Objective: To investigate the effect and mechanism of methyltransferase-like3(METTL3),which functions as m6A modification methyltransferase,on the cellular proliferation,clone formation and migration of nonsmall cell lung cancer(NSCLC) cells. Methods: The METTL3 level and patient overall survival were analyzed by bioinformatics.In the transfected A549 cells,the expression of METTL3 was detected by RT-PCR and Western blot assays,the m6A level was detected by m6A RNA Methylation Assay kit,the cellular viability and growth were detected by CCK-8 assay,the apoptosis was detected by immunofluorescent assay,the colony growth was detected by clone formation assay,the cell migration growth was detected by scratch. Results : Bioinformatics showed that METTL3 was highly expressed in NSCLC and negatively correlated with patient overall survival.The RT-PCR and Western blot data showed that the METTL3 level was higher in NSCLC cells.Moreover,higher METTL3 significantly promoted m6A level,cell proliferation,colony formation,migration,inhibited cell apoptosis,increased the mRNA and protein expressions of EMT-related marker Vimentin but inhibited apoptosis and decreased the mRNA and protein expressions of EMT-related marker E-cadherin in the A549 cells.Furthermore,the contrasting results were obtained in the A549 cells with the knockdown of METTL3. Conclusion The over-expressed METTL3 increases the m6A levels in NSCLC cells and promotes cellular proliferation,colony formation,and migration growth,thereby laying a theoretical foundation for future research on early diagnosis and targeted drug development for NSCLC by targeting METTL3.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

Acute symptomatic osteoporotic thoracolumbar compression fracture (ASOTLF) can lead to chronic low back pain, kyphosis deformity, pulmonary dysfunction, loss of mobility, and even life-threatening complications. Vertebral augmentation is currently the mainstream treatment method for this condition. In 2019, the Editorial Board of Chinese Journal of Trauma and the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association collaboratively led the development of Clinical guideline for vertebral augmentation for acute symptomatic osteoporotic thoracolumbar compression fractures. Six years later, with advances in clinical diagnosis and treatment techniques as well as accumulating evidence in related fields, the 2019 guideline requires updating. To this end, the Spinal Trauma Group of Orthopedic Surgeons Branch of Chinese Medical Doctor Association, the Spinal Health Professional Committee of China Human Health Science and Technology Promotion Association, and the Minimally Invasive Orthopedics Professional Committee of Shaanxi Medical Doctor Association have organized experts in the field to develop the Clinical guideline for vertebral augmentation of acute symptomatic osteoporotic thoracolumbar compression fractures ( version 2025) , based on the latest evidence-based medical researches. This guideline incorporates 3 recommendations retained from the 2019 version with updated strength of evidence, along with 12 new recommendations. It provides recommendations from six aspects of diagnosis, pain management, treatment option selection, prevention of postoperative complications, anti-osteoporosis therapy, and postoperative rehabilitation, aiming to provide a reference for standard treatment of vertebral augmentation for ASOTLF in hospitals at all levels.

ObjectiveTo investigate the current situation of health communication carried out by medical institutions in Shanghai through new media platforms such as WeChat， Weibo， Toutiao， Douyin， Kuaishou， Bilibili and WeChat Videos， and to propose targeted measures. MethodsBased on the systematic collection of new media accounts of medical institutions in Shanghai， and through the combination of keyword screening and manual audit， health communication data of medical institutions on new media platforms were determined. ResultsData from 1 117 new media accounts of 162 medical institutions in Shanghai were collected， including 610 WeChat official accounts， 105 WeChat video accounts， 89 Weibo accounts， 18 Bilibili accounts， 198 Douyin accounts， 37 Toutiao accounts， and 60 Kuaishou accounts， totaling 111 853 posts. After keyword sorting and manual screening， a total of 66 761 health science posts were collected， with WeChat Official Accounts， Douyin， and Weibo having the top three highest number of posts. Video-based new media such as Douyin， WeChat Videos， Kuaishou， and Bilibili had a better communication impact than text and image-based new media like WeChat Official Accounts， Weibo， and Toutiao. Among them， Douyin and Toutiao were the best platforms for video and text-image-based new media， respectively. ConclusionMedical institutions in Shanghai recognize the importance of new media in health communication and have made full use of various media platforms to carry out health communication，having a certain impact on health education. In the future， medical institutions should choose appropriate platforms based on target audiences and content characteristics， fully leverage the advantages of various platforms， explore innovative communication strategies， promote the dissemination of health knowledge， and enhance the health literacy of the public.

