Objective: To investigate the regional differences in the incidence of urothelial carcinoma among kidney transplant recipients between northern and southern China，so as to provide reference for early diagnosis of this disease. Methods: A comprehensive search was conducted across multiple databases，including CNKI，Wanfang，CBM，and PubMed，using the keywords “kidney transplantation” and “tumor” to collect clinical data from qualified kidney transplant centers.The latest and most complete literature data published by 17 transplant centers in northern China and 14 in southern China were included.Statistical analyses were performed to compare the incidence of post-transplant urothelial carcinoma and non-urothelial malignancies. Results: A total of 37 475 kidney transplant recipients were included，among whom 837 (2.23%) developed post-transplant malignancies，including urothelial carcinoma (366/837，43.73%)，non-urothelial carcinoma (444/837，53.05%)，and malignancies with unspecified pathology (27/837，3.23%).The incidence of malignancies was significantly higher in northern China than in southern China [(2.82±1.39)% vs. (1.67±0.83)%，P=0.011]，with a particularly pronounced difference in the incidence of urothelial carcinoma [(1.68±1.12)% vs. (0.32±0.32)%，P<0.001].No significant difference was observed in the incidence of non-urothelial carcinoma between the two regions [(1.11±0.56)% vs. (1.35±0.65)%，P=0.279].Additionally，female transplant recipients exhibited a higher incidence of malignancies than males in both regions (southern China：2.38% vs. 1.80%; northern China：8.93% vs. 2.52%). Conclusion: The incidence of urothelial carcinoma following kidney transplantation is significantly higher in northern China than in southern China，underscoring the importance of implementing regular tumor screening for kidney transplant recipients，particularly for female patients in northern China，to facilitate early diagnosis and timely intervention.

OBJECTIVE: Our study aimed to conduct genomic characterization of Salmonella strains carrying the bla _NDM-1 gene in the intestinal tract of healthy individuals. The objectives were to underscore the importance of genomic surveillance for drug resistance in both commensal and pathogenic bacteria among healthy populations, and to establish protocols for regulating drug resistance plasmids based on the completion of a comprehensive map of drug resistance plasmid genomes. METHODS: We performed antimicrobial susceptibility testing and employed second- and third-generation sequencing techniques to analyze Salmonella strains harboring the bla _NDM-1 gene, to surveil drug-resistant bacteria in the intestines of healthy subjects. Sequence comparison was conducted using both core- and pan-genome approaches. Concurrently, conjugation experiments were carried out to assess the efficiency of plasmid transfer. RESULTS: We isolated a carbapenem-resistant Salmonella enterica serovar Typhimurium strain from a healthy food worker in China. This strain harbored an IncHI2/IncHI2A plasmid carrying bla _NDM-1 along with multiple antibiotic resistance genes (ARGs). Our findings highlight the potential for asymptomatic carriers to facilitate the transmission of ARGs. Pan-genomic analysis revealed that bla _NDM-1-positive plasmids could traverse bacterial species barriers, facilitating cross-host transmission. CONCLUSION This study marks the first detection of bla _NDM-1 in Salmonella strains isolated from healthy individuals. We underscore the risk associated with the transmission of conjugative hybrid plasmids carrying bla _NDM-1, which have the potential to be harbored and transmitted among healthy individuals. Enhanced surveillance of drug-resistant pathogens and plasmids in the intestinal microbiota of healthy individuals could provide insights into the risk of ARG transmission and pathways for population-wide dissemination via ARG transfer factors.
beta-Lactamases/genetics* ; Plasmids/genetics* ; Humans ; Anti-Bacterial Agents/pharmacology* ; China ; Microbial Sensitivity Tests ; Salmonella typhimurium/isolation & purification* ; Salmonella/isolation & purification* ; Salmonella Infections/microbiology*

