Objective:To investigate the value of diffusion kurtosis imaging (DKI) and 18F-prostate specific membrane antigen (PSMA)-1007 in the differential diagnosis of prostate cancer (PCa) and benign prostatic hyperplasia (BPH) by using PET/MR imaging. Methods:From June 2019 to December 2022, a retrospective analysis was conducted on 134 patients ((65.5±10.0) years) with prostate diseases who underwent 18F-PSMA-1007 PET/MR whole-body examination at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, with the prostate specific antigen (PSA) level continuously rising to >4μg/L within 1 month and not yet receiving treatment. Patients were divided into 2 groups (PSA<10μg/L and PSA≥10μg/L). The PET/MR examination included high b-value diffusion imaging, and the ROI was delineated based on the prostate diffusion weighted imaging (DWI) high-signal area and apparent diffusion coefficient (ADC) low-signal area by the professional radiology physician. The SUV max, mean kurtosis (MK), and mean diffusivity (MD) were obtained. Spearman rank correlation analysis was performed, and ROC curve was used to analyze the diagnostic efficacy. Results:Of 134 patients, 72 were with PSA<10μg/L and 62 were with PSA≥10μg/L. There were 68 patients who obtained biopsy results, including 37 cases of BPH and 31 cases of PCa. In PSA<10μg/L group, there were no significant correlations between MK and SUV max, MK and PSA ( rs values: 0.22, 0.06, P values: 0.065, 0.603). In the PSA≥10μg/L group, there were positive correlations between MK and SUV max, MK and PSA ( rs values: 0.52, 0.40, P values: 0.008, 0.005). In the PSA<10μg/L group, SUV max, MK, and MD showed no diagnostic value (AUCs: 0.44-0.67, all P>0.05), while the AUC for combined diagnosis using these three parameters was 0.78( P=0.008). In the PSA≥10μg/L group, the AUCs of SUV max, MK, and MD were 0.81( P=0.001), 0.84( P<0.001) and 0.72( P=0.023) respectively, and the AUC for combined diagnosis using these three parameters was 0.91( P<0.001). Conclusion:The combination of MK, MD and SUV max improves the diagnostic efficacy of PCa in PET/MR examination.

Objective:The prediction model of postoperative recurrence of ovarian endometriosis cyst(OEM)was constructed to provide a reference for evaluating postoperative recurrence of OEM patients.Methods:The clinical,pathological and follow-up data of 342 patients who underwent the initial laparoscopic ovarian cystectomy for OEM at The Second Hospital of Hebei Medical University from January 1,2017 to October 31,2021 were retro-spectively analyzed.Based on univariate and multivariate Cox regression analysis,the relevant factors affecting OEM recurrence were identified.According to the results of multivariate analysis,a nomogram was drawn.The C index and receiver operating characteristic(ROC)curve were used to test the efficiency of the prediction model.Results:The 2-year recurrence rate of OEM patients was 20.4%and the 5-year recurrence rate was 35.2%.Uni-variate and multivariate Cox regression analysis showed that menstrual cycle(HR 0.916,95%CI 0.860-0.976,P=0.006),delivery≥1(HR 0.376,95%CI 0.171-0.827,P=0.015),CA125≥100 U/ml(HR 1.790,95%CI 1.167-2.746,P=0.008),total cyst diameter≥10 cm(HR 2.254,95%CI 1.318-3.854,P=0.003),and postoperative medications(HR 0.434,95%CI 0.292-0.644,P=0.000)were associated with OEM recurrence and were included in the no-mogram prediction model.The C-index of the nomogram prediction model was 0.710(95%CI 0.665-0.754),and the area under the curve(AUC)of the ROC for OEM patients with recurrence at 2 years after surgery was 0.786 and 0.708 at 5 years.Conclusions:In this study,we developed a nomogram to predict the probability of recur-rence at 2 years and 5 years for OEM patients under 45 years who underwent conservative surgery,which has i-deal predictive performance and helps clinicians to screen high-risk patients,and thus give high-risk OEM patients additional attention and intervention.