Objective:To summarize the clinical and pathological characteristics, treatment methods, and prognosis of papillary renal neoplasm with reverse polarity (PRNRP).Methods:The clinical and pathological data of six pathologically confirmed PRNRP patients admitted to Renji Hospital affiliated with Shanghai Jiaotong University School of Medicine from August 2022 to August 2023 were retrospectively analyzed. Among them, three were male and three were female, with an average age of (55.3±10.5) years old. All six cases were incidentally discovered during health examinations. Preoperative contrast-enhanced CT scans showed tumors with cortical phase manifestations of uneven enhancement, avascularity, and indistinct borders, with CT values of (85.6±18.7) HU. In the corticomedullary phase, the CT values showed mild elevation, with an average of (94.3±4.7) HU. In the delayed phase, the tumor boundaries were clear, and the enhancement degree was significantly lower than that of the surrounding renal cortex and medulla, with a tumor CT value of (86.3±11.9) HU. The pseudocapsule of the tumor was not clearly displayed on contrast-enhanced CT scans. All cases underwent partial nephrectomy, including two cases of robot-assisted laparoscopic partial nephrectomy and four cases of laparoscopic partial nephrectomy.Results:Postoperative pathological measurements revealed a maximum tumor diameter ranging from 6 to 15 mm, with an average diameter of (11.0±3.5) mm. All six cases were classified as pT 1aN 0M 0 stage. Microscopically, the tumors exhibited branching papillary structures with eosinophilic cytoplasm, and the tumor cells displayed low-grade nuclei located at the top of the cytoplasm and away from the basal membrane. Immunohistochemical analysis showed diffuse strong positivity for GATA3 and CK7, while CA-Ⅸ expression was negative. The median follow-up time after surgery was 10(9, 13) months, and no tumor recurrence or metastasis was observed. Conclusions:PRNRP is a rare, low-grade malignant papillary renal tumor. Contrast-enhanced CT scan has characteristic features of avascularity. Pathological morphological features are low-grade nuclei located at the top of the cytoplasm and far away from the basal membrane, forming a "reverse polarity". The immunophenotype shows positive expression of GATA3 and CK7. Partial nephrectomy is the recommended treatment approach, and the postoperative prognosis is favorable.

Objective:To explore the predictive value of the systemic immune inflammation index (SII) for the risk of bone metastases in patients with newly diagnosed prostate cancer (PCa).Methods:From Jun. 2012 to Jul. 2019, the clinical features of 308 patients were retrospectively analyzed. For the baseline clinical data of the patients with newly diagnosed PCa, the median age was 71(65-76) years, there were 59(19.2%) patients with a positive digital rectal examination (DRE). In addition, the median serum total prostate-specific antigen (tPSA), prostate volume (PV) and prostate-specific antigen density(PSAD)were 60.55(23.55-100.00) ng/ml, 39.35(28.29-56.66)ml and 1.27(0.58-2.52)ng/(ml·cm 3), respectively. There were 33(10.7%)patients with prostate biopsy Gleason score≤6, 