Objective:To evaluate the efficacy of modified corporeal rotation technique in the treatment of congenital penile downward curvature.Methods:A retrospective analysis was conducted on the clinical data of 32 patients with congenital penile curvature who underwent surgical procedure in Beijing Hospital from June 2021 to December 2022. The patients' age was (25.3±5.4) years old, preoperative erect penile length was (14.0±1.4) cm, preoperative erect penile circumference was (12.3±0.6) cm, preoperative erect penile downward curvature angle was (41.8±9.3)°, and preoperative International Index of Erectile Function(IIEF-5) score was (19.6±2.8). All 32 cases underwent modified corporeal rotation technique with local anesthesia, while the surgical instruments and suturing techniques employed in this study aimed to minimize damage to the penile neurovascular bundle by utilizing plastic surgery instruments and magnifier. Additionally, the use of inverted horizontal mattress sutures, with knots embedded within the tissue, was implemented to reduce their impact on postoperative patient satisfaction. Surgical time, preoperative and immediate postoperative penile length, circumference, and curvature angle were recorded. Follow-ups were conducted at 1, 3, and 6 months postoperatively, and IIEF-5 scores, postoperative penile sensation scores, and surgery-related complications (wound pain, infection, poor incision healing, etc.)were recorded.Results:The immediate postoperative erect penile length was (13.9±1.4) cm, with no statistically significant difference compared to preoperative length( P=0.127).The immediate postoperative erect penile curvature angle was (2.1±1.1) °, with a statistically significant difference compared to preoperative angle, ( P<0.01). IIEF-5 scores at 1, 3, and 6 months postoperatively were (20.4±1.7), (22.0±1.0), and (22.3±0.8) respectively, compared with preoperative scores, the differences were statistically significant ( P<0.001). The proportions of patients with fully restored glans sensation at 1, 3, and 6 months postoperatively were 0, 31.2% (10/32), and 68.8% (22/32), respectively, with sensation scores of (1.1±0.8), (3.2±0.6), and (3.7±0.5). Three patients (9.0%) experienced poor ventral wound healing postoperatively, but fully recovered after regular wound dressing. Conclusions:The modified corporeal rotation technique effectively corrects congenital penile downward curvature without significant loss of penile length, no adverse effects on erectile function or neurological damage were found, presenting high surgical safety and clinical value.

The incidence of intracranial aneurysms is higher in population, and the death and disability rates after rupture are extremely high. Early detection of intracranial aneurysms, prediction of rupture risk, operation program, and evaluation of treatment outcomes are all the clinical concerns. With the continuously deepening integration of artificial intelligence technology and medicine, its application in the diagnosis and treatment of intracranial aneurysms is becoming increasingly widespread. This article reviews the current application status of artificial intelligence technology in the diagnosis and treatment of intracranial aneurysms.

Objective To investigate the predictive value of serum 25-hydroxyvitamin D[25(OH)D]level in early renal transplantation for acute rejection(AR).Methods A total of 324 renal transplant recipients from January 2019 to August 2022 in the Second People's Hospital of Shanxi Province were selected.The clinical data of the recipients were collected.The levels of serum 25(OH)D,parathyroid hormone(PTH),and calcium,phosphorus in early(within 1 month)transplantation were detected by chemiluminescence immunoassay and colorimetry,respectively.The detection season was recorded,and the occurrence of AR within 1 year after renal transplantation was observed.The 25(OH)D level ≥ 20ng/ml was defined as normal,≥ 12 ng/ml～＜20 ng/ml as insufficient and＜12ng/ml as deficient,they were divided into of 25(OH)D normal group(n=106),insufficient group(n=112)and deficient group(n=106).According to the occurrence of AR,they were divided into AR group(n=51)and non-AR group(n=273).The basic situation of serum 25(OH)D level was analyzed.The differences in serum PTH,calcium,phosphorus levels and seasons as well as AR incidence among the three groups of 25(OH)D were compared.Multivariate logistic regression was used to analyze the influencing factors of AR,and receiver operating characteristic(ROC)curve was used to analyze the predictive value of serum 25(OH)D level for AR.Results The incidence of serum 25(OH)D deficiency or insufficiency was 67.28％(218/324).In the 25(OH)D normal group,insufficient group and deficiency group,the serum PTH levels were 75.44(46.42,113.23)pg/ml,78.29(58.27,152.10)pg/ml and 86.84(54.64,127.3)pg/ml,and the incidences of AR were 2.47％(8/324),6.17％(20/324)and 7.10％(23/324),respectively.All of them were the highest in the deficiency group and the lowest in the normal group,and the differences were significant(H=6.784,x2=8.580,all P＜0.05).Additionally,25(OH)D deficiency(OR=3.340,95％CI:1.409～7.916),25(OH)D insufficiency(OR=2.442,95％CI:1.006～5.925)and human leucocyte antigen(HLA)mismatch(4～6)(OR=2.117,95％CI:1.027～4.363)were independent risk factors for AR(all P＜0.05).The area under the curve(AUC)of serum 25(OH)D level in predicting AR was 0.702(95％CI:0.625～0.779),the optimal cut-off value was 13.59 ng/ml,the specificity and the sensitivity were 66.7％and 65.6％,respectively.Conclusion In this study,25(OH)D deficiency(＜12ng/ml)or insufficiency(≥ 12～＜20ng/ml)was an independent risk factor for AR,and serum 25(OH)D level may have a certain predictive value for AR.