Objective:To investigate the value of diffusion kurtosis imaging (DKI) and 18F-prostate specific membrane antigen (PSMA)-1007 in the differential diagnosis of prostate cancer (PCa) and benign prostatic hyperplasia (BPH) by using PET/MR imaging. Methods:From June 2019 to December 2022, a retrospective analysis was conducted on 134 patients ((65.5±10.0) years) with prostate diseases who underwent 18F-PSMA-1007 PET/MR whole-body examination at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, with the prostate specific antigen (PSA) level continuously rising to >4μg/L within 1 month and not yet receiving treatment. Patients were divided into 2 groups (PSA<10μg/L and PSA≥10μg/L). The PET/MR examination included high b-value diffusion imaging, and the ROI was delineated based on the prostate diffusion weighted imaging (DWI) high-signal area and apparent diffusion coefficient (ADC) low-signal area by the professional radiology physician. The SUV max, mean kurtosis (MK), and mean diffusivity (MD) were obtained. Spearman rank correlation analysis was performed, and ROC curve was used to analyze the diagnostic efficacy. Results:Of 134 patients, 72 were with PSA<10μg/L and 62 were with PSA≥10μg/L. There were 68 patients who obtained biopsy results, including 37 cases of BPH and 31 cases of PCa. In PSA<10μg/L group, there were no significant correlations between MK and SUV max, MK and PSA ( rs values: 0.22, 0.06, P values: 0.065, 0.603). In the PSA≥10μg/L group, there were positive correlations between MK and SUV max, MK and PSA ( rs values: 0.52, 0.40, P values: 0.008, 0.005). In the PSA<10μg/L group, SUV max, MK, and MD showed no diagnostic value (AUCs: 0.44-0.67, all P>0.05), while the AUC for combined diagnosis using these three parameters was 0.78( P=0.008). In the PSA≥10μg/L group, the AUCs of SUV max, MK, and MD were 0.81( P=0.001), 0.84( P<0.001) and 0.72( P=0.023) respectively, and the AUC for combined diagnosis using these three parameters was 0.91( P<0.001). Conclusion:The combination of MK, MD and SUV max improves the diagnostic efficacy of PCa in PET/MR examination.

Objective:The prediction model of postoperative recurrence of ovarian endometriosis cyst(OEM)was constructed to provide a reference for evaluating postoperative recurrence of OEM patients.Methods:The clinical,pathological and follow-up data of 342 patients who underwent the initial laparoscopic ovarian cystectomy for OEM at The Second Hospital of Hebei Medical University from January 1,2017 to October 31,2021 were retro-spectively analyzed.Based on univariate and multivariate Cox regression analysis,the relevant factors affecting OEM recurrence were identified.According to the results of multivariate analysis,a nomogram was drawn.The C index and receiver operating characteristic(ROC)curve were used to test the efficiency of the prediction model.Results:The 2-year recurrence rate of OEM patients was 20.4%and the 5-year recurrence rate was 35.2%.Uni-variate and multivariate Cox regression analysis showed that menstrual cycle(HR 0.916,95%CI 0.860-0.976,P=0.006),delivery≥1(HR 0.376,95%CI 0.171-0.827,P=0.015),CA125≥100 U/ml(HR 1.790,95%CI 1.167-2.746,P=0.008),total cyst diameter≥10 cm(HR 2.254,95%CI 1.318-3.854,P=0.003),and postoperative medications(HR 0.434,95%CI 0.292-0.644,P=0.000)were associated with OEM recurrence and were included in the no-mogram prediction model.The C-index of the nomogram prediction model was 0.710(95%CI 0.665-0.754),and the area under the curve(AUC)of the ROC for OEM patients with recurrence at 2 years after surgery was 0.786 and 0.708 at 5 years.Conclusions:In this study,we developed a nomogram to predict the probability of recur-rence at 2 years and 5 years for OEM patients under 45 years who underwent conservative surgery,which has i-deal predictive performance and helps clinicians to screen high-risk patients,and thus give high-risk OEM patients additional attention and intervention.

This study predicts the quality markers(Q-markers) for the cough-relieving and phlegm-expelling effects of Kening Granules based on pharmacodynamics, plasma drug chemistry, network pharmacology, and pharmacokinetics. Strong ammonia solution spray and phenol red secretion assays were employed to evaluate the cough-relieving and phlegm-expelling effects of Kening Granules. Twentysix absorbed prototype components of Kening Granules were identified by ultra high performance liquid chromatography coupled with QExactive Plus quadrupole/Orbitrap high resolution mass spectrometry(UHPLC-Q-Exactive Plus Orbitrap HRMS). Through network pharmacology, 11 potential active components were screened out for the cough-relieving and phlegm-expelling effects of Kening Granules. The 11 components acted on 40 common targets such as IL6, TLR4, and STAT3, which mainly participated in PI3K/Akt, HIF-1, and EGFR signaling pathways. Pharmacokinetic quantitative analysis was performed for 7 prototype components. Three compounds including azelaic acid, caffeic acid, and vanillin were identified as Q-markers for the cough-relieving and phlegm-expelling effects of Kening Granules based on their effectiveness, transmissibility, and measurability. The results of this study are of great significance for clarifying the pharmacological substance basis, optimizing the quality standards, and promoting the clinical application of Kening Granules.
Drugs, Chinese Herbal/administration & dosage* ; Network Pharmacology ; Cough/blood* ; Male ; Humans ; Animals ; Rats ; Rats, Sprague-Dawley ; Biomarkers/blood* ; Quality Control ; Chromatography, High Pressure Liquid ; Antitussive Agents/chemistry*

