Objective:To detect the levels of sex hormones and insulin in follicular fluid(FF)and the expression level of phosphatase and tensin homolog deleted on chromosome ten(PTEN)in granulosa cells in the infertile patients with polycystic ovary syndrome(PCOS),and to preliminarily explain the correlations between the insulin level and the expression level of PTEN mRNA.Methods:Seventy infertile patients were selected as the subjects and divided into PCOS group and control group(tubal obstruction or infertility due to male factors)according to infertility factors.All patients received in vitro fertilization-embryo transfer(IVF-ET)treatment.FF and ovarian granulosa cells were collected on the day of ovulation.The expression levels of PTEN mRNA in ovarian granulosa cells of the patients in two groups were detected by real-time fluorescence quantitative PCR(RT-qPCR)method.The levels of sex hormone and insulin in FF were measured by electrochemiluminescence.The correlations of the PTEN mRNA expression level in ovarian granulosa cells and testosterone(T)in FF with the level of insulin in FF were analyzed by Spearman correlation analysis method.Results:There were no significant differences in age,infertility years,body mass index(BMI),basic sex hormone,total dose of gonadotropin(Gn)and days of ovulation induction in two groups(P＞0.05).Compared with control group,the anti-Mullerian hormone(AMH)and antral follicle counting(AFC)of the patients in PCOS group were significantly increased(P＜0.05).The RT-qPCR results showed that the PTEN mRNA expression level in ovarian granulosa cells of the patients in the PCOS group was higher than that in control group(P＜0.001).The electrochemiluminescence results showed that the levels of T and insulin in FF of the patients in PCOS group were higher than those in control group(P＜0.05),whereas the estrogen and progesterone levels were lower than those in control group(P＜0.05).The Spearman correlation analysis showed that that T level in FF was positively correlated with the insulin level of the patients in PCOS group(r=0.577,P＜0.001),and the PTEN mRNA expression level in ovarian granulosa cells was positively correlated with the insulin levels in FF(r=0.616,P＜0.001);in control group,there was no correlation between T level and insulin level in FF(r=0.266,P=0.123),and there was no correlation between the expression level of PTEN mRNA in granulosa cells and the insulin level in FF in control group(r=-0.214,P=0.216).Conclusion:The high expression of PTEN in granulosa cells of the infertile patients with PCOS may be related to the local hyperinsulin level in the ovary,and PTEN participates in the occurrence and development of PCOS.

Objective To investigate the pathogenic bacteria distribution,clinical features and risk factors of urinary tract infection in patients with ischemic stroke. Methods A retrospective study was conducted on 634 patients with ischemic stroke in Beijing Bo'ai Hospital from Janu-ary,2020 to December,2023.They were divided into control group(n=551,without urinary tract infection)and observation group(n=83,with urinary tract infection)according to whether they developed urinary tract infec-tion.The incidence of urinary tract infection,the distribution of pathogenic bacteria and the resistance of main pathogenic bacteria to different antibacterial drugs were analyzed.The clinical characteristics of the two groups were compared and analyzed.The independent risk factors of urinary tract infection in patients with ischemic stroke were analyzed with multivariate Logistic regression. Results A total of 83 cases of 634 patients with ischemic stroke developed urinary tract infection,and incidence was 13.09%.A total of 127 strains of pathogenic bacteria were isolated from the urine samples of the observation group,of which Gram-negative bacteria accounted for 62.99%(80/127),Gram-positive bacteria accounted for 20.47%(26/127)and strains of fungi accounted for 16.54%(21/127).The main Gram-negative pathogens were Escherichia coli and Klebsiella pneumoniae,which were high resistant to second-generation and third-generation cephalosporins,co-trimoxazole,and levofloxacin;moderately resistant to carbapenems,β-lactamase inhibitor compound preparation and aminoglycosides,etc.;and highly sensitive to tigecycline and polymyxin,etc.The main Gram-positive pathogens were Enterococcus faecalis and Enterococcus faecalis,which were a high resistant to erythromycin and gentamicin,and highly sensitive to linezolid,daptomycin,teicoplanin and vancomycin.The pathogenic fungi detected were not obviously resistant to common antifungal drugs.The proportion of female,di-abetes,indwelling catheter and neurogenic bladder were significantly higher in the observation group than in the control group(χ2>5.043,P<0.05).The female,diabetes,indwelling catheter and neurogenic bladder were inde-pendent risk factors for urinary tract infection in patients with ischemic stroke(P<0.05). Conclusion The pathogenic bacteria of patients with ischemic stroke with urinary tract infection are mainly Gram-nega-tive bacteria,followed by Gram-positive bacteria and fungi.The Gram-negative bacteria showed multiple drug re-sistance.Meanwhile,female,diabetes,indentured catheter and neurogenic bladder are the independent risk fac-tors for urinary tract infection.