Objective To evalutate changes in laboratory indicators and clinical efficacy of roxadustat(Rox)in treating anemia patients after advanced kidney transplantation.Methods A retrospective analysis of 101 patients with anemia after kidney transplantation admitted to the Center of Kidney Diseases and Hemodialysis of Shaanxi Provincial People's Hospital from March 2020 to March 2023 was performed.Among them 48 cases were treated with roxadustat(Rox group)and 53 cases were treated with recombinant human erythropoietin(rhEPO)(rhEPO group).Both groups were treated with polyferose,methycobal and folic acid.The change of red blood cell(RBC),hemoglobin(Hb),erythropoietin(EPO),serum ferrin(SF),transferrin saturation(TSAT),and hepcidin(HePc),tacrolimus trough concentration(Tac CO),cyclosporine A trough concentration(CsA CO),mycophenolic acid area under curve(MPA-AUC),lymphocyte(Lym),T lymphocyte subgroup Th/Ts ratio(Th/Ts),serum creatinine(Scr)and blood urea nitrogen(BUN)were observed in the 1st,3rd and 6th month after treatment respectively.The incidence of side effect induce by medicine during 6 months between the two groups were analysed.Results Before the beginning treatment,there was no significant difference in RBC,Hb,EPO,SF,TSAT,HePc,Tac CO,CsA CO,MPA-AUC,Lym,Th/Ts,Scr and BUN between the two groups and the differences were not statistisally significant(t=-0.319～2.024,all P＞0.05).After the 1st,3rd and 6th month of treatment,the RBC,Hb,EPO,SF,TSAT of the two groups of patients were increased compared to before treatment,while HePc was decreased compared to before treatment,and there were significant differences within the groups(F=234.890,219.907;256.171,201.231;138.023,89.247;92.89,215.780;189.198,179.092;112.132,76.127,all P＜0.05).The RBC,Hb and SF levels in the Rox group were higher than those in the rhEPO group(F=9.672,8.165,139.360),while EPO and HePc levels were lower than those in the rhEPO group(F=124.437,78.147),and the differences were significant(all P＜0.05).There was no significant difference in TSAT between the two groups(F=7.118,P=0.119).Tac CO,CsA CO,MPA-AUC,Lym,Th/Ts showed no significant changes between groups compared to before treatment,the Scr and BUN showed a slight increase compared to before treatment,but there were no statistically significant differences in intra group and between two groups comparisons(F=0.665,1.167,1.097,1.343,5.219,0.696,1.106,all P＞0.05).There was no statistically significant difference in the incidence of adverse reactions between the two groups(x2=0.083,P=0.773).Conclusion Roxadustat has better clinical efficacy in the treatment of patients with anemia after kidney transplantation,which can effectively improve anemia and regulate iron metabolism in the body.There is no significant impact on the immune status of the transplant recipients,and the transplanted kidney function is stable and safe.

So far, the endovascular treatment of intracranial aneurysms has gone through three stages: coil embolization, stent-assisted coil embolization, and placement of flow diverter, which significantly increases the occlusion rate of intracranial aneurysms. Its safety and effectiveness have also been confirmed by many large-scale studies. However, for wide-neck bifurcation aneurysms, there are still issues of difficult treatment and poor treatment outcome. The emergence of intratumoral turbulence devices has provided a new treatment option for wide-neck bifurcation aneurysms and has achieved good short- and mid-term treatment effects. This article reviews the application of the Woven EndoBridge intratumoral turbulence device in intracranial wide-neck bifurcation aneurysms.