115(37.3%)patients with a Gleason score=7 and 160(52.0%)patients with a Gleason score≥8. The T clinical stage also obtained, including 21(6.8%)diagnosed as T 1 stage, 87(28.2%)T 2 stage, 65(21.1%)T 3stage, 135(43.9%)T 4 stage. SII was calculated by the formula platelet×neutrophil/lymphocyte, and the median(interquartile range)of SII was 458.60(300.42-727.11)/L. According to the results of bone scanning, the patients were divided into bone metastasis(146, 47.4%)and a non-bone metastasis groups(162, 52.6%). The differences in the baseline clinical characteristics between the two groups were analyzed. The risk factors of bone metastasis were analyzed by univariate and multivariate logistic regression analysis. The diagnostic efficiency of the risk factors were evaluated by receiver operating characteristic(ROC)curve. Results:The median(interquartile range)of SII was 564.78/L(333.85-961.93/L)in patients with bone metastasis which were higher than those without bone metastasis 413.01(267.63-601.79)/L( P<0.001). The median(interquartile range)of tPSA were 97.79(48.20-119.10)ng/ml in bone metastasis group and 32.56(17.89-72.70)ng/ml in non-bone metastasis group ( P<0.001). The median(interquartile range)of PSAD were 1.91(0.97-3.55)ng/(ml·cm 3)and 0.90(0.45-1.77)ng/(ml·cm 3)in these two groups( P<0.001), respectively. In bone metastasis group, there were 132(90.4%)patients with a positive DRE, yet there were only 117(72.2%) patients with a positive DRE in the other group ( P<0.001). There were 7(4.8%)patients with prostate biopsy Gleason score≤6, 50(34.2%)patients with a Gleason score=7 and 89(61.0%)patients with a Gleason score≥8 in bone metastasis group. There were 26(16.1%)patients with prostate biopsy Gleason score≤6, 65(40.1%)patients with a Gleason score=7 and 71(43.8%)patients with a Gleason score≥8 in non-bone metastasis group ( P<0.001). There were statistically significant difference between the two groups in T clinical stage( P<0.001). In bone metastasis group, there were 2(1.4%)T 1 stage, and 19(13.0%)T 2 stage, 25(17.1%)T 3stage, and 100(68.5%)T 4 stage. Comparatively, there were 19(11.7%)T 1 stage, 68(42.0%)T 2 stage, 40(24.7%)T 3stage, and 35(21.6%)T 4 stage in the other group. There were no statistically significant difference between the two groups in term of age( P=0.057) and TPV( P=0.222). Univariate and multivariate logistic regression analysis showed that tPSA( P=0.003), SII( P<0.001), T clinical stage( P<0.001)could be regarded as independent risk factors of bone metastasis of PCa. Area under the curve of SII+ tPSA was 0.770, which was higher than SII(0.653)or tPSA(0.729) alone( P<0.05). When the cut-off value was 727.72/L, the sensitivity and specificity of the diagnosis of SII alone were 38.4% and 87.7%. The sensitivity and specificity of tPSA alone were 67.1%and 75.9% when the cut-off value was 73.02ng/ml. The sensitivity was 72.6% and the specificity was 71.6% when SII and tPSA was combined. Conclusions:SII is an independent predictor of bone metastasis of newly diagnosed with PCa. , and the patients were at high risk when SII exceeded 727.72/L. The combination of SII and tPSA can improve its predictive validity for the risk of bone metastasis.