Prostate cancer(PCa)is one of the most common malignant tumors in men,marked by the high expression of prostate-specific membrane antigen(PSMA).Radionuclide drug conjugates(RDCs)targeting the PSMA antigen have become a hot topic in PCa research.The development of PSMA-targeted RDCs has progressed rapidly in recent years,significantly contributing to the diagnosis and treatment of PCa.Numerous novel PSMA-related RDCs are now part of clinical research.Due to the special properties of radiopharmaceuticals,it is essential to consider the impact of ionizing radiation in comprehensive clinical evaluation.This article,review the clinical studies from the past decade,and discusses the scope and methodologies of comprehensive clinical evaluation for PSMA-related RDCs.

Multiple myeloma (MM) is a malignant tumor of the blood system that is more common in the elderly with abnormal proliferation of bone marrow plasma cells. The current diagnostic methods mainly rely on the detection of M protein and invasive bone marrow aspiration biopsy. The sensitivity and specificity of conventional imaging tests are low. Molecular imaging technology provides new options and methods for the noninvasive diagnosis of MM. Whole-body MRI (WB-MRI) has good soft tissue contrast and spatial resolution, which can show bone marrow infiltration and vascular conditions. Metabolic imaging such as 18F-FDG, acetate, choline, and methionine are highly sensitive. ImmunoPET imaging screens specific targets for targeted therapy or immunotherapy and evaluates the efficacy. This article reviews the progress of molecular imaging in MM, especially immunoPET imaging.

Objective:To investigate the diagnosis and clinical characteristics of five elderly patients with Chlamydia psittaci-caused severe pneumonia.Methods:Through retrospective analysis, diagnosis and treatment process and clinical characteristics of five elderly inpatients with severe pneumonia caused by Chlamydia psittaci were summarized in the Department of Critical Care Medicine, Quanzhou First Hospital East Street Branch Area, affiliated to Fujian Medical University between January to June 2021.Results:Five patients with severe pneumonia caused by Chlamydia psittaci were aged from 64 to 74 years, with various underlying diseases such as coronary heart disease, chronic heart failure, chronic obstructive pulmonary disease, etc.All patients had an established history of poultry exposure.These cases had high fever, cough, spitting, and dyspnea as the main clinical manifestations.Some of them also had systemic symptoms or weakness of the limbs as the prodromal symptoms.The disease progressed rapidly, with severe respiratory failure, acute kidney injury, and shock appearing soon, accompanied by different degrees of muscle injury, and damage to the heart, liver, blood coagulation, and immune systems at the same time.Laboratory examination showed that levels of inflammatory indicators were increased: at 3, 5, 7 d after admission, the level of C reactive protein was 214.6(153.9-256.3)mg/L, 199.2(115.8-333.8)mg/L, 151.0(11.19-173.7)mg/L, respectively; and interleukin 6 level was 1 241.0(912.1-6822.0)ng/L, 779.1(451.2-7122.0)ng/L, 631.2(7.0-4 321.0)ng/L, respectively.And monitoring results of nutritional index indicated a high metabolic state.The imaging examinations showed that consolidation and ground-glass shadows spreaded to both lungs, may accompany the miliary and nodular shadows, and may also involve pleural which caused pleural effusion.After the clinical use of metagenomic next-generation sequencing(mNGS), mNGS has been confirmed as an important method for the diagnosis of Chlamydia psittaci infection.The disease course and prognosis were related to the severity of the disease, advanced age, underlying diseases, and timely diagnosis and effective treatment.Conclusions:The progression of Chlamydia psittaci pneumonia to severe disease may be related to advanced age, more basic diseases such as chronic cardiopulmonary disease, smoking, and timely diagnosis and treatment.Generally, laboratory and imaging examinations have no diagnostic specificity, but mNGS is of great significance for early diagnosis, transition to target treatment and improvement of prognosis.