Objective Our study aimed to conduct genomic characterization of Salmonella strains carrying the b/aNDM-1 gene in the intestinal tract of healthy individuals.The objectives were to underscore the importance of genomic surveillance for drug resistance in both commensal and pathogenic bacteria among healthy populations,and to establish protocols for regulating drug resistance plasmids based on the completion of a comprehensive map of drug resistance plasmid genomes.Methods We performed antimicrobial susceptibility testing and employed second-and third-generation sequencing techniques to analyze Salmonella strains harboring the b/aNDM-1 gene,to surveil drug-resistant bacteria in the intestines of healthy subjects.Sequence comparison was conducted using both core-and pan-genome approaches.Concurrently,conjugation experiments were carried out to assess the efficiency of plasmid transfer.Results We isolated a carbapenem-resistant Salmonella enterica serovar Typhimurium strain from a healthy food worker in China.This strain harbored an lncHI2/lncHI2A plasmid carrying blaNDM-1 along with multiple antibiotic resistance genes(ARGs).Our findings highlight the potential for asymptomatic carriers to facilitate the transmission of ARGs.Pan-genomic analysis revealed that b/aNDM-1-positive plasmids could traverse bacterial species barriers,facilitating cross-host transmission.Conclusion This study marks the first detection of b/aNDM-1 in Salmonella strains isolated from healthy individuals.We underscore the risk associated with the transmission of conjugative hybrid plasmids carrying blaNDM-1,which have the potential to be harbored and transmitted among healthy individuals.Enhanced surveillance of drug-resistant pathogens and plasmids in the intestinal microbiota of healthy individuals could provide insights into the risk of ARG transmission and pathways for population-wide dissemination via ARG transfer factors.

【Objective】 To reduce the misdiagnosis rate by analyzing the clinical data of patients with primary upper tract urothelial carcinoma (UTUC) complicated with calculi. 【Methods】 Clinical data of 7 UTUC with calculi patients treated during Sep.2018 and Apr.2022 were retrospectively analyzed, including general data, time from visit to diagnosis, imaging data, urine exudation cytological results, surgical methods, pathological stages and follow-up data. 【Results】 The ratio of male to female was 3∶4, and the mean age was 66.4 (55-72) years. The initiate imaging examination results only showed calculi, but did not indicate suspicious tumor (including 1 case with missing data). The median time from the first visit to diagnosis was 12 months (5-36 months). Of all 7 cases, 2 (2/4) were clinically diagnosed by enhanced CT, 3 (3/4) by MRI, and 2 (2/7) by positive urine exudation cytology. All patients received surgical treatment. Postoperative pathology showed 85.71% (6/7) were high-grade UTUC. Postoperative staging was T1N0M0 in 4 cases, T3N0M0 in 2 cases, and T4N2M0 in 1 case. Adjuvant chemotherapy was conducted in 2 cases. During the median follow-up of 12 months (6-41), 1 case developed multiple systemic metastases in month 9, while the other cases had no recurrence or metastasis. 【Conclusion】 For UTUC patients without obvious filling defect on imaging, especially when ipsilateral calculi were complicated, misdiagnosis should be alerted for timely treatment and better prognosis.

【Objective】 To investigate the expressions of P53 and Ki-67 in prostate cancer (PCa)and to explore their correlation with the clinicopathological characteristics. 【Methods】 The expressions of P53 and Ki-67 in 90 PCa patients were detected with immunohistochemistry. Patients’ age, preoperative prostate-specific antigen (PSA) level, postoperative Gleason score, pathological stage, and invasion of neurovascular cancer embolus of all patients were recorded. The relationship of P53 expression with the above indexes was evaluated. 【Results】 The positive rates of P53 and Ki-67 were 27.8% (25/90) and 46.7% (42/90), respectively. The positive rate of P53 in pT2 and pT3-T4 stage groups were 19.7% (13/66) and 50.0% (12/24) (P=0.005), and the positive rate of Ki-67 were 36.4% (24/66) and 75.0% (18/24) (P=0.001), respectively. The positive rate of Ki-67 in Gleason score ≤6, ≤7 and ≥8 groups were 30.4%, 53.8% and 66.7%, respectively, with statistical difference. Positive expression of P53 was related to Ki-67 expression, but not to patients’ age, preoperative PSA level, postoperative Gleason score and nerve and invasion of neurovascular cancer embolus. 【Conclusion】 P53 expression is related to tumor stage and Ki-67, while Ki-67 expression is associated with tumor stage ang grade.