyzed.Results:Nineteen drainage procedures were all successfully performed on the 18 children, and no puncture injury, drainage tube obstruction, drainage tube infection, and other complications were observed.Postoperative drainage volume on the first day ranged from 100 mL to 1 010 mL.Postoperative catheterization time spanned from 6 to 93 days, with a median of 29 days.One patient experienced drainage tube displacement after surgery, and one patient progressed to chronic pancreatitis.The remaining patients achieved clinical cure and had their drainage tubes removed.No serious short-term or long-term complications were noted postoperatively.Conclusions:Ultrasound-guided percutaneous drainage emerges as an effective therapeutic approach for children with acute pancreatitis, offering advantages such as favorable efficacy, straightforward operation, high safety, and minimal trauma.

Objective To assess the prognostic value of serum lysine hydroxylase 3(PLOD3)and cytokeratin 19 fragment(CYFRA21-1)in predicting the efficacy of three-dimensional brachytherapy in patients with pulmonary metastases.Methods A total of 102 patients with lung metastases who underwent three-dimensional brachytherapy at our hospital were selected as the lung metastasis group from August 2021 to August 2023.During the same period,a control group consisting of 60 healthy individuals who underwent physical examinations was selected.The lung metastasis group was further divided into an effective group(n=66)and an ineffective group(n=36)based on therapeutic outcomes.Enzyme-linked immunosorbent assay was employed to measure the levels of serum PLOD3 and CYFRA21-1.Multiple logistic regression analysis was conducted to identify factors influencing the efficacy of three-dimensional brachytherapy in the lung metastasis group.Receiver operating characteristic(ROC)curves were used to assess the predictive value of serum PLOD3 and CYFRA21-1 for treatment efficacy.Results The levels of serum PLOD3 and CYFRA21-1 in the case group were(34.47±6.17)μg/L,(27.85±5.14)μg/L,respectively,which exhibited significantly higher values compared to those observed in the control group(7.26±2.21)μg/L,(9.31±2.46)μg/L(P<0.05).A positive correlation was found between serum PLOD3 and CYFRA21-1 in the Lung metastasis group(r=0.667,P=0.000).Logistic regression analysis revealed that multiple metastatic lesions along with elevated serum levels of PLOD3 and CYFRA21-1 were identified as risk factors for the efficacy of three-dimensional brachytherapy in patients with lung metastases(P<0.05).Furthermore,when combined with three-dimensional brachytherapy,the area under the curve(AUC)for serum PLOD3 and CYFRA21-1 was calcu-lated as 0.868,demonstrating a superior performance compared to individual measurements of either serum PLOD3 alone(AUC=0.815)or CYFRA21-1 alone(P<0.05).Conclusions The levels of serum PLOD3 and CYFRA21-1 are elevated in patients with lung metastases,exhibiting a significant correlation with the efficacy of three-dimensional brachytherapy.The combined utilization of these two biomarkers demonstrates a robust predictive value for treatment efficacy in patients suffering from lung metastases.

Objective:To investigate the clinical application of ultrasound-guided percutaneous catheter drainage in the management of pediatric pancreatitis, delineate the indications, and assess the efficacy and safety of the procedure.Methods:A retrospective case analysis.Eighteen patients who underwent ultrasound-guided percutaneous drainage at Children′s Hospital of Chongqing Medical University from September 2018 to January 2023 were conducted.The cohort comprised 10 males and 8 females aged 1 year 4 months to 15 years and 9 months.The causes of disease were traumatic pancreatitis (9 cases), acute pancreatitis (8 cases), and recurrent pancreatitis (1 case).The disease duration ranged from 1 day to 5 months.The indications for the procedure included acute peripancreatic fluid collection with infection and peritonitis, pancreatic pseudocyst, progressive increase of acute peripancreatic fluid collection, or compression symptoms.Patients′ clinical data, including drainage site, drainage condition, puncture technique, puncture success rate and puncture complications, were collected and analyzed.Results:Nineteen drainage procedures were all successfully performed on the 18 children, and no puncture injury, drainage tube obstruction, drainage tube infection, and other complications were observed.Postoperative drainage volume on the first day ranged from 100 mL to 1 010 mL.Postoperative catheterization time spanned from 6 to 93 days, with a median of 29 days.One patient experienced drainage tube displacement after surgery, and one patient progressed to chronic pancreatitis.The remaining patients achieved clinical cure and had their drainage tubes removed.No serious short-term or long-term complications were noted postoperatively.Conclusions:Ultrasound-guided percutaneous drainage emerges as an effective therapeutic approach for children with acute pancreatitis, offering advantages such as favorable efficacy, straightforward operation, high safety, and minimal trauma.