Objective:To investigate the diagnosis, treatment and prognosis of squamous cell carcinoma of renal pelvis.Methods:The clinic data of 28 cases with squamous cell carcinoma of renal pelvis confirmed by pathologic examination treated during June 2007 and September 2019 was retrospectively analyzed. There were 19 male and 9 female patients, with a median age of 56 years. Hematuria was present in 18 cases, flank pain was present in 11 cases, and abdominal mass was present in 1 case. All 28 cases accepted CT or MRI examination. Renal pelvis or renal tumors were found in 26 cases, and severe hydronephrosis was observed in 2 cases. 2 cases underwent PET/CT, and bone metastasis was found in 1 case. Preoperative diagnoses were renal pelvic tumor in 13 cases, renal tumor in 13 cases and renal abscess in 2 cases. Coexisting renal calculi or renal pelvic calculus was detected in 19 cases. All 28 cases underwent surgical excision, including radical nephroureterectomy in 13 cases, radical nephrectomy in 12 cases, palliative resection in 1 case, and pyonephrenectomy in 2 cases. Enlarged lymph nodes were found in 9 cases during the surgery, and local lymph node dissection was performed in these cases.Results:The mean diameter of the tumors was 8.5 cm. Histopathological examination revealed that 9 cases were well differentiated, 11 cases were moderately differentiated, and 8 case was poorly differentiated. 1 case had pT 2 stage, 15 cases had pT 3 stage and 12 cases had pT 4 stage. 9 cases had lymph node metastasis. 5 cases had renal vein thrombosis. Immunohistochemistry staining exhibited consistent characteristics including CK5(+ ), 34βE12(+ ), p63(+ ), CK20(-) and GATA3(-). Postoperatively, 12 cases received adjuvant therapy including chemotherapy, radiotherapy and/or immunotherapy. Within a median follow-up of 6.0 months (ranging 1-80 months), median overall survival was 10.0 months. 15 cases died of tumor progression. Conclusion:Squamous cell carcinoma is a rare and highly aggressive neoplasm, typically associated with long-lasting renal calculi, hydronephrosis and chronic inflammation. The diagnosis should be established on pathologic examination.CK5, 34βE12 and p63 positivity contribute to the diagnosis of squamous cell carcinoma. Surgery is the foremost choice of treatment, but the risk of recurrence and metastasis is high. The prognosis is extremely poor as the majority of patients are diagnosed with advanced stages.

Objective:To study the pathological characteristics, diagnosis and treatment of primary adenocarcinoma of renal pelvis and ureter.Methods:The clinical pathological characteristics, treatment and prognosis of 5 patients with adenocarcinoma of upper urinary tract treated between January 2007 and May 2019 was retrospectively reviewed. There were 4 male and 1 female patients, with a median age of 60 years. The major symptoms were hematuria in 5 cases and low back pain in 4 cases. All cases underwent B-ultrasound and CT examination, and 4 cases accepted cystoscopy. Preoperative diagnoses were ureter tumor in 2 cases, renal pelvis tumor in 1 case, renal tumor in 1 case and renal calculus in 1 case.Results:5 cases were treated with surgery. Radical nephroureterectomy was performed in 3 cases, and nephrectomy in one case. 1 case underwent first-stage percutaneous nephrolithotomy and second-stage radical nephroureterectomy due to the discovery of tumor. 1 case was treated with radiotherapy and immune checkpoint inhibitor postoperatively. The mean diameter of the tumors was 4.4 cm. There were 3 renal pelvis adenocarcinomas and 2 ureter adenocarcinomas confirmed by pathologic examination, including 3 cases of pT 3 stage and 1 case of pT 4 stage. Lymph node metastasis was found in 2 cases. Immunohistochemistry revealed that CDX2(+ ), p63(-), GATA3(-), β-catenin(-)were the common features of five cases. The median survival was 12 months with a median follow-up of 6 months. 2 cases died of tumor progression within 1 year. Conclusions:Adenocarcinoma is an extremely rare malignancy, typically associated with long-standing calculi and chronic inflammation. Given the fact that clinical and imaging findings are nonspecific, the diagnosis is based on pathologic examination, supported by glandular structure of histology. Immunohistochemical staining exhibited CDX2 and CK20 positivity and β-catenin negativity, moreover, GATA3, p63 and CK7 was usually negative or partially positive. Surgery is the foremost choice of treatment. The prognosis is correlated with subtypes, whereas the overall prognosis is poor due to high rates of recurrence and metastasis.