Objective To evaluate the effect on nexible ureteroscope one-step treat and step-by-step treat for impacted upper ureteral calculi. Methods The clinical data of 98 cases of impacted upper ureteral calculi were retrospectivelv analvzed between January 2016 and January 2018. The one-step nexible ureteroscopic lithotripsy was used in 48 cases (observation group), and the step-by-step nexible ureteroscopic lithotripsy was used in 50 cases (control group). During the one-step nexible ureteroscopic lithotripsy, only flexible ureteroscope was used to crush the stone, no matter whether the stone located in the ureter or returned to the renal pelvis. During step-by-step nexible ureteroscopic lithotripsy, the rigid ureteroscopy was firstly used for crushing the stone in the ureter. When the stone returned to the renal pelvis, the rigid ureteroscopy was changed into nexible uretemscope for continuous crushing the stone. Operating time, 2 weeks stone clearance rate and the cases of fever after operation were compared between two groups. Results Compared with that of the control group, the operation time of the observation group was significantly shortened [(38.3 ± 10.5) min vs. (55.1 ± 12.7) min, t=-6.415], and the proportion of postoperative body temperature ≥ 38.5 ℃ was also reduced [(4.2％ (2/48) vs. 22.0％(11/50), χ2=5.276]. The differences between the two groups were statistically significant (P<0.05). Two weeks stone clearance rate was 89.6％(43/48) in observation group and 82.0％(41/50)in control group, and there was no significant difference between two groups (χ2=0.493, P > 0.05). Conclusions Flexible ureteroscope one-step method is a safe and effective alternation for incarcerated upper ureteral calculi.

Objective To explore the value of 18F-FDG PET/CT in diagnosis of retroperitoneal fibrosis (RPF).Methods Totally 12 RPF patients underwent 18 F-FDG PET/CT scanning,and the characteristics of metabolic activity,distribution of retroperitoneal lesions and maximum standardized uptake value (SUVmax) were analyzed retrospectively.Results Among 12 patients,7 were initial evaluation patients,5 were post-treatment patients.Of 7 initial evaluation patients,there were 4 patients with secondary RPF,including prostate carcinoma,breast cancer and IgG4-related disease.Retroperitoneal mass isodense with muscle surrounding the abdominal aorta or the iliac arteries were found in 12 patients,and ureteral involvement were found in 11 paients (11/12,91.67％).SUVmax in initial evaluation patients (4.21±1.76) was higher than that in patients after treatment (1.46±0.25,P＜0.05).According to PET/CT,3 idiopathic RPF patients as initial evaluation with high metabolic activity lesions received immunosuppressive therapy including corticosteroids and tamoxifen,and 4 secondary RPF patients with high metabolic activity lesions received treatment based on causes.Among 5 post-treatment patients,3 continued to accept current corticosteroids maintenance dose,while 2 did not receive any other treatment.Conclusion PET/CT may be used to evaluate the activity and extension of lesions in patients with RPF.