Objective·To investigate the effect of plasma exchange combined with classical chemotherapy on renal function in patients with multiple myeloma(MM).Methods·A retrospective analysis was conducted on data from patients newly diagnosed with MM in the Department of Hematology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,between October 2021 and September 2023.Sixty-eight MM patients admitted from October 2021 to September 2022 served as the control group,and 41 patients admitted from October 2022 to September 2023 comprised the experimental group.The control group received classical chemotherapy for MM[PAD(bortezomib+adriamycin+dexamethasone)or PCD(bortezomib+cyclophosphamide+dexamethasone)],and the experimental group underwent plasma exchange before classic chemotherapy.The frequency of plasma exchange was determined according to the clearance rate of M-protein in patients,with the criterion being a reduction of more than 40%in plasma M-protein levels after exchange,and the total number of exchanges ranged from 1 to 3 sessions.After 2 chemotherapy courses,the free light chain difference(dFLC),serum creatinine(Scr),and other renal function indexes were compared between the two groups.Results·Compared with the control group,the experimental group showed no statistically significant difference in dFLC levels.The Scr level decreased[67.00(54.00,75.00)μmol/L vs 77.50(63.00,94.00)μmol/L,P=0.011],and the estimated glomerular filtration rate(eGFR)increased[97.80(92.80,101.30)mL/(min·1.73 m2)vs 85.80(61.35,95.35)mL/(min·1.73 m2),P<0.001]after treatment.Before treatment,the numbers of patients with MM-related severe renal injury[eGFR<50 mL/(min·1.73 m2)]were 41 in the control group and 28 in the experimental group.After treatment,8 patients(19.51%)in the control group achieved complete renal response[eGFR≥60 mL/(min·1.73 m2)],while 12 patients(42.86%)in the experimental group achieved the same,with the difference being statistically significant(P=0.036).After two courses of treatment,the overall response rates(ORR)of the control group and the experimental group were 76.47%and 92.68%,respectively,and the difference in overall therapeutic efficacy was statistically significant(P=0.031).Conclusion·Plasma exchange combined with classical chemotherapy can significantly reduce the Scr levels and increase eGFR in MM patients within a short period,ameliorating the MM-related renal impairment to some extent and improving clinical treatment outcomes.

Objective:To explore the clinical phenotype and genetic characteristics of a Chinese Han pedigree with Darier′s disease(DD).Methods:A DD pedigree, who visited Tongji Hospital of Tongji University on October 22, 2023, was selected as the study subject. Clinical data of the pedigree were collected, and whole-genome exom sequencing was performed on the proband. Suspected variant loci were screened, and Sanger sequencing was used to validate the variant in pedigree members. Bioinformatics analysis was performed on the variant loci. This study was approved by the Medical Ethics Committee of Tongji Hospital of Tongji University(Ethics No.K-W-2024-004).Results:① The proband is a 67-year-old female with clinical features of DD, such as keratotic papules in sebaceous areas. ② Whole-genome exom sequencing revealed a missense variant, c. 68G>A (p.Gly23Glu), in the exon 1 of ATP2A2 gene of the proband. Sanger sequencing showed that the proband′s eldest daughter also carried this variant. This variant was not detected in other pedigree members, indicating a co-segregation of the variant with the disease phenotype in the pedigree. ③ According to the interpretation principles of gene variants by the American College of Medical Genetics and Genomics (ACMG), this variant was classified as pathogenic (PS1+ PM1+ PM2_Supporting+ PP1+ PP3+ PP4). Conclusions:The c. 68G>A (p.Gly23Glu) variant in the ATP2A2 gene may be the genetic cause of the disease in this pedigree. This finding further enriches the genetic variant spectrum in DD patients and provides a basis for clinical diagnosis and genetic counseling for patients.

Objective:To explore the clinical phenotype and genetic characteristics of a Chinese Han pedigree with Darier′s disease(DD).Methods:A DD pedigree, who visited Tongji Hospital of Tongji University on October 22, 2023, was selected as the study subject. Clinical data of the pedigree were collected, and whole-genome exom sequencing was performed on the proband. Suspected variant loci were screened, and Sanger sequencing was used to validate the variant in pedigree members. Bioinformatics analysis was performed on the variant loci. This study was approved by the Medical Ethics Committee of Tongji Hospital of Tongji University(Ethics No.K-W-2024-004).Results:① The proband is a 67-year-old female with clinical features of DD, such as keratotic papules in sebaceous areas. ② Whole-genome exom sequencing revealed a missense variant, c. 68G>A (p.Gly23Glu), in the exon 1 of ATP2A2 gene of the proband. Sanger sequencing showed that the proband′s eldest daughter also carried this variant. This variant was not detected in other pedigree members, indicating a co-segregation of the variant with the disease phenotype in the pedigree. ③ According to the interpretation principles of gene variants by the American College of Medical Genetics and Genomics (ACMG), this variant was classified as pathogenic (PS1+ PM1+ PM2_Supporting+ PP1+ PP3+ PP4). Conclusions:The c. 68G>A (p.Gly23Glu) variant in the ATP2A2 gene may be the genetic cause of the disease in this pedigree. This finding further enriches the genetic variant spectrum in DD patients and provides a basis for clinical diagnosis and genetic counseling for patients.