Objective:To investigate the prognostic significance of tumor architecture in patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy.Methods:A retrospective study was performed on 958 patients who underwent nephroureterectomy in Second Affiliated Hospital of Zhejiang university (156) and Renji Hospital (802) between January 1998 and June 2019. There were 630 males and 328 females with median age 67 years old, ranging 30-89 years old. Among them, 499 patients suffered with preoperative hydronephrosis, 370 patients suffered with hypertension, 120 patients suffered with diabetes, 252 patients had history of smoking and 119 patients had history of non-muscle invasive bladder cancer (NMIBC) or with NMIBC. 489 patients had tumor in renal pelvic, 394 patients had tumor in ureter and 75 patients had tumor in both sites. Laparoscopic surgery was performed in 543 patients while open surgery was performed in 415 patients. The χ 2 test was used to detect the association between tumor architecture and several clinicopathological features. Kaplan-Meier method with the log-rank test was used to assess survival analysis. Multivariate analyses were conducted using Cox proportional-hazards regression model. Results:516 cases (53.9%) showed papillary architecture(Group A) and 442 cases (46.1%) showed sessile architecture(Group B). 543 patients had a tumor ≤3 cm and 415 had a tumor >3 cm. Low pathological grade and high grade was diagnosed in 275 and 683 patients, respectively. The distribution of pathological stage was pT a-1 in 441 cases, pT 2 in 180 cases, pT 3 in 308 cases and pT 4 in 29 cases. Lymphadenectomy was performed in 227 patients and 62 patients were pathologically confirmed lymph node metastasis. 48 patients were found squamous or glandular differentiation. Lymphovascular invasion (LVI) was observed in 150 patients. 134 patients were multifocality. Positive surgical margin was found in 43 patients. Median follow-up was 39 (ranging, 2-206) months. During follow-up, a total of 304 patients died and 236 died of UTUC. 5-year OS and CSS were 76.6% and 81.8%, respectively, in patients with papillary architecture (group A), which were significantly higher than 54.4% and 60.5% in patients with sessile architecture (group B, all P<0.001). Patients in group B had more female patients (38.9% vs.30.3%, P=0.005), ureteral location (47.1% vs. 36.1, P=0.002), hydronephrosis (55.9% vs.48.8%, P=0.030) and postoperative adjuvant chemotherapy (27.1% vs. 14.7%, P<0.001), higher pathological grade (89.6% vs.55.6%, P<0.001) and stage (79.4% vs.32.4%, P<0.001), lymph node metastasis rate (12.0% vs.1.7%, P<0.001), squamous or glandular differentiation (9.5% vs.1.2%, P<0.001) and LVI (24.4% vs.8.1%, P<0.001) than patients in group A. Cox multivariate regression analysis showed that sessile architecture ( P=0.022, 0.028), age ≥65 years ( P<0.001, <0.001), history of diabetes ( P=0.008, 0.043), history of NMIBC or with NMIBC ( P<0.001, <0.001), higher grade ( P=0.002, <0.001), advanced tumor stage ( P=0.003, 0.005), lymph node metastasis ( P=0.003, 0.044), squamous or glandular differentiation ( P=0.008, 0.027) and positive surgical margin ( P=0.003, 0.010) were independent risk factors for OS and CSS. However, tumor >3 cm ( P=0.013, 0.131) and positive LVI ( P=0.045, 0.174) were independent risk factors for CSS rather than OS. Conclusions:UTUC is high malignancy. Tumor architecture was one of an independent risk factor for OS and CSS in UTUC patients and sessile tumors were more malignant, more aggressive and have worse prognosis.

Histone lysine-specific demethylase 1 (LSD1) has been implicated in the disease progression of several types of solid tumors. This study provides the first evidence showing that LSD1 overexpression occurred in 62.6% (224/358) of clear cell renal cell carcinomas (ccRCC). LSD1 expression was associated with the progression of ccRCC, as indicated by TNM stage (=0.006), especially tumor stage (=0.017) and lymph node metastasis (=0.030). High LSD1 expression proved to be an independent prognostic factor for poor overall survival (<0.001) and recurrence-free survival (<0.001) of ccRCC patients. We further show that LSD1 inhibition by siRNA knockdown or using the small molecule inhibitor SP2509 suppressed the growth of ccRCC and . Mechanistically, inhibition of LSD1 decreased the H3K4 demethylation at the gene promoter, which was associated with P21 upregulation and cell cycle arrest at G1/S in ccRCC cells. Our findings provide new mechanistic insights into the role of LSD1 in ccRCC and suggest the therapeutic potential of LSD1 inhibitors in ccRCC treatment.