Objective To observe the metabolic changes of subcortical structures in children with intractable epilepsy using 18 F-FDG PET/CT,and to investigate the mechanism of subcortical structure involvement in epileptic seizures and its clinical significance.Methods Features of 18F-FDG PET/CT imaging in 611 intractable epilepsy children were analyzed.The metabolic changes of cortex and subcortical structures (basal ganglia,thalamus and cerebellum) were observed.The children were divided into three groups (young,middle and older groups) according to age,also mild group and severe group according to the number of involved lobar,respectively.The incidence of metabolic abnormalities in subcortical structures of different groups were analyzed.Results Among 611 children,unilateral cortical metabolic abnormality was found in 525,and bilateral cortical metabolic abnormalities were found in 86 children.The involvement of subcortical structures was detected in 190 children,including basal ganglia (n=64),thalamus (n=113) and cerebellum (n=105).The incidence of metabolic abnormality in subcortical structures under different age groups was not statistically different (all P＞ 0.05),while the incidence of metabolic abnormality in subcortical structures of severe group was significantly higher than that of mild group (all P＜0.001).Conclusion 18 F-FDG PET/CT might be able to detect the metabolic abnormalities of subcortical structures,therefore indicating the involvement of cerebral cortex.

Objective To investigate whether quality assurance and quality control using multimodal image guidance and radiation dosimetry optimization could ensure and improve the targeting of 125I seeds brachytherapy.Methods A total of 287 patients (184 males,103 females,average age 61.9 years) with non-small-cell lung cancer (NSCLC) and 122 patients (average age 65.5 years) with prostate cancer who were diagnosed by pathology or imaging methods (coincidence imaging,CT,flexible fiberoptic bronchoscopy,ultrasonography) from October 2002 to October 2016 were retrospectively enrolled.All imaging methods were used to locate the target area.Optimization of radiation dosimetry was made according to treatment planning system (TPS) and evaluated by dose-volume histogram (DVH).125I seeds implantation was performed under the imaging guidance,followed by real-time location verification,dosimetric verification.Therapeutic efficacy was evaluated.Paired t test was used to analyze the data.Results The prescribed dose (PD) of planning target volume (PTV) was above 140 Gy.Immediate dosimetric verification was performed in 59 patients with NSCLC and 31 patients with pulmonary metastases.The radiation dose before and after the implantation was coincident in 93.2％ (55/59) of NSCLC and 93.5％ (29/31) of pulmonary metastases.The coincident rate of patients with dose delivered to 90％ GTV (D90)＞matched peripheral dose (MPD) was 93.2％ (55/59) and 87.1％ (27/31) respectively in NSCLC and pulmonary metastases.There was no significant difference in MPD,D90 and conformity index (CI) before and after implantation (t values:2.11-9.71,all P＞0.05).The average dose of the risk organs was significantly lower than the tolerance dose of the normal tissue.The incidence of radiation pneumonitis was 1.05％ (3/287).No other serious complications were found.Conclusion Targeted diagnosis and therapy of multimodal image guidance could be optimized to improve the effect of targeting and therapeutic gain ratio of 125I seeds brachytherapy.

Objective To investigate the characteristics of metabolic foci on 18F-fluorodeoxyglucose (FDG) PET/CT scan in pediatric patients with epilepsy.Methods Twenty-three pediatric patients (15 males,8 females,age range:0.5-13.3 years) with epilepsy were retrospectively reviewed from March 2014 to December 2016.All patients underwent 18F-FDG PET/CT and metabolic foci were found.The visual method and semi-quantitative analysis were used to analyze images.Fourteen of them underwent surgery and were followed up for 3-24 months.Results Glucose hypermetabolism were observed most frequently in the frontal and parietal lobes,with or without surrounding/remote hypometabolism.On the day of PET/CT imaging,8 patients had no seizures,14 patients had seizures,and 1 patient was uncertain.The sites of resection were consistent with the regions of hypermetabolism in 9 patients,among whom the pathological results showed 8 cortical malformations and 1 Rasmussen's syndrome.Follow-up results for the above 9 patients showed that there was 7 Engel class Ⅰ patients and 2 Engel class Ⅲ patients.Conclusion The hypermetabolism may mostly appear in the frontal and parietal lobes of pediatric patients with epilepsy,and malformations of cortical development seem to be the most common pathology results.