Objective·To investigate the effect of plasma exchange combined with classical chemotherapy on renal function in patients with multiple myeloma(MM).Methods·A retrospective analysis was conducted on data from patients newly diagnosed with MM in the Department of Hematology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,between October 2021 and September 2023.Sixty-eight MM patients admitted from October 2021 to September 2022 served as the control group,and 41 patients admitted from October 2022 to September 2023 comprised the experimental group.The control group received classical chemotherapy for MM[PAD(bortezomib+adriamycin+dexamethasone)or PCD(bortezomib+cyclophosphamide+dexamethasone)],and the experimental group underwent plasma exchange before classic chemotherapy.The frequency of plasma exchange was determined according to the clearance rate of M-protein in patients,with the criterion being a reduction of more than 40%in plasma M-protein levels after exchange,and the total number of exchanges ranged from 1 to 3 sessions.After 2 chemotherapy courses,the free light chain difference(dFLC),serum creatinine(Scr),and other renal function indexes were compared between the two groups.Results·Compared with the control group,the experimental group showed no statistically significant difference in dFLC levels.The Scr level decreased[67.00(54.00,75.00)μmol/L vs 77.50(63.00,94.00)μmol/L,P=0.011],and the estimated glomerular filtration rate(eGFR)increased[97.80(92.80,101.30)mL/(min·1.73 m2)vs 85.80(61.35,95.35)mL/(min·1.73 m2),P<0.001]after treatment.Before treatment,the numbers of patients with MM-related severe renal injury[eGFR<50 mL/(min·1.73 m2)]were 41 in the control group and 28 in the experimental group.After treatment,8 patients(19.51%)in the control group achieved complete renal response[eGFR≥60 mL/(min·1.73 m2)],while 12 patients(42.86%)in the experimental group achieved the same,with the difference being statistically significant(P=0.036).After two courses of treatment,the overall response rates(ORR)of the control group and the experimental group were 76.47%and 92.68%,respectively,and the difference in overall therapeutic efficacy was statistically significant(P=0.031).Conclusion·Plasma exchange combined with classical chemotherapy can significantly reduce the Scr levels and increase eGFR in MM patients within a short period,ameliorating the MM-related renal impairment to some extent and improving clinical treatment outcomes.

Objective To investigate the distribution and antimicrobial resistance profiles of clinically isolated Haemophilus influenzae and Moraxella catarrhalis in hospitals across China from 2015 to 2021,and provide evidence for rational use of antimicrobial agents.Methods Data of H.influenzae and M.catarrhalis strains isolated from 2015 to 2021 in CHINET program were collected for analysis,and antimicrobial susceptibility testing was performed by disc diffusion method or automated systems according to the uniform protocol of CHINET.The results were interpreted according to the CLSI breakpoints in 2022.Beta-lactamases was detected by using nitrocefin disk.Results From 2015 to 2021,a total of 43 642 strains of Haemophilus species were isolated,accounting for 2.91％of the total clinical isolates and 4.07％of Gram-negative bacteria in CHINET program.Among the 40 437 strains of H.influenzae,66.89％were isolated from children and 33.11％were isolated from adults.More than 90％of the H.influenzae strains were isolated from respiratory tract specimens.The prevalence of β-lactamase was 53.79％in H.influenzae strains.The H.influenzae strains isolated from children showed higher resistance rate than the strains isolated from adults.Overall,779 strains of H.influenzae did not produce β-lactamase but were resistant to ampicillin(BLNAR).Beta-lactamase-producing strains showed significantly higher resistance rates to these antimicrobial agents than the β-lactamase-nonproducing strains.Of the 16 191 M.catarrhalis strains,80.06％were isolated from children and 19.94％isolated from adults.M.catarrhalis strains were mostly susceptible to both amoxicillin-clavulanic acid and cefuroxime,evidenced by resistance rate lower than 2.0％.Conclusions The emergence of antibiotic-resistant H.influenzae due to β-lactamase production poses a challenge for clinical anti-infective treatment.Therefore,it is very important to implement antibiotic resistance surveillance for H.influenzae and guide rational antibiotic use.All local clinical microbiology laboratories should actively improve antibiotic susceptibility testing and strengthen antibiotic resistance surveillance for H.influenzae.