Objective:To investigate the clinicopathological characteristics, immunophenotypes, diagnostic criteria and differential diagnosis of atrophic kidney-like lesion (AKLL).Methods:Three cases of AKLL were collected from April 2021 to October 2023 at the Xiangya Hospital of Central South University, Changsha, Zhejiang Provincial People′s Hospital, Hangzhou and Ningbo Clinical Pathology Diagnosis Center, Ningbo, China. The clinical, morphological, and immunohistochemical characteristics were analyzed. Relevant literature was also reviewed. A targeted DNA-based next-generation sequencing (a panel of 150 genes) was performed on one of the three cases.Results:There were 1 female and 2 males, aged 30, 57, and 17 years (mean 34.6 years), respectively. The lesions were all incidentally identified during physical or imaging examination. Radiologically, they were all presented as a unilateral renal parenchymal mass. Grossly, the maximum diameters of the lesions were 1.8, 4.0, and 6.5 cm (mean 4.1 cm), respectively. The tumor cut-surfaces were sponge-like, multilocular cystic, and solid, respectively. At low magnification, the lesions were well-circumscribed, while a thick fibromuscular capsule was noted in cases 1 and 3. Cases 1 and 2 were composed of thin-walled cysts or follicular like structures of varying sizes, with the cyst wall lined by flattened and atrophic, or hobnail cells. The luminal spaces contained dense eosinophilic secretion and associated calcifications, while some cysts contained discohesive cells floating in the eosinophilic material. The tissue between the cysts showed predominantly small atrophic tubular structures. Case 3 was almost entirely composed of atrophic and collapsed tubular structures with focal cyst formation, imparting a solid sheets growth pattern under low magnification. Immunohistochemical staining revealed that the cyst lining cells and the intracystic floating cells were WT1 positive, PAX8 negative and CK7 negative, while the atrophic renal tubules were WT negative, PAX8 positive and CK7 positive. Targeted next-generation sequencing in case 1 showed no significant genetic abnormalities. All 3 patients underwent partial nephrectomy. No evidence of recurrence or metastasis was found with a follow-up of 17 to 36 months.Conclusions:AKLL is a rare and novel benign renal disease. It is easily misdiagnosed as a renal neoplasm grossly and histologically. Careful morphological observation combined with characteristic immunophenotypes can aid in its diagnosis and differential diagnosis.

Objective:To explore the clinical characteristics, treatment, and prognosis of patients with spondyloarthritis (SpA) and clinically insignificant monoclonal garmmopathy of undetermined significance (MGUS).Methods:A retrospective study was performed to analyze the clinical characteristics of patients simultaneously diagnosed with both SpA and MGUS at the First Affiliated Hospital to Zhengzhou University between January 2020 and December 2024, supplemented by a literature review.Results:Among the 5 patients (2 males, 3 females; age range 33~65 years), 4 presented with peripheral arthritis and 2 with extra-articular manifestations. All patients demonstrated elevated globulin and IgG levels, with 4 being HLA-B27 positive. M-protein typing revealed IgG/κ in 3 cases and IgA/λ in 2. All five patients underwent both X-ray and MRI examinations, with sacroiliitis being detected in 4 cases. Three patients with long disease duration showed poor response to conventional therapy (NSAIDs/DMARDs). Targeted therapies yielded variable outcomes: one patient achieved normalized globulin/IgG levels with etanercept (3-year follow-up without MGUS progression); another showed marked clinical improvement and significant globulin/IgG reduction with JAK inhibitor (tofacitinib, treated for 7 years); while a third demonstrated no symptom relief then switching from TNF-α inhibitor to IL-17 inhibitor.Conclusion:Persistent hyperglobulinemia in SpA patients warrants MGUS screening. Those with SpA-MGUS may require targeted therapies, where JAK inhibitors and monoclonal TNF-α inhibitors appear to be the preferred options, though long-term monitoring for MGUS progression remains essential.

Objective To explore the clinical efficacy of repeated transcranial magnetic stimulation(rTMS)and acupuncture therapy in the treatment of chronic insomnia disorder(CID)patients.Methods A total of 80 patients with CID,who were treated at Nanchang First Hospital from January 2022 to December 2023,were selected for the study.The patients were randomly divided into control group and treatment group,with 40 cases in each group.The control group patients were treated with dexmedetomidine,while the treatment group patients received rTMS and acupuncture therapy in addition to control group.The treatment course was 4 weeks,and the sleep quality,sleep related indicators,and psychological condition improvement of both groups of patients were observed before and after treatment.Results After treatment,the Pittsburgh sleep quality index scores of both groups of patients decreased(P＜0.05);The sleep latency and number of awakenings were lower than before treatment(P＜0.05),and the total sleep time,sleep efficiency,and proportion of rapid eye movement sleep were higher than before treatment,treatment group showed more significant improvement than control group(P＜0.05).After treatment,the Hamilton anxiety and depression scale scores of both groups of patients decreased compared to before treatment,but there was no statistically significant difference in control group before and after treatment(P＞0.05).However,there was a statistically significant difference in treatment group before and after treatment(P＜0.05).Conclusion The combination of rTMS and acupuncture treatment can significantly improve the sleep quality of CID patients,while also reducing the accompanying symptoms of anxiety and depression.